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甲状腺结节的诊治方法

Approach to Thyroid Nodules: Diagnosis and Treatment.

作者信息

AlSaedi Aram H, Almalki Dalia S, ElKady Reem M

机构信息

College of Medicine, Taibah University, Madinah, SAU.

College of Medicine, Taibah University, Jeddah, SAU.

出版信息

Cureus. 2024 Jan 13;16(1):e52232. doi: 10.7759/cureus.52232. eCollection 2024 Jan.

Abstract

Thyroid nodules (TNs) are prevalent and found in up to 50% of individuals. While most TNs are benign, some can be malignant. The evaluation of TNs is crucial to rule out malignancy and identify those requiring surgical intervention. This study aimed to clarify the reported prevalence of TNs, focusing specifically on their various types, assessment and diagnostic processes, current evaluation methods, and evidence-based management. It also provides recommendations for follow-up. TNs are typically found during physical exams or incidentally during imaging procedures. Routine laboratory and clinical evaluations of TNs are common. Ultrasound is the preferred imaging method to determine if a TN needs a biopsy. Fine-needle aspiration (FNA) is crucial in deciding whether surgery or surveillance is necessary. TNs that show suspicious features on the ultrasound may require cytologic analysis to assess the risk of malignancy. The effectiveness of several supplementary molecular tests is still uncertain, although some studies report promising results. The management and treatment approach for TNs primarily depends on the results of FNA cytology and ultrasound characteristics. The optimal treatment strategy for TNs ranges from straightforward follow-ups for low-risk cases to surgical intervention for high-risk patients. Rather than adopting a uniform approach, clinicians should assess each patient on a case-by-case basis using current knowledge and a collaborative, multidisciplinary method.

摘要

甲状腺结节(TNs)很常见,在高达50%的个体中都能发现。虽然大多数甲状腺结节是良性的,但有些可能是恶性的。对甲状腺结节的评估对于排除恶性肿瘤以及识别那些需要手术干预的结节至关重要。本研究旨在阐明已报道的甲状腺结节患病率,特别关注其各种类型、评估和诊断过程、当前的评估方法以及循证管理。它还提供了随访建议。甲状腺结节通常在体格检查期间或在影像学检查过程中偶然发现。对甲状腺结节进行常规实验室和临床评估很常见。超声是确定甲状腺结节是否需要活检的首选影像学方法。细针穿刺抽吸活检(FNA)对于决定是否需要手术或进行监测至关重要。在超声检查中显示出可疑特征的甲状腺结节可能需要进行细胞学分析,以评估恶性风险。尽管一些研究报告了有前景的结果,但几种补充分子检测的有效性仍不确定。甲状腺结节的管理和治疗方法主要取决于FNA细胞学检查结果和超声特征。甲状腺结节的最佳治疗策略范围从对低风险病例进行直接随访到对高风险患者进行手术干预。临床医生不应采用统一的方法,而应根据当前知识并采用协作性的多学科方法对每个患者进行个案评估。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f75/10861804/651a03af7b31/cureus-0016-00000052232-i01.jpg

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