Sorrenti Salvatore, Baldini Enke, Tartaglia Francesco, Catania Antonio, Arcieri Stefano, Pironi Daniele, Calò Pier Giorgio, Filippini Angelo, Ulisse Salvatore
Department of Surgical Sciences, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
Aging Clin Exp Res. 2017 Feb;29(Suppl 1):7-13. doi: 10.1007/s40520-016-0654-y. Epub 2016 Nov 10.
Epithelial thyroid cancers (TC) comprise two differentiated histotypes (DTC), the papillary (PTC) and the follicular (FTC) thyroid carcinomas which, following dedifferentiation, are assumed to give rise to the poorly differentiated thyroid carcinomas and the rare, but highly aggressive and invariably fatal, anaplastic thyroid carcinomas. Although thyroid cancer mortality has not been changed, its annual incidence has increased over the last two decades, mainly because of the improved ability to diagnose malignant transformation in small non-palpable thyroid nodules. Despite DTC patients have a favorable prognosis, aggressive disease is more frequently observed in the elderly showing a higher disease-specific mortality. Of relevance is the high prevalence of nodular thyroid disease in aged patients being higher than 90%, in women older than 60 year, and 60% in men older than 80 year. This implies a careful evaluation of thyroid nodules in this group of patients in order to exclude malignancy. In fact, despite the tremendous progress in the comprehension of the underlying molecular mechanisms deregulated in DTC progression, several aspects of their clinical management remain to be solved and novel diagnostic strategies are sorely needed. Here, we will attempt to review new molecular approaches, which are currently being exploited in order to ameliorate the diagnosis of thyroid nodules.
甲状腺上皮癌(TC)包括两种分化型组织学类型(DTC),即乳头状甲状腺癌(PTC)和滤泡状甲状腺癌(FTC),在去分化后,它们被认为会发展为低分化甲状腺癌以及罕见但高度侵袭性且必然致命的间变性甲状腺癌。尽管甲状腺癌的死亡率没有变化,但在过去二十年中其年发病率有所上升,主要是因为诊断不可触及的小甲状腺结节恶变的能力有所提高。尽管DTC患者预后良好,但侵袭性疾病在老年人中更常见,且疾病特异性死亡率更高。值得注意的是,老年患者中结节性甲状腺疾病的患病率很高,60岁以上女性高于90%,80岁以上男性为60%。这意味着需要对这组患者的甲状腺结节进行仔细评估以排除恶性肿瘤。事实上,尽管在理解DTC进展中失调的潜在分子机制方面取得了巨大进展,但其临床管理的几个方面仍有待解决,迫切需要新的诊断策略。在这里,我们将尝试回顾目前正在探索的新分子方法,以改善甲状腺结节的诊断。