【甲状腺结节的探查与处理】。

Q4 Medicine
Revue Du Praticien Pub Date : 2023-04-01
Hamza Benderradji, Christine Do Cao, Miriam Ladsous, Jean-Louis Wémeau
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引用次数: 0

摘要

甲状腺结节的探查与治疗。大多数甲状腺结节是良性的(95%),可以从临床和超声监测中获益。可能怀疑是癌症(约5%的结节),特别是颈部接受过放疗的受试者,如果结节坚硬、不规则、不断演变,或血清降钙素很高(> 100 pg/ml)。当结节超过超厘米阶段时,识别癌症是至关重要的。甲状腺超声检查是最常见、方便、安全和经济有效的甲状腺结节成像工具。它根据EU-TIRADS评分对甲状腺结节进行分类,其中包括与恶性肿瘤风险增加相关的5类。超声引导下的细针穿刺活检(FNA)仅在EU-TIRADS分级5、4和3的结节中进行,分别超过1、1.5和2厘米。FNA材料的细胞学分析根据Bethesda系统将甲状腺结节分为6类,每一类都有自己的预后价值。细胞学评估的困难与无法解释(Bethesda I)和不确定(特别是III和IV)的结果有关,因此必须讨论通过扫描和细胞学分子标记重新评估和随访的机会。管理是不完全可编纂的:从最初没有可疑因素的监测到有可疑因素的全甲状腺切除术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Exploration and management of thyroid nodules].

EXPLORATION AND MANAGEMENT OF THYROID NODULES. Most thyroid nodules are benign (95%) and can benefit from clinical and ultrasound monitoring. Cancers (approximately 5% of nodules) could be suspected, particularly in subjects whose neck was irradiated, in cases of a hard, irregular, evolving nodule, or with very high serum calcitonin (> 100 pg/ml). It is crucial to recognize cancers when nodules exceed the supracentimeter stage. Thyroid ultrasonography is the most common, handy, safe, and cost-effective tool to image thyroid nodules. It classifies thyroid nodules according to the EU-TIRADS score, which comprises 5 categories associated with an increasing risk of malignancy. An ultrasound-guided fine needle aspiration (FNA) biopsy is performed only in nodules staged EU-TIRADS classes 5, 4, and 3 over 1, 1.5, and 2 cm, respectively. Cytologic analysis of FNA material classifies thyroid nodules according to the Bethesda system into 6 classes, each with its own prognostic value. The difficulties in cytological evaluation are related to the uninterpretable (Bethesda I) and indeterminate (especially III and IV) results, for which have to be discussed opportunities of reassessment and follow-up by scintiscans and cytological molecular markers. Management is imperfectly codifiable: from surveillance in the absence of suspicious elements initially to total thyroidectomy in their presence.

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来源期刊
Revue Du Praticien
Revue Du Praticien Medicine-Medicine (all)
CiteScore
0.20
自引率
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发文量
161
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