Langenbecks Arch Surg. 2014 Feb;399(2):165-84. doi: 10.1007/s00423-013-1140-z.
This paper aims to review controversies in the management of minimally invasive follicular thyroid carcinoma (MIFTC) and to reach an evidence-based consensus.
MEDLINE search of the literature was conducted using keywords related to MIFTC. The search term was identified in the title, abstract, or medical subject heading. Available literature meeting the inclusion criteria were assigned the appropriate levels of evidence and recommendations in accordance with accepted international standards. Results were discussed at the 2013 Workshop of the European Society of Endocrine Surgeons devoted to MIFTC.
Published papers on MIFTC present inadequate power with a III–IV level of evidence and C grade of recommendation. Several issues demanded a comparison of published studies from different medical reports regarding MIFTC definition, specimen processing, characteristics, diagnosis, prognoses, and therapy. As a consequence, it is difficult to make valuable statements on MIFTC with a sufficient recommendation rating. MIFTC diagnosis requires clearer, unequivocal, and reproducible criteria for pathologist, surgeons, and endocrinologists to use in the management of these patients. If the distinction between MIFTC and WIFTC cannot be made, an expert in thyroid pathologist should be consulted.
According to published papers, the following conclusions can be drawn. (a) Candidates for hemithyroidectomy are MIFTC with exclusive capsular invasion, patients <45 years old at presentation, tumor size <40 mm, without vascular invasion, and without any node or distant metastases. (b) Candidates for total thyroidectomy are MIFTC in patients ≥45 years at presentation, tumor size ≥40 mm, vascular invasion present, positive nodes, and positive distant metastases. (c) In the absence of clinical evidence for lymph node metastasis, patients with MIFTC do not require prophylactic lymph node dissection. (d) Radio iodine ablation is indicated in elderly patients (>45 years), large tumor size (>40 mm), extensive vascular invasion, presence of distant synchronous or metachronous metastasis, positive nodes, and if recurrence is noted at follow-up.
本文旨在回顾微创滤泡性甲状腺癌（MIFTC）治疗中的争议，并达成基于证据的共识。
使用与 MIFTC 相关的关键词对 MEDLINE 文献进行检索。搜索词在标题、摘要或医学主题词中确定。符合纳入标准的可用文献根据公认的国际标准被赋予适当的证据水平和推荐等级。结果在 2013 年欧洲内分泌外科医师学会专门讨论 MIFTC 的研讨会上进行了讨论。
发表的关于 MIFTC 的论文证据水平为 III-IV 级，推荐等级为 C 级，证据效力不足。有几个问题需要对不同医学报告中关于 MIFTC 定义、标本处理、特征、诊断、预后和治疗的发表研究进行比较。因此，很难对 MIFTC 做出有充分推荐等级的有价值的陈述。MIFTC 的诊断需要病理学家、外科医生和内分泌学家使用更清晰、明确和可重复的标准。如果不能区分 MIFTC 和 WIFTC，则应咨询甲状腺病理专家。
根据发表的论文，可以得出以下结论。（a）行半甲状腺切除术的候选者为仅包膜受侵、发病时＜45 岁、肿瘤大小＜40mm、无血管侵犯、无任何淋巴结或远处转移的 MIFTC 患者。（b）行全甲状腺切除术的候选者为发病时≥45 岁、肿瘤大小≥40mm、存在血管侵犯、阳性淋巴结和阳性远处转移的 MIFTC 患者。（c）在无临床证据表明淋巴结转移的情况下，MIFTC 患者无需预防性淋巴结清扫。（d）对于老年患者（＞45 岁）、肿瘤较大（＞40mm）、广泛血管侵犯、存在远处同步或异时性转移、阳性淋巴结以及在随访中发现复发的患者，建议进行放射性碘消融。
