• <tr id="yyy80"></tr>
  • <sup id="yyy80"></sup>
  • <tfoot id="yyy80"><noscript id="yyy80"></noscript></tfoot>
  • 99热精品在线国产_美女午夜性视频免费_国产精品国产高清国产av_av欧美777_自拍偷自拍亚洲精品老妇_亚洲熟女精品中文字幕_www日本黄色视频网_国产精品野战在线观看 ?

    2017 Chinese expert consensus on the clinical application of serum marker for thyroid cancer

    2018-12-07 06:21:42MingGaoMinghuaGeQinghaiJiRuochuanChengHankuiLuHaixiaGuanWeiCuiLiGaoZairongGaoLinGuo0ZhumingGuoTaoHuangXiaomingHuangYansongLinQinjiangLiuXinNiJianwuQinLiRenZhongyanShanHuiSunXudongWangZhengangXu0YangYuBinZhang
    Cancer Biology & Medicine 2018年4期

    Ming Gao, Minghua Ge, Qinghai Ji, Ruochuan Cheng, Hankui Lu, Haixia Guan, Wei Cui, Li Gao, Zairong Gao, Lin Guo0, Zhuming Guo, Tao Huang, Xiaoming Huang, Yansong Lin, Qinjiang Liu, Xin Ni, Jianwu Qin, Li Ren, Zhongyan Shan, Hui Sun, Xudong Wang, Zhengang Xu0, Yang Yu, Bin Zhang, Daiwei Zhao, Ying Zheng, Jingqiang Zhu, Xiangqian Zheng, Chinese Association of Thyroid Oncology (CATO),China Anti-Cancer Association

    1Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin’s Clinical Research Center for Cancer,Tianjin 300060, China; 2Department of Head and Neck, Zhejiang Cancer Hospital, Hangzhou 310022, China; 3Department of Head and Neck Tumor, Fudan University Shanghai Cancer Center, Shanghai 200433, China; 4Department of General Surgery,First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; 5Department of Nuclear Medicine, The Sixth Affiliated Hospital of Shanghai Jiao Tong University, Shanghai 200025, China; 6Department of Endocrinology, The First Hospital of China Medical University, Shenyang 110001, China; 7Department of Clinical Laboratory, Cancer Hospital Chinese Academy of Medical Science, Beijing 100021, China; 8Department of Head and Neck, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, China; 9Department of Nuclear Medicine, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China; 10Department of Clinical Laboratory, Fudan University Shanghai Cancer Center, Shanghai 200433, China; 11Sun Yat-sen University Cancer Center, Guangzhou 510060,China; 12Department of Thyroid and Breast, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China; 13Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; 14Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing 100730, China; 15Department of Head and Neck, Gansu Provincial Cancer Hospital, Lanzhou 730050, China; 16Department of Head and Neck, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China; 17Department of Thyroid, Head and Neck, Henan Cancer Hospital, Zhengzhou 450008, China; 18Department of Clinical Laboratory, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China; 19Department of Thyroid, Sino Japanese Union Hospital of Jilin University, Changchun 130033, China; 20Department of Head and Neck, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China; 21Department of Head and Neck, Peking Union Medical College Hospital, Beijing 100730, China; 22Department of General Surgery, The Second Affiliated Hospital of Guizhou Medical University, Kaili 556099, China; 23Department of Head and Neck, Jilin Tumor Hospital, Changchun 130012, China;24Department of Thyroid and Breast, West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610047, China

    In recent years, the clinical incidence of thyroid cancer has been increasing year by year, and its risk assessment and clinical management methods have also been accordingly modified and constantly improved. There are great differences between the clinical diagnostic and therapeutic modes and disease management of thyroid cancer employed by various medical institutions in China, particularly with regard to the clinical application of serum marker of thyroid cancer. To this end, the China Anti-Cancer Association Thyroid Cancer Specialized Committee Chinese Association of Thyroid Oncology organized this compilation of Expert Consensus on Clinical Application of Serum Marker of Thyroid Cancer to help and impel relevant clinical institutions and professionals to standardize clinical diagnosis, treatment, and long-term management of thyroid cancer, and to properly utilize the serum marker for scientific auxiliary clinical diagnosis and assessment of thyroid cancer before and after operation. A total of 14 recommendations have been put forward in this consensus for measuring the levels of serum marker of thyroid cancer. In view of the limited references,especially regarding the perspective data currently available at home and abroad, omissions are inevitable. Moreover, we also hope that the professionals can give more valuable suggestions for regular revision in the future (see categories of recommendations in Table 1 and detailed recommendations in Table 2).

