Hermann M, Tonninger K, Kober F, Furtlehner E-M, Schultheis A, Neuhold N
Chirurgische Abteilung, Kaiserin-Elisabeth-Spital der Stadt Wien, Osterreich.
Chirurg. 2010 Jul;81(7):627-30, 632-5. doi: 10.1007/s00104-009-1884-8.
Current treatment guidelines for follicular thyroid carcinoma (FTC) recommend total thyroidectomy, lymphadenectomy and radioiodine ablation. Considering the low malignant potential of minimally invasive follicular thyroid carcinoma (MIFTC), a limited radical therapeutic procedure may be adequate. MIFTC is an intensely discussed group of tumors and a review of the literature reveals disagreement among experts concerning the criteria for a distinct definition. Therefore, in 2005 Rosai proposed a clinically more significant classification of FTC based on the extent of capsular and vascular invasion: MIFTC with capsular invasion only, with limited (< or =3) vascular invasion, encapsulated FTC with extensive (>3) vascular invasion and broadly invasive FTC with extensive invasive growth.For the diagnosis of MIFTC a complete investigation of the encapsulated follicular lesion should be performed by the pathologist and examination of at least 10 tissue blocks is mandatory. Due to the excellent prognosis hemithyroidectomy constitutes an adequate therapeutic approach in MIFTC with capsular invasion only and may also be considered for MIFTC with limited vascular invasion. There are no indications for systematic lymphadenectomy.
目前滤泡性甲状腺癌（FTC）的治疗指南推荐行甲状腺全切除术、淋巴结清扫术和放射性碘消融术。鉴于微小浸润性滤泡性甲状腺癌（MIFTC）的恶性潜能较低，有限的根治性治疗方法可能就足够了。MIFTC是一组备受争议的肿瘤，文献综述显示专家们对其明确的定义标准存在分歧。因此，2005年罗赛提出了一种基于包膜和血管侵犯程度的临床上更具意义的FTC分类：仅伴有包膜侵犯的MIFTC、伴有有限（≤3处）血管侵犯的MIFTC、伴有广泛（>3处）血管侵犯的包膜内FTC以及具有广泛浸润性生长的广泛浸润性FTC。对于MIFTC的诊断，病理学家应完整检查包膜内滤泡性病变，且至少检查10个组织块是必需的。由于预后良好，对于仅伴有包膜侵犯的MIFTC，甲状腺次全切除术是一种合适的治疗方法，对于伴有有限血管侵犯的MIFTC也可考虑采用。没有进行系统性淋巴结清扫的指征。
