《2025年美国甲状腺协会（ATA）成人分化型甲状腺癌管理指南》双语对照版

《2025年美国甲状腺协会（ATA）成人分化型甲状腺癌管理指南》双语对照版Introduction引言English:Differentiatedthyroidcancer(DTC)includespapillary,follicular,andoncocyticcarcinomas,comprisingthevastmajority(>90%)ofallthyroidcancers.IntheUnitedStates,itisestimatedthattherewere44,020newcasesofthyroidcancerin2024,comparedwith37,200in2015whenthelastAmericanThyroidAssociation(ATA)guidelineswerepublished.中文：分化型甲状腺癌（DTC）包括乳头状癌、滤泡状癌和嗜酸细胞型癌，占所有甲状腺癌的绝大多数（>90%）。在美国，预计2024年将有44,020例新的甲状腺癌病例，而2015年美国甲状腺协会（ATA）上次发布指南时为37,200例。English:Theyearlyincidencetripledfrom4.9per100,000in1975to14.3per100,000in2015.Approximately25%ofthenewthyroidcancersdiagnosedin1988–1989were<1cm,comparedwith39%in2008–2009.Thisshifttoearlierdetection/diagnosiscorrelateswiththeincreasinguseofneckultrasonographyandultrasound-guidedfineneedleaspiration(FNA).中文：甲状腺癌的年发病率从1975年的每10万人4.9例上升至2015年的14.3例，增长了三倍。1988–1989年间被诊断出的新发甲状腺癌中约25%的肿瘤直径小于1厘米，而到2008–2009年这一比例上升至39%。这种早期发现与诊断的变化，与颈部超声检查及超声引导下细针穿刺（FNA）技术的广泛应用密切相关。English:However,since2014,theincidence—particularlyofsmallthyroidcancers—hasdeclinedintheUnitedStates.ThislikelyreflectstheadoptionofATAandotherorganizations’recommendationsdiscouragingFNAofnodules<1cmwithoutsuspiciouslymphnodesorinvasion,giventheirexcellentprognosisandtherisksofovertreatment.中文：然而，自2014年以来，美国甲状腺癌的发病率，尤其是小肿瘤的发病率有所下降。这一趋势可能反映了ATA及其他组织的建议被广泛采纳——即对无可疑淋巴结或侵犯迹象、直径小于1厘米的结节不主张行FNA穿刺，因为此类肿瘤预后极好，过度诊治的风险反而更大。English:Beyondtheearly-stagemanagementchanges,priorguidelinesalsointroducedcriteriaforinitialdecision-makingandframeworksforresponseassessmentafterinterventions.Thesehavebeenvalidatedandadoptedintoclinicalpractice.中文：除早期甲状腺癌管理方式的调整外，前版指南还提出了初始治疗决策标准及治疗反应评估框架。这些标准随后得到了验证并被临床广泛采纳。English:Majoradvancesinunderstandingthemolecularmechanismsofthyroidcancerhavecreatednewapprovedtreatmentoptionsforspecificsubgroupsofpatients.Suchdevelopmentsnecessitateserialupdatesoftheguidelinestosupportoptimalclinicalcare.中文：随着对甲状腺癌分子机制认识的显著进展，一些针对特定患者亚群的新型治疗方法获得批准。这些进展使得持续更新指南成为保障最佳临床实践的必要措施。English:Inthis2025update,aclinicaldecision-makingframeworkisintroducedcalled“DATA”:Diagnosis,risk/benefitAssessment,Treatmentdecisions,andresponseAssessment.Itaccompaniespatientsfromdiagnosisthroughtheirentirediseasejourney.中文：2025年新版指南引入了一个新的临床决策框架——“DATA”模型：即