    Criteria for setting of recommendation grade

    The recommendations on the clinical application of serum marker of thyroid cancer in Expert Consensus are based on evidence-based medicine and expert opinions, and the categories of recommendations are as follows:

    For the clinical laboratory test of serum marker of thyroid cancer, immunological test methods are more commonly used at present, including methods used for estimating levels of thyroglobulin (Tg) and calcitonin (Ctn). Ctn is the serum marker of medullary thyroid carcinoma (MTC), and Tg can be used as the serum marker of differentiated thyroid carcinoma (DTC). Anti-thyroglobulin antibody (TgAb) is the autoimmune antibody generated against Tg, and the existence of serum TgAb and the quantitative changes associated with it have a direct impact on the measurement of the serum Tg value. The carcinoembryonic antigen (CEA)is associated with diagnosis and clinical progress in some patients with MTC, and it can be used as a serum marker for MTC along with Ctn.

    DTC

    Preoperative serological test and assessment of DTC

    Recommendation 1: For all patients with thyroid cancer considered for operative treatment, thyroid function including serum thyroid-stimulating hormone level shall be tested before the operation (grade of recommendation: A).For all patients with thyroid tumor considered for operative treatment, thyroid function, including the level of thyroidstimulating hormone (TSH), shall be tested. Assessing thyroid function can help surgeons and anesthetists to judge the safety in operative treatment of patients, and preoperative thyroid function shall be routinely tested. For patients with abnormal thyroid function, medical treatment shall be appropriately performed to ensure that the thyroid function is within the acceptable range for surgery. A previous study1showed that the incidence of malignant nodules in patients with thyroid tumor and TSH level below the normal range is lower than that in patients with normal or elevated TSH level. Therefore, to some extent, TSH level serves as a meaningful reference for malignant tumor assessment, and it is routinely recommended to measure it.

    Recommendation 2: It is not recommended to use Tg for diagnosis and differentiation of benign and malignant thyroid tumor (grade of recommendation: E).

    Tg is the specific protein generated by thyroid and secreted by the thyroid follicular epithelial cells. Many thyroid diseases can cause the elevation of serum Tg level, including DTC, goiter, thyroiditis, thyroid injury, hyperthyroidism, etc.At present, the detection reagents are unable to distinguish“tumor-induced” Tg from the “normal tissue-derived.”Therefore, serum Tg cannot be used to distinguish the difference between benign and malignant thyroid tumor2-4.

    Recommendation 3: Tg and TgAb levels can be tested routinely before operation of thyroid cancer, and it is recommended to simultaneously test both for assessment of the initial clinical state and serological index baseline(grade of recommendation: A).

    High level of preoperative serum Tg suggests its better sensitivity in postoperative monitoring, and preoperative measurements of Tg and TgAb baseline values can theoretically assess the reliability of Tg and TgAb tests in postoperative assessment. Trumboli et al.5conducted a largesample analysis on serum Tg levels in patients with thyroid nodules and indicated that the preoperative serum Tg level can be taken as an index for assessment of the initial clinical state of thyroid cancer and should be routinely tested before operation. The expert group recommends that a simultaneous test of Tg and TgAb levels should be conducted for an assessment of the initial clinical state and serological index baseline.

    Table 1 Categories of recommendations

    Table 2 Recommendations

    Marker measurements in washout fluid from preoperative fine needle aspiration (FNA) of lymph nodes of DTC

    Recommendation 4: If suspected metastatic lymph nodes are observed in preoperative neck examination of DTC,measurement of Tg level in FNA washout fluid can be optionally used as an auxiliary method to evaluate metastatic lymph nodes (grade of recommendation: B).

    Cervical lymph node metastasis is commonly observed in DTC. Ultrasonography and CT are commonly used to assess the cervical lymph node metastasis, but they have limitations.For a few suspicious metastatic lymph nodes undetermined in imaging examination, ultrasound-guided FNA pathology diagnosis and/or Tg measurement in washout fluid can be used as auxiliary diagnostic methods6-7. If the evidence for assessment of lymph node cytology is insufficient or if the cytological findings are not in consensus with the imaging findings, measurement of Tg values in washout fluid must be performed. A study showed that the sensitivity, specificity,and accuracy of FNA combined with Tg measurement in washout fluid were 87.0%, 100%, and 92.2%, respectively8-10.Therefore, the measurement of Tg value in FNA washout fluid can be used as an auxiliary method to determine the lymphatic metastasis. However, a minority of false-positive results may occur, particularly during evaluation of central compartment lymph nodes in the presence of thyroid11-12.

