Fragu P
U. 158 Inserm, Hôpital Necker-Enfants malades et service de médecine nucléaire, Institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif Cedex.
Bull Cancer. 2000 Feb;87(2):145-54.
This paper is an attempt to evaluate the role of diagnostic and therapeutic tools to define differentiated thyroid carcinoma. At the beginning of the last century, physicians described its clinical feature: hard and invasive goiter arising after 25 and leading to death. In 1860, the surgical revolution encouraged the surgeons of goiter to treat thyroid cancer: simple goiter was viewed as precancer. From 1880, cell and tumor theories led pathologists to define microscopically thyroid cancer. In 1920, they demonstrated that the two most constant indications of thyroid epithelial malignancy were invasion of the blood vessels and distant metastasis. In 1930, radiotherapists introduced the concept of prognostic classification which combines histological criteria and patient survival for thyroid cancer. From 1940, the medical use of radioiodine led to distinguish two groups of thyroid tumors: those which are able to concentrate radioiodine and those which are not. Physicians, specialised in thyroid endocrinology, established the rules of thyroid cancer treatment. Our purpose is to analyse the epistemological and historical context of this pathology definition.
本文旨在评估诊断和治疗工具在鉴别分化型甲状腺癌方面的作用。上世纪初，医生描述了其临床特征：25岁以后出现的坚硬且具有侵袭性的甲状腺肿，并可导致死亡。1860年，外科手术革命促使甲状腺肿外科医生开始治疗甲状腺癌：单纯性甲状腺肿被视为癌前病变。从1880年起，细胞和肿瘤理论引导病理学家在显微镜下定义甲状腺癌。1920年，他们证明甲状腺上皮恶性肿瘤最恒定的两个指征是血管侵犯和远处转移。1930年，放射治疗师引入了预后分类的概念，该概念将组织学标准与甲状腺癌患者的生存率相结合。从1940年起，放射性碘的医学应用使得区分出两类甲状腺肿瘤：能够摄取放射性碘的肿瘤和不能摄取的肿瘤。专门从事甲状腺内分泌学的医生确立了甲状腺癌的治疗规则。我们的目的是分析这种病理学定义的认识论和历史背景。