诊断（Diagnosis）、风险与获益评估（Assessment）、治疗决策（Treatmentdecisions）

以及

反应评估（Assessment）。这一框架贯穿患者从确诊到整个疾病管理过程。English:TheDATAframeworkhelpscliniciansandpatientsevaluatewhetherinterventionsareappropriatebasedonrisks,benefits,andindividualfactors.Itguidestheselectionofoptimalstrategiesandinformssubsequentmonitoringorfurthertreatment.中文：DATA框架帮助临床医生和患者在风险、获益及个体差异的基础上判断干预措施的适宜性，从而选择最优的管理策略，并为后续监测与进一步治疗提供指导。English:Sincethefirst1996ATAguidelinesforthyroidnodulesandDTC,therehavebeenremarkableadvancesindiagnosisandtreatment.Nevertheless,controversiespersist,underscoringtheneedforindividualizedtherapy.中文：自1996年ATA首次发布甲状腺结节与分化型甲状腺癌指南以来，诊断与治疗领域均取得了显著进展。然而，许多方面仍存在争议，强调了个体化治疗的重要性。English:Forexample,lessaggressivemanagementispreferredforearly-stageDTCwithexcellentprognosisorforthoseathighriskoftreatmentcomplications,whilemoreaggressivestrategiesarewarrantedforpatientswithhigh-riskorrefractorydisease.中文：例如，对于预后良好的早期DTC或具有较高治疗并发症风险的患者，应采用较为保守的管理方式；而对于高风险或初治无效的患者，则应采取更积极的治疗策略。English:Despiteprogress,thereremaintoofewhigh-qualityclinicaltrialsinthyroidcancer,contributingtoongoinguncertaintyinmanymanagementareas.Thisguidelinehighlightskeytopicsrequiringfurtherresearch.中文：尽管取得了显著进展，但甲状腺癌领域仍缺乏高质量的临床研究，这导致许多管理环节仍存在不确定性。指南特别指出了若干亟待进一步研究的关键问题。English:Clinicaldecisionsareincreasinglysharedbetweenpatientsandclinicians.Thus,survivorship,psychosocialfactors,andpatient-reportedoutcomesareemphasized.Multidisciplinaryandtransdisciplinarycollaboration—suchastumorboardsandco-locatedclinics—isencouraged.中文：临床决策正越来越多地由医生与患者共同完成。因此，本指南特别强调了癌症幸存者管理、心理社会因素以及患者报告结局的重要性。同时，倡导多学科及跨专业协作，例如多学科肿瘤讨论会及联合门诊，以促进高质量的综合诊疗。AimandTargetAudience指南目的与目标读者English:Theobjectiveintheseguidelinesistoinformclinicians,patients,researchers,andhealthpolicymakersaboutthebestavailableevidence(anditslimitations)relatingtothediagnosisandtreatmentofadultpatients(over18yearsofage)withdifferentiatedthyroidcancer(DTC).ATAguidelinesforpediatricthyroidcancerhavebeenpublishedand/orareunderdevelopment.中文：本指南的目标是为临床医生、患者、科研人员以及卫生政策制定者提供有关成人（18岁及以上）分化型甲状腺癌（DTC）诊断与治疗的最新、最可靠的循证依据（同时指出证据的局限性）。此外，美国甲状腺协会（ATA）针对儿童甲状腺癌的指南已发布或正在制定中。English:Comparedwithpriorguidelines,thisdocumentappliesonlytoDTC,includingindividualsdiagnosedwithnoninvasivefolliculartumorswithpapillary-likenuclearfeatures(NIFTP)andfolliculartumorswithuncertainmalignantpotential(FUMP),whichareextremelylow-risklesionsdiagnosableonlyaftersurgicalexcision.中文：与以往指南不同，本文件仅适用于DTC患者，其中包括被诊断为**具有乳头状核特征的非侵袭性滤泡性肿瘤（NIFTP）及恶性潜能不确定的滤泡性肿瘤（FUMP）**的个体。这些病变属于极低风险类型，通常只有在外科切除并经病理检查后才能确诊。English:Thisdocumentisintendedtoinformclinicaldecision-makingusingtheDATAframeworkaspatientsprogressthroughtheirjourneywiththyroidcancer—minimizingpotentialharmfromovertreatmentinlow-riskpatientswhileintensivelymonitoringandtreatingthoseathigherrisk,includingaggressiveformsofDTC.中文：本指南旨在通过“DATA”框架指导临床决策，贯穿患者整个甲状腺癌诊疗过程。对于低风险患者，应尽量避免过度治疗造成的潜在损害；而对于高风险或侵袭性DTC患者，则需加强监测与治疗。English:Theseguidelinesshouldnotbeinterpretedasareplacementforclinicaljudgmentandaremeanttocomplementinformed,sharedpatient–cliniciandecision-making.Recommendationsshouldbeappliedinthecontextofindividualdemographic,clinical,andpathologicalcharacteristics.中文：本指南并非用于取代临床医生的专业判断，而应作为医生与患者在知情基础上共同决策的辅助工具。各项推荐应结合个体的年龄、临床表现及病理特征等因素进行灵活应用。English:Itisrecognizedthatnationalclinicalpracticeguidelinesmaynotconstitutealegalstandardofcareinalljurisdictions.Physiciansencounteringpracticesettingdifferencesmayadapttheseguidelinesusingestablishedmethods,suchasthoseoftheADAPTECollaboration().中文：应当认识到，国家级临床实践指南在不同地区未必构成法律意义上的“标准医疗行为”。