Complexity in the interpretation and application of multiple guidelines for thyroid nodules: the need for coordinated recommendations for "small" lesions.

IF 8 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Pierpaolo Trimboli
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引用次数: 0

Abstract

Multiple guidelines for thyroid nodule management have been developed by endocrinologists, often in collaboration with surgeons and radiologists. While there is now a lot of scientific information available to meet the needs of healthcare providers, there is not always uniformity and standardization among recommendations. Consequently, the interpretation and application of guidelines in clinical practice remain somewhat limited. In this context, the management of "small" thyroid nodule warrants full discussion. Looking at treatment guidelines, surgery is the first-line option and the risk of cancer relapse can be assessed only after at least thyroidectomy; in addition, according to guidelines of minimally invasive treatment, thermal ablation may be considered for patients with small classical papillary carcinoma. However, the Thyroid Imaging Reporting And Data Systems do not recommend biopsy in nodules less than 1 cm; and performing biopsy may yield a result that is suspicious or consistent with malignancy without specifying the cancer subtype. With these premises, facing cases of "small" nodule less than 1 cm is challenging. Even if the recommendations of guidelines sound singularly appropriate, they may seem conflicting. Coordinated guidelines are needed.

Abstract Image

多种甲状腺结节指南解释和应用的复杂性:“小”病变需要协调一致的建议。
内分泌学家经常与外科医生和放射科医生合作,制定了甲状腺结节管理的多种指南。虽然现在有很多科学信息可以满足医疗保健提供者的需求,但建议并不总是统一和标准化的。因此,指南在临床实践中的解释和应用仍有一定的局限性。在这种情况下,“小”甲状腺结节的处理值得充分讨论。看看治疗指南,手术是一线选择,只有在至少甲状腺切除术后才能评估癌症复发的风险;此外,根据微创治疗指南,对于小型经典乳头状癌患者可考虑热消融。然而,甲状腺影像报告和数据系统不推荐小于1cm的结节活检;并且在不指定癌症亚型的情况下,进行活检可能产生可疑或与恶性肿瘤一致的结果。在这些前提下,面对小于1厘米的“小”结节是具有挑战性的。即使指导方针的建议听起来非常合适,它们看起来也可能相互矛盾。需要协调一致的指导方针。
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来源期刊
Reviews in Endocrine & Metabolic Disorders
Reviews in Endocrine & Metabolic Disorders 医学-内分泌学与代谢
CiteScore
14.70
自引率
1.20%
发文量
75
审稿时长
>12 weeks
期刊介绍: Reviews in Endocrine and Metabolic Disorders is an international journal dedicated to the field of endocrinology and metabolism. It aims to provide the latest advancements in this rapidly advancing field to students, clinicians, and researchers. Unlike other journals, each quarterly issue of this review journal focuses on a specific topic and features ten to twelve articles written by world leaders in the field. These articles provide brief overviews of the latest developments, offering insights into both the basic aspects of the disease and its clinical implications. This format allows individuals in all areas of the field, including students, academic clinicians, and practicing clinicians, to understand the disease process and apply their knowledge to their specific areas of interest. The journal also includes selected readings and other essential references to encourage further in-depth exploration of specific topics.
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