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《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
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
- 中国癌症杂志 2025年35卷第9期 页码：826-832
- 作者机构：
1. 中国医学科学院北京协和医学院中日友好医院（中日友好临床医学研究所），北京 100029
2. 中日友好医院超声医学科，北京 100029
3. 国家呼吸医学中心，呼吸和共病全国重点实验室，国家呼吸疾病临床研究中心，中国医学科学院呼吸病学研究院，中日友好医院呼吸中心，北京 100029
- 作者简介：
[ "刘如玉（ORCID: 0000-0002-5709-7144），博士在读，主治医师。" ]
[ "张波，中日友好医院超声医学科主任，主任医师、博士研究生导师，首都医科大学超声医学系副主任，中日医学科技交流协会超声医学分会会长。主持国家自然科学基金等课题20余项，以第一作者或通信作者发表中英文论文120余篇，其中在SCI收录期刊上发表48篇，执笔指南与共识17部，主编/副主编专著24部。兼任北京超声医学学会副理事长、北京医学会超声医学分会常委、中国临床肿瘤学会甲状腺专家委员会副主任委员等。获“国之名医”“全国科普先进工作者”称号及华夏医学科技奖二等奖、中国研究型医院学会医学科技奖一等奖等9项省部级奖励，在甲状腺疾病的超声诊治方面具有较深造诣。" ]
- 基金信息：2024年首都卫生发展科研专项(CFH-2024-2-4068)
DOI：10.19401/j.cnki.1007-3639.2025.09.002
中图分类号： R736.1收稿：2025-09-08，
修回：2025-09-21，
纸质出版：2025-09-30
- 稿件说明：
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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.
Ruyu LIU, Chenyi WANG, Bo ZHANG. 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.
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. DOI： 10.19401/j.cnki.1007-3639.2025.09.002.
Ruyu LIU, Chenyi WANG, Bo ZHANG. 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. DOI： 10.19401/j.cnki.1007-3639.2025.09.002.
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。
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.
关键词
Keywords
references
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