若临床实践环境存在差异，医生可参照既定方法（如ADAPTE协作组织，网址：）对指南进行本地化调整。English:TheADAPTECollaborationisaninternationalnetworkofresearchersandguidelinedevelopersdedicatedtopromotingthedevelopmentandadaptationofclinicalpracticeguidelinesworldwide.中文：ADAPTE协作组织是一个由全球研究者和指南制定者组成的国际网络，致力于促进临床实践指南的制定与本地化应用。English:Asourprimaryfocuswasthequalityofevidencerelatedtohealthoutcomesanddiagnostictesting,thetaskforcechosenottoemphasizeeconomicresourcesorfinancialimplicationswithinindividualrecommendations.中文：由于本指南的核心聚焦于健康结局及诊断检测相关的证据质量，专家组在各项推荐中并未将经济资源或费用影响作为主要考量因素。English:However,withattentiontosurvivorshipandtheinclusionofapatientadvocate,adedicatedsectionaddresses“financialtoxicity”—theeconomicburdencausedbycancerdiagnosisandtreatment—asanemergingareaofclinicalandpolicyconcern.中文：然而，鉴于指南同时关注癌症幸存者问题并吸纳了患者代表的意见，文中特别设立章节讨论了“经济毒性”（financialtoxicity）——即癌症诊疗带来的经济负担——这一逐渐受到临床与政策重视的新领域。English:ItisrecognizedthatotherorganizationshavedevelopedDTCguidelinesbothwithintheUnitedStatesandinternationally.Whiletherearemanysimilaritiesacrossguidelines,differencesexistinappraisalmethods,practicepatterns,andaccesstodiagnosticortherapeuticresources.中文：同时，我们也认识到，美国国内及国际上其他组织亦制定了DTC相关指南。虽然多数指南在总体思路上相似，但在证据评价方法、临床实践模式以及诊疗资源可及性等方面仍存在差异。English:Thesevariationsunderlinetheimportanceofclarifyingevidentialuncertaintiesthroughadditionalresearchandhighlightthatcompleteconsensusamongorganizationsisneitherexpectednornecessary.中文：这些差异进一步凸显了通过更多研究来澄清证据不确定性的必要性，也表明不同学术组织之间不必在所有问题上完全一致。Methods方法学English:TheATAGuidelinesTaskForceonDifferentiatedThyroidCancer(DTC)wasestablishedbytheATABoardofDirectorsandincludedexpertsinendocrinology,surgery,nuclearmedicine,oncology,radiology,pathology,epidemiology,andpatientadvocacy.中文：美国甲状腺协会（ATA）董事会组建了分化型甲状腺癌（DTC）指南专家工作组。该工作组成员包括来自内分泌学、外科学、核医学、肿瘤学、影像学、病理学、流行病学以及患者倡导领域的专家。English:ThemultidisciplinarycompositionofthetaskforceaimedtoensurethattherecommendationswouldreflectthefullspectrumofclinicalcareandscientificexpertiserelevanttoDTC.中文：工作组的多学科构成旨在确保指南推荐能够充分反映DTC相关的全面临床照护与科学研究视角。English:Allmemberscompletedconflictofinterest(COI)disclosures.AnypotentialconflictswerereviewedbytheATAGuidelinesandStatementsCommittee.Memberswithsignificantconflictsabstainedfromvotingonrelevantrecommendations.中文：所有成员均填写了利益冲突（COI）披露表。潜在利益冲突由ATA指南与声明委员会进行审查；若成员存在实质性利益冲突，则在相关推荐内容表决时需回避。English:TheguidelinedevelopmentprocessadheredtotheprinciplesoutlinedbytheInstituteofMedicine(nowNationalAcademyofMedicine)fortrustworthyguidelinedevelopment,emphasizingtransparency,evidencequality,andmultidisciplinaryinput.中文：指南的制定过程遵循了美国医学研究院（现为美国国家医学院）提出的“可信赖临床指南制定原则”，重点强调透明性、证据质量以及多学科参与。English:LiteraturesearcheswereconductedusingPubMedandEmbasedatabasesthroughAugust2023.Thesearchtermsincludedcombinationsof“thyroidcancer,”“differentiatedthyroidcarcinoma,”“treatment,”“surgery,”“radioiodine,”“TSHsuppression,”“ultrasound,”andrelatedtopics.中文：文献检索通过PubMed与Embase数据库进行，截止至2023年8月。检索关键词包括：“thyroidcancer”（甲状腺癌）、“differentiatedthyroidcarcinoma”（分化型甲状腺癌）、“treatment”（治疗）、“surgery”（手术）、“radioiodine”（放射性碘）、“TSHsuppression”（TSH抑制）、“ultrasound”（超声）及其他相关主题。English:Theevidencereviewprioritizedsystematicreviewsandmeta-analyses,supplementedbylargeprospectiveandretrospectivestudieswhenhigh-qualitysyntheseswereunavailable.中文：证据评估优先采用系统综述与Meta分析；当缺乏高质量综合研究时，补充纳入大规模前瞻性或回顾性研究。English:Recommendationswereformulatedthroughconsensusduringstructuredmeetingsandvirtualdiscussions.EvidencequalityandrecommendationstrengthweregradedusingtheGRADEsystem(GradingofRecommendations,Assessment,Development,andEvaluation).中文：推荐意见通过结构化会议及线上讨论形成共识，并依据