    As normal saline does not contain Tg and is the most commonly used solution in clinical practice, puncture needles must be washed with normal saline and dilute into washout fluid. A study showed that the FNA-Tg levels in serum separation tubes (pro-coagulation tubes) and heparin anti-coagulation tubes significantly decreased compared with those in common serum tubes. Therefore, a common serum tube is recommended to be used in the collection of FNA washout fluid. The requirements for lymph node FNA-Tg detection reagents are in accordance with those for serum Tg detection reagent. Meanwhile, reagents with high sensitivity shall be used to ensure that the little amount of Tg in washout fluid can be detected.

    Serological test in DTC postoperative assessment and follow-up

    Recommendation 5: Tg and TgAb should be routinely tested after total thyroidectomy of DTC, using the same manufacturer’s reagents, and should be evaluated serially over time at various time points during follow-up for continuous assessment of postoperative recurrence risk and treatment response (grade of recommendation: A).

    Serum Tg can be a tumor maker of DTC after total thyroidectomy (particularly after the treatment with radioactive iodine ablation), and its level has a positive correlation with tumor burden in DTC patients, which can be used as a clinical marker for assessment of tumor recurrence and metastasis. However, as the serological Tg test is affected by TgAb level in the body, clinical studies in different populations and with test assays showed that positive TgAb can be found in 25%–30% of DTC patients in the first diagnosis13. To accurately evaluate, TgAb shall be routinely measured along with serum Tg. The fist measurement shall be generally conducted within 3–4 weeks after operation or ablation, and the expert group recommends to continuously measure Tg and TgAb for assessment of postoperative recurrence risk and treatment response based on the trend in changing values.

    DTC treatment responses are as follows: 1) excellent response: no disease-related evidence, including no clinical and biochemical indexes or structural-related evidence; 2)biochemical incomplete response: continuous elevation of serum Tg or TgAb, without evidence of local lesion; 3)structural incomplete response: continuous or new local/distant metastasis; 4) indeterminate response: no specific biochemical or structural abnormality or unable to confirm whether the lesion is benign or malignant. Patients may have stable or decreased TgAb value, without relevant evidence to prove the existence of the lesion.

    Recurrence risk of DTC and disease-related mortality can change at any time under the impact of clinical disease course and treatment response. Therefore, the initial recurrence risk stratification cannot remain stubbornly unchanged and shall be continuously amended during follow-up14. See Tables 3 and 4 for the summary for dynamic risk stratification with total thyroidectomy15.

    Recommendation 6: Unstimulated Tg and TgAb test results can be taken as the baseline values for treatment response assessment after thyroid lobectomy of DTC, and further examination shall be performed to confirm whether there is recurrence and metastasis if Tg level continuously elevates (grade of recommendation: B).

    After thyroid lobectomy of DTC, accurately assessing the cutoff value of serum Tg level for treatment response has no clear definition. However, the results of unstimulated serum Tg test performed 1 month after operation can be considered as the baseline Tg value for long-term follow-up anddynamic risk assessment of patients according to the present available data16,17. For patients with continuous elevation in unstimulated serum Tg level, clinically visible lesions mostly exist, and further imaging examination is recommended to confirm lesions18. A stable or declined unstimulated serum Tg value is a good predictive index for “disease-free status”with a predicating accuracy up to above 80%19. See Table 5 for the dynamic risk stratification with thyroid lobectomy of DTC15.

    Table 3 Dynamic risk stratification in DTC patients with total thyroidectomy and radioiodine remnant ablation15

    Table 4 Dynamic risk stratification in DTC patients with total thyroidectomy only15

    Along with the update on Tg detection reagents20, the detection sensitivity, and sensitivity and precision in low concentration range of highly sensitive Tg (functional sensitivity less than 0.1 ng/mL) have greatly improved. With the emergence of highly sensitive Tg test, the “TSH-stimulated Tg level” might no longer be used for routine assessment of “excellent response” in DTC patients who underwent total thyroidectomy. Suppressed Tg level test is effective in monitoring the postoperative remission of diseases16.

    Recommendation 7: It is recommended to frequently measure serum Tg and TgAb after surgery and assess the dynamic risk stratification to guide the adjustment of DTC follow-up scheme and treatment decisions (grade of recommendation: A).

