诊断学理论与实践 ›› 2024, Vol. 23 ›› Issue (04): 362-370.doi: 10.16150/j.1671-2870.2024.04.003

• 专家论坛 • 上一篇    下一篇

中国甲状腺结节超声诊治现状及挑战

周建桥(), 张璐, 徐上妍   

  1. 上海交通大学医学院附属瑞金医院超声科,上海 200025
  • 收稿日期:2024-02-18 接受日期:2024-06-02 出版日期:2024-08-25 发布日期:2024-08-25
  • 通讯作者: 周建桥 E-mail:zhousu30@126.com

Current status and challenges in ultrasound diagnosis and treatment of thyroid nodules in China

ZHOU Jianqiao(), ZHANG Lu, XU Shangyan   

  1. Ultrasound Department, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2024-02-18 Accepted:2024-06-02 Published:2024-08-25 Online:2024-08-25

摘要:

甲状腺结节在中国患病率高,达36.9%,女性显著高于男性,且存在地区差异。超声检查作为首选诊断工具,因无创、便捷及高灵敏度而被广泛应用。近年来,超声诊断技术不断发展,包括TIRADS系统、多模态超声、细针穿刺及分子检测、人工智能(artificial intelligence, AI)等。其中,2020版中国影像报告数据系统(China-Thyroid Imaging Reporting and Data System, C-TIRADS)结合中国国情,提高了诊断准确率。多模态超声评估结合多种超声技术,显著提高了诊断效能,减少了不必要的穿刺。分子检测与AI辅助诊断则进一步提升了诊断精度,但AI模型的泛化能力和长期临床应用效果尚需验证。超声引导下的介入治疗在甲状腺结节管理中占据重要地位,包括化学消融和热消融技术。化学消融主要用于囊性为主结节,热消融则适用于囊实性及实性结节,两者联合应用效果更佳。热消融技术在甲状腺微小乳头状癌治疗中的应用虽存争议,但初步研究的结果已显示了其疗效和安全性。尽管超声技术在甲状腺结节诊治中取得了显著进展,但仍存在挑战,如诊断标准的不统一、不同地区医院之间的设备及技术水平差异、热消融治疗的长期疗效与安全性缺乏大规模研究数据等。未来的发展方向包括改进风险分层系统、加强多模态超声评估研究、提升AI模型泛化能力、规范分子检测技术应用、探索消融治疗适应证和规范化疗效评估等。

关键词: 甲状腺结节, 超声, 诊断, 介入治疗

Abstract:

Thyroid nodules (TNs) exhibit a high prevalence rate of 36.9% in China, with a marked preponderance in females over males, and regional variations observed. Ultrasonography (US), due to its non-invasiveness, convenience, and high sensitivity, has emerged as the primary diagnostic tool for TNs. In recent years, advancements in US diagnostic techniques have flourished, including the Thyroid Imaging Reporting and Data System (TIRADS), multimodal US, fine-needle aspiration (FNA) coupled with molecular testing, and artificial intelligence (AI). Notably, the 2020 edition of the Chinese-specific C-TIRADS system has improved diagnostic accuracy by tailoring to China's healthcare landscape. Multimodal US assessment, integrating various US techniques, has significantly enhanced diagnostic efficacy, reducing unnecessary biopsies. Molecular testing and AI-assisted diagnosis have further improved diagnostic precision; however, the generalization capabilities of AI models and their long-term clinical application efficacy remain to be validated. Ultrasound-guided interventional therapies occupy a pivotal position in TN management, including chemical ablation and thermal ablation techniques. Chemical ablation is primarily utilized for cystic-predominant nodules, whereas thermal ablation is suitable for both cystic-solid and solid nodules, with their combined application yielding optimal results. Although the application of thermal ablation in thyroid micropapillary carcinoma remains controversial, preliminary studies have demonstrated its efficacy and safety. Despite the remarkable progress in US technologies for TN diagnosis and treatment, challenges persist, including inconsistent diagnostic criteria, disparities in equipment and technical expertise across regions and hospitals, and the absence of large-scale studies on the long-term efficacy and safety of thermal ablation. Future directions encompass refining risk stratification systems, intensifying research on multimodal US assessment, enhancing the generalization capabilities of AI models, standardizing the application of molecular testing, exploring indications for ablation therapy, and establishing standardized efficacy assessments.

Key words: Thyroid nodules, Ultrasonography, Diagnosis, Interventional therapy

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