GRADE系统（推荐分级、评估、制定与评价）评估证据质量与推荐强度。English:UndertheGRADEframework,thequalityofevidenceiscategorizedashigh,moderate,low,orverylow,dependingonfactorssuchasstudydesign,consistencyofresults,directnessofevidence,andprecision.中文：按照GRADE框架，证据质量分为“高（high）”、“中（moderate）”、“低（low）”和“极低（verylow）”四个等级，评估标准包括研究设计、结果一致性、证据直接性及结果精确性等因素。English:Thestrengthofeachrecommendationwasclassifiedaseitherstrongorweak(conditional).Astrongrecommendationindicatesthatmostinformedpatientswouldchoosetherecommendedmanagement,whileaweakrecommendationimpliesvariationdependingonpatientvaluesorclinicalcircumstances.中文：推荐强度分为“强（strong）”或“弱/条件性（weak/conditional）”。“强推荐”意味着大多数知情患者都会选择该管理策略；“弱推荐”则表示患者选择可能因个体价值观或临床情况而有所不同。English:DraftrecommendationswerereviewedbytheATAGuidelinesandStatementsCommitteeandtheATABoardofDirectorsbeforepublicpostingforstakeholdercomment.Feedbackwasincorporatedintothefinalversionfollowingadditionaldeliberation.中文：指南初稿由ATA指南与声明委员会及董事会审查后，向公众公开征求意见。专家组根据反馈意见进行进一步讨论和修订，最终形成正式发布版本。English:ThefinaldocumentwaspeerreviewedandapprovedbytheATABoardofDirectors.Theguidelinerepresentstheconsensusofthetaskforcebasedonavailableevidenceandexpertinterpretation.中文：最终文件经同行评审，并获得ATA董事会批准。本指南代表专家工作组基于现有证据与专家解读达成的共识性意见。English:Giventherapidlyevolvingfield,theATAintendstoupdatethisguidelineperiodicallyasnewdataemergethatcouldsignificantlyaffectrecommendations.中文：鉴于该领域发展迅速，ATA计划在未来定期更新本指南，以便在有重要新证据出现时及时调整相关推荐。KeyChangesfromthe2015ATAGuidelines相较2015年指南的主要变化English:The2025ATAguidelinesincorporatenumerousupdatesreflectingadvancesinclinicalpractice,diagnostics,andtherapeuticsoverthepastdecade.Thesechangesaimtorefinepatientselection,reduceunnecessaryinterventions,andintegratenovelmolecularandimagingtools.中文：2025版ATA指南在临床实践、诊断及治疗等多个方面进行了更新，反映了过去十年内的重要进展。本次修订旨在进一步优化患者分层、减少不必要的干预，并纳入新的分子学与影像学技术。English:Amongthemostsignificantupdatesistheadoptionofthe