    After total thyroidectomy, Tg level in most patients with DTC reaches the lowest concentration 1 month after operation20-21. As the postoperative early assessment indexes and important predictive factors, serum Tg and TgAb values can be used to guide the selection of clinical treatment regimen. The major guidance is listed below:

    1) Excellent response: The follow-up intensity and frequency shall be decreased, and the goal of TSH suppressive treatment shall be broadened (lower limit of normal: 2.0 mU/L). Definition of low-risk patients with treatment of total thyroidectomy is to have a postoperative stimulated or suppressed Tg of less than 1 ng/mL, whose prognosis is reliable. Intermediate-risk patients are to have postoperative Tg of less than 1 ng/mL, whose prognosis is reliable with a possibility of micrometastasis. For low-risk and intermediaterisk patients without radioactive iodine treatment,postoperative unstimulated Tg of less than 1 ng/mL indicates favorable treatment response, and the recurrence risk is less than 1%22.

    Table 5 Dynamic risk stratification in DTC patients with thyroid lobectomy only15

    2) Biochemical incomplete response: If Tg value is stable or gradually declining, most patients can be continuously observed on the premise of constant TSH suppressive treatment (lower limit of normal: 0.1 mU/L), and it is not recommended to immediately perform exploratory/preventive operation or radioactive iodine treatment. An elevated Tg or TgAb level is associated with risk for recurrence; because of this, the follow-up frequency might increase, other examinations might be conducted, or other possible treatments might be given. After total thyroidectomy, suppressed or stimulated Tg of 5–10 ng/mL23-26indicates a higher probability of positive imaging on radioactive iodine scan and confirmation of local or distant metastasis. If postoperative Tg is more than 10 ng/mL, other assessments and treatments are probably required. However, Tg may also be very low or undetectable once the tumor becomes undifferentiated or dedifferentiated.

    3) Structural incomplete response: Imaging examination shows that the diseases persistently exist or recur with Tg of more than 10–30 ng/mL after total thyroidectomy, which mostly occurs in patients with failed initial ablation who have local or distant metastasis. Incomplete structure response can cause an increase in mortality27-28. Therefore,multidisciplinary diagnosis and treatment shall be recommended.

    4) Indeterminate response: The goal of TSH suppressive treatment is slightly broadened (lower limit of normal: 1.0 mU/L), and treatment response classification can be reassessed based on the results of imaging examinations and serum Tg/TgAb tests. The initial examination frequency of imaging and serum Tg/TgAb is 1–2 times per year, and the interval can be appropriately prolonged if the condition is stable.

    Recommendation 8: For DTC patients with positive TgAb, postoperative disease states shall be continuously assessed by measuring the variation tendency of serum TgAb levels (grade of recommendation: C).

    Positive TgAb on immunological detection usually means that serum TgAb value is greater than the upper limit of normal reference range of population. However, for postoperative patients with DTC, some scholars think that it is more appropriate to select the lower limit of detection of TgAb as the positive cutoff value of interfering TgAb29-30. For DTC patients who are TgAb positive preoperatively, TgAb value must be monitored during follow-up. As a surrogate indicator, the trend of TgAb is more important than the numerical value. Decreasing serum TgAb level indicates that the disease remits. Conversely, disease recurrence shall be suspected with a continuous increase in serum TgAb levels.Patients with stable serum TgAb shall be diagnosed as indetermination. For follow-up recommendations on DTC patients with positive TgAb after total thyroidectomy, see Figure 130.

    MTC

    Postoperative serological test and assessment of MTC

    Recommendation 9: For patients suspected of malignant thyroid tumor, serum Ctn shall be routinely tested before operation to identify and screen for MTC. For patients with elevated Ctn or considered for MTC, CEA shall also be tested (grade of recommendation: B).

    A series of prospective non-randomized studies have assessed the utility of Ctn and proved that routine serum Ctn screening can discover early C-cell hyperplasia and MTC, so as to improve the detectable rate and overall survival rate of MTC31-35. The American Thyroid Association maintains a neutral attitude to Ctn screening28but still accepts that Ctn screening is of significant value in some patient subgroups.The consensus recommends that preoperative Ctn test should be routinely performed on patients suspected of having malignant thyroid tumor.

    Meanwhile, the expert group suggests that basal values of serum Ctn and CEA should be simultaneously tested if MTC is considered clinically. The serum Ctn value in a few MTC patients may be in normal range, and significant elevation in serum CEA but relative reduction in Ctn may occur in some patients with advanced MTC; some scholars think that patients with poorly differentiated MTC may either have normal serum Ctn and CEA levels or experience a simultaneous decline in serum Ctn and CEA levels36.Therefore, for judgment and assessment of MTC, clinicians should fully analyze the clinical and pathological results in addition to serum Ctn and CEA as reference.

