《2025版美国甲状腺学会成人甲状腺结节管理指南》及《2025版美国甲状腺学会成人分化型甲状腺癌管理指南》解读：甲状腺结节及分化型甲状腺癌超声、CT、MRI以及消融部分的进展

doi:10.19401/j.cnki.1007-3639.2025.09.002

摘要/Abstract

摘要：

2025年美国甲状腺学会（American Thyroid Association，ATA）首次将甲状腺结节与分化型甲状腺癌（differentiated thyroid cancer，DTC）管理分为两部指南，对比2015版ATA指南的影像学部分，2025版ATA指南更新如下：① 明确对家族性非髓样癌筛查的建议，并提出使用胰高血糖素样肽-1受体激动剂（glucagon-like peptide-1 receptor agonist，GLP-1 RA）患者治疗前不建议进行甲状腺超声筛查；② 改进甲状腺结节超声恶性风险分层，实现全部结节可分类；③ 提高超声引导下细针抽吸活检（fine needle aspiration，FNA）径线阈值，强调参考年龄、合并症等个体化指标；④ 调整未穿刺结节及细胞学检查良性结节的随访周期，并提出超声随访终点；⑤ 明确cT1aN0M0甲状腺乳头状癌主动监测的标准化超声方案；⑥ 新增颈部可疑淋巴结异常血流及量化证据；⑦ 提出动态风险分层，根据患者病灶残留或疾病复发风险以及对治疗的反应调整随访周期，并新增持续疗效满意的低危DTC术后随访终点；⑧ 强调术前计算机体层成像（computed tomography，CT）或磁共振成像（magnetic resonance imaging，MRI）在评估远处转移方面的应用，而不再推荐CT或MRI作为术后常规随访的影像学手段；⑨ 提出热消融适应证包括良性结节、低危微小癌及复发或转移灶。2025版ATA指南影像学评估方面推荐意见更加明确，兼顾科学性、实用性及卫生经济学，为甲状腺结节和分化型甲状腺癌的全周期影像学管理提供了崭新范式。

关键词: 甲状腺结节, 分化型甲状腺癌, 美国甲状腺学会指南, 超声, 计算机体层成像, 磁共振成像, 消融

Abstract:

In 2025, the American Thyroid Association (ATA) divided the management of thyroid nodules and differentiated thyroid cancer (DTC) into two separate guidelines for the first time. This review highlighted the imaging-related updates and compared them with the 2015 ATA guidelines. The 2025 ATA guidelines introduce the following key updates: ① Clarifying recommendations for screening of familial non-medullary thyroid cancer, and proposing that thyroid ultrasound screening is not recommended before treatment for patients who will receive glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy; ② Refined the sonographic malignancy risk stratification system, enabling classification of all nodule types; ③ Increasing size thresholds for fine-needle aspiration (FNA) and emphasized individualized decisions based on age, comorbidities and other factors; ④ Follow-up intervals for nodules not meeting FNA criteria or with benign cytology have been adjusted, and clear ultrasound surveillance endpoints have been proposed; ⑤ A standardized ultrasound protocol is established for active surveillance of cT1aN0M0 papillary thyroid cancer; ⑥ Additional suspicious features, including abnormal blood flow in cervical lymph nodes, are introduced with quantitative evidence; ⑦ Proposing dynamic risk stratification, adjusting follow-up intervals based on the patient’s risk of residual lesion or disease recurrence and their response to treatment, and adding new endpoints for postoperative follow-up for low-risk DTC patients with sustained excellent response; ⑧ Stressing the preoperative use of computed tomography (CT) or magnetic resonance imaging (MRI) to evaluate distant metastasis, while no longer recommending them as routine imaging tools during follow-up; ⑨ Defining indications for thermal ablation: benign nodules, low-risk microcarcinomas and recurrent or metastatic lesions. Guided by evidence-based medicine, the 2025 ATA guidelines promote the transformation of thyroid ultrasound towards “precision, minimal invasiveness, individualization”, providing a new paradigm for the whole-process clinical management of thyroid diseases.

Key words: Thyroid nodule, Differentiated thyroid cancer, American Thyroid Association guidelines, Ultrasound, Computed tomography, Magnetic resonance imaging, Ablation

中图分类号:

R736.1

刘如玉, 王晨一, 张波. 《2025版美国甲状腺学会成人甲状腺结节管理指南》及《2025版美国甲状腺学会成人分化型甲状腺癌管理指南》解读：甲状腺结节及分化型甲状腺癌超声、CT、MRI以及消融部分的进展[J]. 中国癌症杂志, 2025, 35(9): 826-832.

LIU Ruyu, WANG Chenyi, ZHANG Bo. Interpretation of the 2025 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and the 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer: progress in ultrasound, CT, MRI and ablation of thyroid nodules and differentiated thyroid cancer[J]. China Oncology, 2025, 35(9): 826-832.

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参考文献 11

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2015 ATA guidelines		2025 ATA guidelines
Sonographic pattern	FNA size cut-off (largest dimension)	Sonographic pattern	FNA size cut-off (largest dimension)	Range to consider FNA (largest dimension)	Strength of recommendation/quality of evidence
Benign (RoM<1%)	No FNA	Benign (RoM≈1%)	No FNA	NA	Strong/moderate
Very low suspicion (RoM<3%)	≥2.0 cm	Very low suspicion (RoM<3%)	No FNA	NA	Conditional/moderate
Low suspicion (RoM 5%-10%)	≥1.5 cm	Low suspicion (RoM 3%-20%)	≥2.5 cm	1.0-1.5 cm	Conditional/moderate
Moderate suspicion (RoM 10%-20%)	≥1.0 cm	Moderate suspicion (RoM 20%-50%)	≥2.0 cm	1.0-2.0 cm	Strong/moderate
High suspicion (RoM 70%-90%)	≥1.0 cm	High suspicion (RoM>50%)	≥1.5 cm	1.0-1.5 cm	Strong/moderate

Factor	Favors smaller size	Favors larger size
Age	Younger	Older
Personal risk factors for thyroid cancer present (e.g. childhood X-ray therapy, genetic syndrome)	Present	Absent
Comorbidities	Absent	Present
Evidence for sonographic pattern RoM	Strong	Weak
¹⁸F-FDG or Ga-68 Dotatate avidity (incidental finding; not recommended for thyroid nodule evaluation)	Present	Absent
Symptom attributable to nodule	Present	Absent
Nodule location	Isthmus, posterior portion	Other
	Patient preference

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