DATAframework—aclinicaldecision-makingmodelthatemphasizesDiagnosis,risk/benefitAssessment,Treatmentdecisions,andresponseAssessmentthroughoutthepatient’sdiseasecourse.中文：本次更新最重要的变化之一是引入了

DATA决策框架

——该临床决策模型在患者整个疾病管理过程中强调

诊断（Diagnosis）、风险与获益评估（Assessment）、治疗决策（Treatmentdecisions）

与

反应评估（Assessment）。English:ThismodelpromotesacontinuousandindividualizedapproachtoDTCmanagement,encouragingshareddecision-makingbetweencliniciansandpatientsandensuringthattherapeuticintensitymatchesdiseaserisk.中文：该模型倡导以持续、个体化为核心的DTC管理方式，鼓励医生与患者共同决策，并确保治疗强度与疾病风险相匹配。English:Otherkeychangesinclude:RefinementofFNAIndications:

Updatedthresholdsforbiopsyofthyroidnodulesbasedonsonographicpatternandriskcategory,reflectingdataonmalignancyratesandoutcomes.RevisionofRiskStratification:

Expandeduseofpostoperativeriskclassificationincorporatingmolecularmarkersandhistopathologicvariables.UpdatedRecommendationsforRadioiodine(RAI)Therapy:

MoreselectiveuseofRAIinlow-riskpatientsandindividualizeddosimetryforintermediate/high-riskdisease.DynamicRiskAssessment:

Greateremphasisonusingresponsetotherapytoguidelong-termfollow-upintensity.IntegrationofMolecularTesting:

Guidanceontheroleofmoleculardiagnosticsinindeterminatecytologyandrecurrent/metastaticdisease.SurvivorshipandFinancialToxicity:

