Department of General, Visceral and Vascular Surgery, Medical Faculty, University of Halle-Wittenberg, University Hospital, Ernst-Grube-Strasse 40, Halle/Saale, Germany.
J Endocrinol Invest. 2012;35(6 Suppl):10-5.
Differentiated thyroid cancers (DTC) are malignancies of follicular cell derivation. Histopathologically and oncologically, DTC fall into two broad tumor categories: papillary (PTC) and follicular thyroid cancer (FTC). These major tumor categories, based on clinical manifestation and biological behavior, are further subdivided into low-risk [papillary microcarcinoma (mPTC); minimally invasive follicular cancer (MIFTC)] and high-risk DTC [PTC>1 cm or metastatic; MIFTC with histopathological angioinvasion; widely invasive FTC (WIFTC)]. Recently, a surgical approach has been adopted that differentiates between low-risk and high-risk DTC. The rationale behind this new concept is to better balance oncologic risk (high vs low) with the surgical morbidity attendant to the procedure (recurrent laryngeal nerve palsy and hypoparathyroidism). This surgical risk is larger with routine total thyroidectomy (TT) and central node dissection (CND) than with less than TT or TT without CND.Whereas TT with CND remains the treatment of choice for high-risk DTC with metastases, the extent of thyroid resection and lymph node dissection can be reduced in low-risk PTC and FTC without demonstrable loss of oncological benefit. In the new millennium, the surgical approach to DTC, especially low-risk PTC and FTC, has undergone considerable change, resulting in less extensive procedures. This risk-adapted strategy relies not only on the skillful histopathologic detection of multifocality in PTC and vascular invasion in MIFTC, but likewise necessitates diligent follow-up to spot and adequately treat local recurrences and distant metastases as they become clinically apparent.
分化型甲状腺癌（DTC）是滤泡细胞来源的恶性肿瘤。从组织病理学和肿瘤学角度来看，DTC 分为两大类肿瘤：甲状腺乳头状癌（PTC）和滤泡状甲状腺癌（FTC）。这些主要的肿瘤类别，基于临床表现和生物学行为，进一步细分为低风险[甲状腺微小乳头状癌（mPTC）；微小侵袭性滤泡癌（MIFTC）]和高风险 DTC[PTC＞1cm 或转移；有组织病理学血管侵犯的 MIFTC；广泛侵袭性 FTC（WIFTC）]。最近，采用了一种手术方法来区分低风险和高风险的 DTC。这一新概念背后的原理是更好地平衡肿瘤风险（高与低）与手术相关的发病率（喉返神经麻痹和甲状旁腺功能减退）。与非 TT 或 TT 无 CND 相比，常规全甲状腺切除术（TT）和中央淋巴结清扫术（CND）的手术风险更大。尽管 TT 加 CND 仍然是转移性高风险 DTC 的首选治疗方法，但在无明显肿瘤获益丧失的情况下，可以减少低风险 PTC 和 FTC 的甲状腺切除和淋巴结清扫范围。在新千年，DTC 的手术方法，特别是低风险 PTC 和 FTC，已经发生了很大的变化，导致手术范围缩小。这种风险适应策略不仅依赖于 PTC 中多灶性和 MIFTC 中血管侵犯的熟练组织病理学检测，而且同样需要通过勤奋的随访来发现和充分治疗局部复发和远处转移，因为它们会在临床上变得明显。
