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Current controversies and future directions in the diagnosis and management of differentiated thyroid cancers

机译:分化型甲状腺癌的诊断和治疗的当前争议和未来方向

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摘要

Despite the development of novel diagnostic, surgical, and chemotherapeutic approaches to differentiated thyroid cancers (DTCs), the diagnosis and management of these tumors remains controversial. The most recent American Thyroid Association (ATA) guidelines, released in 2015, reflect a recent shift towards less aggressive management for patients with DTCs. However, many clinicians have expressed concern that more conservative management will put patients at risk for disease recurrence and metastasis. In particular, the management of indeterminate nodules on fine needle aspiration (with special attention to genetic and epigenetic markers of malignancy), the extent of surgery for known differentiated cancers, the role of adjuvant radioactive iodine (RAI) therapy, and novel targeted treatments with tyrosine kinase inhibitors (TKIs) represent current areas of uncertainty and opportunities for future research. In this review, we examine the current state of the art in these areas, and address some of the questions that remain.
机译:尽管开发了针对分化型甲状腺癌(DTC)的新型诊断,手术和化学治疗方法,但这些肿瘤的诊断和治疗仍存在争议。美国甲状腺协会(ATA)于2015年发布了最新指南,反映了最近向DTC患者降低积极性管理的转变。但是,许多临床医生对更保守的治疗将使患者处于疾病复发和转移的风险表示担忧。特别是细针穿刺术中不确定结节的处理(特别注意恶性肿瘤的遗传和表观遗传学标志),已知分化癌症的手术范围,辅助放射碘治疗(RAI)的作用以及新的靶向治疗酪氨酸激酶抑制剂(TKIs)代表了当前的不确定性领域和未来研究的机会。在这篇评论中,我们研究了这些领域的最新技术,并解决了一些尚待解决的问题。

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