Newfocusonqualityoflife,psychosocialaspects,andtheeconomicburdenassociatedwiththyroidcancercare.中文：其他主要更新包括：FNA穿刺适应证的优化：根据超声影像特征及风险分级调整穿刺阈值，反映最新恶性率与临床结局研究数据。风险分层体系的修订：扩大术后风险分类体系的应用，纳入分子标志物与组织病理特征。放射性碘治疗（RAI）建议更新：对于低风险患者更加谨慎选择RAI；中高风险患者则建议个体化剂量评估。动态风险评估（DynamicRiskAssessment）：更加强调根据治疗反应动态调整长期随访强度。分子检测的整合：明确分子诊断在不确定细胞学结果及复发/转移性疾病中的作用。癌症幸存者与经济毒性：新增章节关注生活质量、心理社会影响以及甲状腺癌诊疗带来的经济负担。English:Theguidelinealsointroducesamoredetailedapproachto

TSHsuppression,advocatingforpersonalizedtargetsbasedondiseasestage,age,comorbidities,andresponsetotherapy.中文：本指南还提出了更为细化的

TSH抑制策略，主张根据疾病分期、患者年龄、合并症及治疗反应制定个体化目标。English:Furthermore,thesectionon

activesurveillance

forsmall,low-riskpapillarythyroidcancershasbeenexpandedwithupdatedevidenceandclearerselectioncriteriaforcandidatessuitableforobservation.中文：此外，关于

小体积、低风险乳头状甲状腺癌的主动监测（activesurveillance）

部分得到了扩展，纳入了最新研究证据，并明确了适合观察随访的患者选择标准。English:Newrecommendationsareprovidedforthemanagementof

recurrentandmetastaticdisease,includingtheintegrationofmolecularlytargetedtherapiessuchasRET,NTRK,andBRAFinhibitors.中文：新增了针对

复发及转移性疾病

的管理建议，包括整合分子靶向治疗，如RET、NTRK及BRAF抑制剂的临床应用。English:Updatesin

imagingandfollow-up

includearefinedroleforultrasound,diagnosticRAIscans,andcross-sectionalimaging(CT,MRI,PET/CT),dependingonresponsetoinitialtherapy.中文：在

影像学与随访

方面，更新了超声、诊断性RAI显像以及断层影像（CT、MRI、PET/CT）在不同治疗反应阶段的具体应用建议。English:Finally,thisguidelinerecognizesthegrowingimportanceof

patient-centeredcare,includingcommunication,decisionsupport,andaddressingsurvivorshipissuessuchasfertility,fatigue,andfearofrecurrence.中文：最后，本指南强调了

以患者为中心的照护理念

的日益重要性，强调在诊疗过程中应重视医患沟通、决策支持，以及癌症幸存者常见问题的管理，如生育、疲劳及复发焦虑等。English:Collectively,theseupdatesreflectashifttowardprecisionmedicineandvalue-basedcare—providingtherighttreatment,attherighttime,fortherightpatient.中文：总体而言，这些更新体现了向

