Angell Trevor E
Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, The Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Endocrinol Diabetes Obes. 2017 Oct;24(5):372-376. doi: 10.1097/MED.0000000000000354.
The current review focuses on the uncertainty regarding the management of rat sarcoma viral oncogene homolog RAS-positive thyroid nodules. The application of oncogene testing has been heralded for improving risk assessment for indeterminate cytology thyroid nodules and has grown in clinical use. RAS mutations are historically considered oncogenic. However, RAS mutation detection in thyroid nodules has proven problematic, as these mutations are found in benign and malignant lesions.
RAS-positive thyroid nodules frequently have indeterminate cytology and a finding of a positive RAS mutation identifies a significant number of benign lesions as well as thyroid cancers. Long-term follow-up of RAS-positive nodules with benign cytology shows an indolent course not consistent with eventual malignant transformation. Many RAS-positive nodules previously diagnosed as follicular variant of papillary thyroid carcinoma now will be reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features, indicating a more indolent nature of these RAS-positive lesions.
Recent findings have underscored that diagnosis of a RAS-positive thyroid nodule is not synonymous with thyroid malignancy. The ideal clinical and surgical management of these nodules remains challenging.
本综述聚焦于大鼠肉瘤病毒癌基因同源物RAS阳性甲状腺结节管理方面的不确定性。癌基因检测的应用已被视为有助于改善甲状腺结节细针穿刺结果不确定时的风险评估，且在临床应用中不断增加。从历史角度看，RAS突变被认为具有致癌性。然而，甲状腺结节中RAS突变的检测已被证明存在问题，因为这些突变在良性和恶性病变中均有发现。
RAS阳性甲状腺结节的细针穿刺结果常常不确定，RAS突变检测结果呈阳性可识别出大量良性病变以及甲状腺癌。对细针穿刺结果为良性的RAS阳性结节进行长期随访显示，其病程进展缓慢，与最终恶变不符。许多先前被诊断为甲状腺乳头状癌滤泡亚型的RAS阳性结节，现在将被重新分类为具有乳头状核特征的非侵袭性滤泡性甲状腺肿瘤，这表明这些RAS阳性病变的性质更为惰性。
最近的研究结果强调，RAS阳性甲状腺结节的诊断并不等同于甲状腺恶性肿瘤。对这些结节进行理想的临床和手术管理仍然具有挑战性。
