中国癌症杂志2025，Vol.35Issue(9)：826-832,7.DOI:10.19401/j.cnki.1007-3639.2025.09.002
《2025版美国甲状腺学会成人甲状腺结节管理指南》及《2025版美国甲状腺学会成人分化型甲状腺癌管理指南》解读:甲状腺结节及分化型甲状腺癌超声、CT、MRI以及消融部分的进展
摘要
Abstract
In 2025,the American Thyroid Association(ATA)divided the management of thyroid nodules and differentiated thyroid cancer(DTC)into two separate guidelines for the first time.This review highlighted the imaging-related updates and compared them with the 2015 ATA guidelines.The 2025 ATA guidelines introduce the following key updates:① Clarifying recommendations for screening of familial non-medullary thyroid cancer,and proposing that thyroid ultrasound screening is not recommended before treatment for patients who will receive glucagon-like peptide-1 receptor agonist(GLP-1 RA)therapy;② Refined the sonographic malignancy risk stratification system,enabling classification of all nodule types;③ Increasing size thresholds for fine-needle aspiration(FNA)and emphasized individualized decisions based on age,comorbidities and other factors;④ Follow-up intervals for nodules not meeting FNA criteria or with benign cytology have been adjusted,and clear ultrasound surveillance endpoints have been proposed;⑤ A standardized ultrasound protocol is established for active surveillance of cT1aN0M0 papillary thyroid cancer;⑥ Additional suspicious features,including abnormal blood flow in cervical lymph nodes,are introduced with quantitative evidence;⑦ Proposing dynamic risk stratification,adjusting follow-up intervals based on the patient's risk of residual lesion or disease recurrence and their response to treatment,and adding new endpoints for postoperative follow-up for low-risk DTC patients with sustained excellent response;⑧ Stressing the preoperative use of computed tomography(CT)or magnetic resonance imaging(MRI)to evaluate distant metastasis,while no longer recommending them as routine imaging tools during follow-up;⑨ Defining indications for thermal ablation:benign nodules,low-risk microcarcinomas and recurrent or metastatic lesions.Guided by evidence-based medicine,the 2025 ATA guidelines promote the transformation of thyroid ultrasound towards"precision,minimal invasiveness,individualization",providing a new paradigm for the whole-process clinical management of thyroid diseases.关键词
甲状腺结节/分化型甲状腺癌/美国甲状腺学会指南/超声/计算机体层成像/磁共振成像/消融Key words
Thyroid nodule/Differentiated thyroid cancer/American Thyroid Association guidelines/Ultrasound/Computed tomography/Magnetic resonance imaging/Ablation分类
医药卫生引用本文复制引用
刘如玉,王晨一,张波..《2025版美国甲状腺学会成人甲状腺结节管理指南》及《2025版美国甲状腺学会成人分化型甲状腺癌管理指南》解读:甲状腺结节及分化型甲状腺癌超声、CT、MRI以及消融部分的进展[J].中国癌症杂志,2025,35(9):826-832,7.基金项目
2024年首都卫生发展科研专项(首发2024-2-4068). The Capital's Funds for Health Improvement and Research(CFH-2024-2-4068). （首发2024-2-4068）