精准医疗

与

价值导向医疗

的转变——即在正确的时间，为合适的患者提供最恰当的治疗。TheDATAFrameworkinDetailDATA决策框架详解English:TheDATAframeworkprovidesastructured,cyclicalapproachtoclinicaldecision-makingacrossthecontinuumofcarefordifferentiatedthyroidcancer(DTC).Itemphasizestheinterplaybetweendiagnosticprecision,individualizedrisk–benefitassessment,targetedtreatment,andadaptivefollow-up.中文：DATA框架为分化型甲状腺癌（DTC）的临床决策提供了一种结构化、循环性的管理模式。它强调诊断精确性、个体化风险与获益评估、靶向治疗策略以及动态随访之间的相互衔接。English:Unlikelineartreatmentalgorithms,DATArepresentsadynamiccycle—wheretheoutcomeofeachphaseinformsthenext,andreassessmentisintegraltoongoingcare.中文：不同于传统的线性治疗流程，DATA模型体现了一个动态循环的概念——每个阶段的结果都会影响后续决策，而持续的再评估是整个管理过程的核心组成部分。1.D–Diagnosis诊断English:Accuratediagnosisremainsthecornerstoneofeffectivemanagement.Diagnosisintegratesclinicalhistory,physicalexamination,high-resolutionneckultrasound,cytology,and,whenindicated,moleculartesting.中文：准确诊断始终是有效管理的基石。诊断过程应整合患者病史、体格检查、高分辨率颈部超声、细胞学检查，并在必要时辅以分子检测。English:The2025ATAguidelinesemphasizejudicioususeofFNA,avoidingunnecessarybiopsiesinnodules<1cmlackingsuspiciousfeatures.Moleculartestingmayrefineriskassessmentinindeterminatenodules(BethesdaIII/IV).中文：2025版ATA指南强调FNA（细针穿刺活检）的合理使用，避免对直径<1cm且无可疑征象的结节进行不必要的穿刺。对于细胞学结果不确定（BethesdaIII/IV类）的结节，可通过分子检测进一步明确风险分级。2.A–Risk/BenefitAssessment风险与获益评估English:Followingdiagnosis,cliniciansassessbothdisease-relatedandpatient-specificfactorstoweighrisksandbenefitsofdifferentmanagementstrategies.中文：确诊后，临床医生需综合评估疾病特征与患者个体因素，以权衡不同管理策略的风险与获益。English:Riskassessmentintegratestumorstage,histologicsubtype,molecularprofile,andcomorbidities.Patientpreferences,psychosocialcontext,andpotentialtreatment-relatedharmsareequallyimportant.中文：风险评估应结合肿瘤分期、组织学类型、分子特征及合并疾病等信息。同时，患者的意愿、心理社会背景以及治疗相关潜在损伤也应纳入考虑。English:Thisindividualizedassessmentensuresthatovertreatmentisminimizedinlow-riskdisease,whilepatientswithintermediate-orhigh-riskdiseasereceivetimelyandappropriatetherapy.中文：通过这种个体化评估，可最大程度避免低风险患者的过度治疗，同时确保中高风险患者获得及时、恰当的干预。3.T–TreatmentDecisions治疗决策English:TreatmentdecisionsencompasstheentirespectrumofDTCmanagement—rangingfromactivesurveillanceandthyroidlobectomytototalthyroidectomy,radioactiveiodine(RAI)therapy,andsystemictargetedtreatments.中文：治疗决策涵盖DTC管理的全程，包括主动监测、甲状腺叶切除、全甲状腺切除、放射性碘（RAI）治疗以及系统性靶向治疗等。English:TheDATAframeworkencouragestailoringtreatmentintensitytoriskcategoryandresponsetopriortherapy.Forexample,low-riskmicrocarcinomasmaybeobserved,whileadvanceddiseasemaywarrantmultimodaltherapy.中文：DATA框架鼓励根据风险等级和既往治疗反应调整治疗强度。例如，低风险微小癌可采用观察随访，而进展性疾病则可能需要多模式联合治疗。English:Decision-makingshouldbesharedbetweenclinicianandpatient,guidedbyevidenceandpatientvalues,ensuringalignmentbetweenmedicalrecommendationsandindividualpreferences.中文：治疗决策应由医生与患者共同制定，在循证依据的指导下充分尊重患者价值观，确保医疗建议与个体意愿相一致。4.A–ResponseAssessment反应评估English:Responsetotherapymustbecontinuouslyevaluatedusingbiochemicalmarkers(suchasthyroglobulinandanti-thyroglobulinantibodies),imagingstudies,andclinicalparameters.中文：治疗反应的评估应持续进行，综合参考生化指标（如甲状腺球蛋白及其抗体）、影像学检查及临床表现。English:Dynamicriskstratificationallowsclinicianstomodifyfollow-upintensityandtherapeuticapproachbasedonevolvingdiseasebehaviorratherthanstaticbaselinecategories.中文：动态风险分层使临床医生能够根据疾病进展的实际表现，而非仅依据初始分层，灵活调整随访频率和治疗策略。English:Forexample,apatientinitiallyclassifiedasintermediateriskwhodemonstratesanexcellentresponsemaytransitiontoalessintensivefollow-upprotocol.中文：例如，一位最初被归为中等风险的患者若表现出极佳的治疗反应，可转入较低频率的随访方案。IntegrationandReassessment整合与再评估English:TheDATAcycleisiterative—eachreassessmentmayreinitiatethediagnosticprocess,updateriskassessment,orprompttreatmentmodification.中文：DATA循环是可重复的——每次再评估都可能重新启动诊断流程、更新风险评估，或促使调整治疗方案。English:Thiscontinuousfeedbackloopsupportsprecisionmedicinebyaligningmanagementdecisionswithevolvingevidenceandpatientoutcomes.中文：这种持续反馈机制使管理决策能够与最新证据和患者结局保持一致，从而实现真正的精准医疗。English:Ultimately,DATApromotesacultureofadaptive,evidence-based,andpatient-centeredcare—acknowledgingthatmanagementofDTCisnotstaticbutanevolvingpartnershipbetweenclinicianandpatient.中文：归根结底，DATA框架倡导一种动态、循证且以患者为中心的照护理念，承认DTC管理不是一成不变的过程，而是医生与患者共同成长、不断调整的协作关系。DiagnosisofDifferentiatedThyroidCancer分化型甲状腺癌的诊断English:Accuratediagnosisisthefoundationofappropriatemanagementfordifferentiatedthyroidcancer(DTC).Diagnosisreliesontheintegrationofclinicalfindings,imaging,cytology,and,whereindicated,moleculartesting.Thegoalistodistinguishbenignfrommalignantnodulesandtoguidetheextentofsurgeryorsurveillance.中文：准确的诊断是分化型甲状腺癌（DTC）合理管理的基础。诊断应综合临床表现、影像学检查、细胞学结果及必要时的分子检测。其核心目标在于区分良性与恶性结节，并据此指导手术范围或观察随访策略。ClinicalEvaluation临床评估English:Initialevaluationbeginswithathoroughhistoryandphysicalexamination.Riskfactorsassociatedwithmalignancyincludepriorchildhoodheadandneckirradiation,familyhistoryofthyroidcarcinoma,rapidnodulegrowth,hoarseness,andcervicallymphadenopathy.中文：初步评估应从详尽的病史采集和体格检查开始。与恶性风险相关的因素包括：儿童期头颈部放射史、家族性甲状腺癌病史、结节快速生长、声音嘶哑以及颈部淋巴结肿大等。English:Physicalexaminationshouldfocusonpalpationofthethyroidglandandcervicallymphnodes,notingfixation,tenderness,orinvasionintoadjacentstructuressuchasthetracheaorstrapmuscles.中文：体格检查应重点触诊甲状腺及颈部淋巴结，注意结节是否固定、是否有压痛，以及有无侵犯气管或颈前肌群等邻近结构的迹象。UltrasoundEvaluation超声检查English:High-resolutionneckultrasonographyistheprimaryimagingmodalityforevaluatingthyroidnodules.Itprovidesinformationonnodulesize,composition,echogenicity,margincharacteristics,presenceofcalcifications,andvascularity.中文：高分辨率颈部超声是评估甲状腺结节的首选影像学手段。超声可提供结节大小、内部成分、回声特征、边缘形态、钙化情况及血流分布等信息。English:Suspicioussonographicfeaturesincludemarkedhypoechogenicity,irregularmargins,microcalcifications,taller-than-wideshape,andevidenceofextrathyroidalextension.中文：可疑的超声特征包括：显著低回声、不规则边缘、微钙化、纵径大于横径的形态（高宽比＞1）、以及超出甲状腺包膜的侵犯征象。English:TheATAultrasoundriskstratificationsystemcategorizesnodulesasbenign,verylow,low,intermediate,orhighsuspicionbasedontheirappearance,withcorrespondingrecommendationsforfine-needleaspiration(FNA).中文：ATA超声风险分层系统根据结节影像学特征将其分为良性、极低风险、低风险、中等风险和高风险五类，并为每一类提供相应的细针穿刺（FNA）建议。Fine-NeedleAspiration(FNA)细针穿刺活检English:FNAremainsthegoldstandardforcytologicdiagnosisofthyroidnodules.ThedecisiontoperformFNAisbasedonnodulesizeandsonographicriskcategory.中文：细针穿刺活检（FNA）仍是甲状腺结节细胞学诊断的金标准。是否行FNA取决于结节大小及其在超声中的风险分级。English:Accordingtothe2025ATAguidelines,FNAisgenerallyrecommendedfor:Nodules≥1cmwithhighorintermediatesuspicionpatterns.Nodules≥1.5cmwithlowsuspicionpatterns.Nodules≥2cmwithverylowsuspicionpatterns,ifobservationisnotchosen.中文：根据2025年ATA指南，FNA一般建议用于：直径≥1cm且超声表现为高或中等可疑的结节；直径≥1.5cm且为低可疑模式的结节；直径≥2cm且为极低可疑模式的结节（若未选择观察随访）。English:Nodules<1cmaretypicallynotbiopsiedunlessthereisevidenceofsuspiciouslymphnodesorlocalinvasion.中文：直径小于1cm的结节通常不建议穿刺，除非伴有可疑淋巴结或局部侵犯征象。CytologyandBethesdaSystem细胞学与Bethesda分类系统English:CytologicresultsshouldbereportedusingtheBethesdaSystemforReportingThyroidCytopathology(BSRTC),whichclassifiesspecimensintosixdiagnosticcategorieswithassociatedmalignancyrisks.中文：细胞学结果应采用

