中国癌症杂志2026，Vol.36Issue(7)：636-641,6.DOI:10.19401/j.cnki.1007-3639.2026.07.002
甲状腺癌组织病理学与分子病理学整合诊断的2025年新进展
Integrated histopathological and molecular pathological diagnosis of thyroid carcinoma:a 2025 update
摘要
Abstract
In recent years,breakthrough progress has been made in the pathological diagnosis and molecular testing of thyroid carcinoma.The release of the 5th edition World Health Organization(WHO)classification of endocrine and neuroendocrine tumors,the update of the 2025 American Thyroid Association(ATA)management guidelines for adult patients with differentiated thyroid carcinoma,and the publication of the Chinese Medical Association Expert consensus on postoperative pathological diagnosis of thyroid carcinoma(version 2025)mark the entry of thyroid carcinoma diagnosis and treatment into a new era of"integrated histopathological and molecular pathological diagnosis".This review is grounded in the latest international classification systems,clinical practice guidelines,and domestic expert consensus statements,and is supplemented by evidence from the published literature.It summarizes and critically analyzes key updates in the pathological diagnosis and molecular testing of thyroid carcinoma.The principal advances covered in this review are highlighted in the following aspects:① The 5th edition WHO classification categorizes follicular cell-derived thyroid tumors into differentiated thyroid carcinoma,high-grade non-anaplastic thyroid carcinoma and anaplastic thyroid carcinoma,and for the first time systematically introduces a molecular subtyping framework(BRAF-like and RAS-like tumors);② Although histological criteria are identical in children and adults,molecular profiles differ markedly,with kinase fusions(RET,NTRK,ALK)being predominant in children and strongly associated with the diffuse sclerosing and infiltrative follicular variants of papillary thyroid carcinoma;③ The 2025 ATA guidelines have clarified the indications for germline genetic testing in hereditary syndromes associated with pathological features such as cribriform-morular thyroid carcinoma;④ The Chinese expert consensus emphasizes the importance of quantification of vascular invasion,assessment of extranodal extension,and recognizing the spatiotemporal heterogeneity of molecular testing in postoperative pathological reports.The integrated diagnostic model combining histomorphology,immunophenotype and molecular testing represents the future direction of precision diagnosis and treatment of thyroid carcinoma.Pathologists should master the latest classification system,appropriately apply molecular testing techniques,and play a central decision-making role in multidisciplinary treatment teams.关键词
甲状腺癌/病理学诊断/分子检测/第5版世界卫生组织分类/美国甲状腺协会指南/专家共识Key words
Thyroid carcinoma/Pathological diagnosis/Molecular testing/5th edition World Health Organization classification/American Thyroid Association guidelines/Expert consensus分类
医药卫生引用本文复制引用
刘志艳..甲状腺癌组织病理学与分子病理学整合诊断的2025年新进展[J].中国癌症杂志,2026,36(7):636-641,6.基金项目
国家自然科学基金面上项目(82472629) （82472629）
上海市自然科学基金(23ZR1448200) （23ZR1448200）
上海东方英才计划拔尖项目(BJWS2025042) （BJWS2025042）
上海市第六人民医院2025年度医学教育研究课题(毕业后教育)(LYBYHZD202501). National Nature Science Foundation of China(82472629) （毕业后教育）
Nature Science Fund of Science and Technology Commission of Shanghai Municipality(23ZR1448200) （23ZR1448200）
Shanghai Leading Talent Program of Eastern Talent Plan(BJWS2025042) （BJWS2025042）
Shanghai Sixth People's Hospital 2025 Research Project on Medical Education(Postgraduate Education)(LYBYHZD202501). （Postgraduate Education）