Bethesda甲状腺细胞病理报告系统（BSRTC）

进行分级。该系统将标本分为六个诊断类别，并对应相应的恶性风险。English:The2025guidelinesreaffirmtheuseofBSRTCbutnotethatintegrationofmoleculartestingcanrefinethemanagementofindeterminatecategories(IIIandIV).中文：2025年版指南继续推荐使用Bethesda系统，同时指出可通过整合分子检测进一步优化对不确定类别（III、IV类）的管理决策。MolecularTesting分子检测English:Moleculartestingevaluatesgeneticalterationsassociatedwiththyroidmalignancy,includingpointmutations(BRAF,RAS),genefusions(RET/PTC,PAX8/PPARγ),andothermolecularsignatures.中文：分子检测用于识别与甲状腺恶性肿瘤相关的基因变异，包括点突变（如BRAF、RAS）、基因融合（如RET/PTC、PAX8/PPARγ）及其他分子特征。English:Innoduleswithindeterminatecytology,thepresenceofhigh-riskmutations(e.g.,BRAFV600E,RET/PTCfusion)supportsasurgicalapproach,whileabsenceofsuchfindingsmayfavorsurveillance.中文：对于细胞学结果不确定的结节，若检测到高风险突变（如BRAFV600E、RET/PTC融合），可倾向于手术治疗；若未检测到此类变异，则更倾向于观察随访。HistopathologicDiagnosis组织病理诊断English:DefinitivediagnosisofDTCisestablishedbyhistopathologicexaminationaftersurgery.Subtypesincludepapillarythyroidcarcinoma(PTC),follicularthyroidcarcinoma(FTC),andoncocytic(Hürthlecell)carcinoma.中文：DTC的最终确诊依赖于术后组织病理学检查。其主要亚型包括：乳头状甲状腺癌（PTC）、滤泡状甲状腺癌（FTC）及嗜酸细胞型（Hürthle细胞）癌。English:Certainvariants,suchastallcell,columnarcell,andhobnailvariantsofPTC,areassociatedwithmoreaggressivebehaviorandshouldbespecificallyreported.中文：部分乳头状癌变异型，如高柱状细胞型、柱状细胞型及钉突细胞型（hobnailvariant），通常具有更高的侵袭性，应在病理报告中明确标注。English:Conversely,noninvasivefollicularthyroidneoplasmwithpapillary-likenuclearfeatures(NIFTP)isnolongerclassifiedascarcinomaduetoitsindolentcourseandexcellentprognosis.中文：相反，具有乳头状核特征的非侵袭性滤泡性甲状腺肿瘤（NIFTP）由于其惰性生长及极佳预后，现已不再归类为癌。InitialRiskStratificationandStaging初始风险分层与分期English:Followingdefinitivediagnosisofdifferentiatedthyroidcancer(DTC),initialriskstratificationisessentialforguidingmanagementdecisions,includingtheextentofsurgery,useofradioactiveiodine(RAI),TSHsuppressiontargets,andfollow-upintensity.中文：在确诊分化型甲状腺癌（DTC）后，进行初始风险分层至关重要。这一步有助于指导后续管理决策，包括手术范围、是否行放射性碘（RAI）治疗、TSH抑制目标以及随访强度。1.TNMStaging(AJCC8thEdition)TNM分期（AJCC第8版）English:TheAmericanJointCommitteeonCancer(AJCC)8theditionstagingsystemremainsthestandardforprognosticclassificationofDTC.Itisbasedontumorsize(T),nodalinvolvement(N),anddistantmetastasis(M),withageservingasakeyprognosticmodifier.中文：美国癌症联合委员会（AJCC）第8版TNM分期系统仍是DTC预后评估的标准。其基于肿瘤大小（T）、淋巴结受累情况（N）和远处转移（M）进行分级，同时将患者年龄作为重要的预后修正因素。English:IntheAJCC8thedition,theagecutoffwasraisedfrom45to55years.Patientsunder55yearsareclassifiedasstageI(nodistantmetastasis)orstageII(withmetastasis),regardlessofTorNstage.中文：在AJCC第8版中，年龄分界点由45岁上调至55岁。对于年龄小于55岁的患者，无论肿瘤T或N分期如何，只要无远处转移则归为Ⅰ期，若有远处转移则为Ⅱ期。English:Forpatients≥55years,stagingfollowsconventionalTNMcombinations,withdisease-specificsurvivaldecliningprogressivelyfromstageItostageIV.中文：而对于≥55岁的患者，分期则依据传统TNM组合进行，疾病特异性生存率随着分期的升高（I至IV期）逐步下降。2.ATAInitialRiskStratificationATA初始风险分层English:TheATAinitialriskstratificationsystemcomplementsTNMstagingbyfocusingontheriskof

structuraldiseaserecurrence

ratherthanmortality.中文：ATA初始风险分层系统是对TNM分期的补充，其重点在于预测结构性复发风险，而非仅关注死亡率。English:Patientsarecategorizedintothreemaingroups:LowRisk:

Intrathyroidaltumorswithoutaggressivehistologyorvascularinvasion,andnoevidenceofresidualdisease.IntermediateRisk:

Microscopicextrathyroidalextension,vascularinvasion,ormetastasestosmall-volumecervicallymphnodes(<3cm).HighRisk:

Grossextrathyroidalextension,incompletetumorresection,ordistantmetastases.中文：患者分为三大类：低风险组：

肿瘤局限于甲状腺内，无侵袭性组织学类型或血管侵犯，且无残余病灶。中风险组：

存在显微镜下包膜外侵犯、血管侵犯，或颈部小体积淋巴结转移（<3cm）。高风险组：

出现明显包膜外侵犯、肿瘤切除不全或远处转移。English:TheATAsystemenablesclinicianstotailortheintensityofinitialtreatmentandfollow-upaccordingtorecurrencerisk,minimizingovertreatmentinlow-riskcases.中文：ATA分层体系使临床医生能够根据复发风险调整初始治疗与随访强度，从而减少低风险患者的过度治疗。3.IntegrationofMolecularMarkers分子标志物的整合应用English:Molecula