    Recommendation 10: Elevated serum Ctn value can reflect tumor burden in patients with MTC and can be taken as a strong evidence to guide clinical assessment of MTC (grade of recommendation: A).

    Figure 1 Treatment and follow-up flow chart of patients with differentiated thyroid cancer who have positive TgAb WBS: whole body scintiscanning; LT4: levothyroxine; TSH: thyroid stimulating hormone; FT3: free triiodothyronine; FT4: free thyroxine; TgAb: antithyroglobulin antibody; Tg: thyroglobulin; dxWBS: whole body imaging of diagnostic radioactive iodine; PET/CT: positron emission tomography/computed X-ray tomography.

    MTC is characterized by high malignancy, commonly with lymph node metastasis and distant metastasis. Primary and metastatic tumor burden of MTC co-determine and is positively correlated with serum Ctn level. Clinicians can perform a clinical assessment of MTC based on the level of serum Ctn. A study showed that the risk of lymph node metastasis increased when serum Ctn value is more than 20 pg/mL, and the possibility of distant metastasis increased when serum Ctn value is more than 500 pg/mL37. For patients with preoperative serum Ctn value less than 10 pg/mL, “biochemical cure” can be achieved after treatment with complete lymphadenectomy, and postoperative 10-year survival rate is 97.7%38.

    Recommendation 11: Patients diagnosed with MTC shall be mainly treated with total thyroidectomy, and cervical lymph node metastasis and extent of dissection shall be preliminarily evaluated using imaging studies and serum Ctn value (grade of recommendation: B).

    The incidence of lymph node metastasis in MTC patients is high, about 70%–90%, and the lymph node metastasis’behavior is associated with the size and location of primary tumor39,40. Necessary lymph node dissection is required during initial thyroidectomy, and comprehensive assessment shall be conducted on the probability of cervical lymph node metastasis based on the location and size of primary MTC lesion and serum Ctn values. Imaging studies are routine methods employed to assess whether the lymph nodes have metastasis, and preoperative serum Ctn values can also effectively assist in determining the extent of lymph node metastasis. Previous studies showed41,42that it is generally indicated that suspicious lymph nodes had metastasized to the ipsilateral central zone and ipsilateral lateral neck zone,contralateral central zone, and contralateral lateral neck zone and superior mediastinum zone when the serum Ctn values are more than 50, 200, and 500 pg/mL, respectively.

    Recommendation 12: For carriers with hereditary MTC(HMTC) family mutation gene, serum Ctn can be monitored regularly from infancy, which helps discover the changes in disease status early and determine whether operative treatment shall be performed discretionarily according to the patient’s condition (grade of recommendation: B).

    At present, it is recommended in all guidelines at home and abroad that the carriers with HMTC family mutation genes should undergo total thyroidectomy. Due to limited knowledge, most of patients’ family members in China refuse to undergo preventive surgery, while the clinicians shall fully inform them of the serious condition, closely monitor with imaging, and follow up the changes in Ctn.

    In principle, for patients with asymptomatic multiple endocrine neoplasia 2A and familial MTC above 5 years old,and patients with asymptomatic multiple endocrine neoplasia 2B above 1 year old, thorough operative treatment shall be carried out if basal serum Ctn value is more than 40 pg/mL. For adolescent HMTC patients with RET mutation genes and serum Ctn less than 30 pg/mL, preventive thyroidectomy shall be carried out. For patients with serum Ctn value higher than threshold value (10 pg/mL), close follow-up will be the best choice, and preventive thyroidectomy can also be considered43-44. It must be carefully decided whether young infants should undergo surgery or not because they can have elevated serum calcitonin levels and yet still normal for their age group45.

    Intraoperative serological test in MTC

    Recommendation 13: For patients with MTC, it is not recommended to test serum Ctn and CEA during operation to assess the thoroughness of excision (grade of recommendation: F).

    Ctn and parathyroid hormone (PTH) co-participate in the regulation of calcium in the body and maintain stability of calcium metabolism. The half-life of Ctn is more than 1 h,mainly undergoing degradation and excretion from the kidney. However, the half-life of its precursor serum procalcitonin in human body is about 20–24 hours with good stability, continuously forming calcitonin. For patients with high level of preoperative Ctn, the intraoperative Ctn value after tumor resection cannot immediately reflect the thoroughness of operative excision. Similarly, serum CEA is mainly eliminated by Kupffer cells and liver cells with a halflife of 1–7 days. However, depending on liver function, the half-life of serum CEA is prolonged in cholestasis and hepatocellular diseases. Therefore, it is not recommended to routinely test serum Ctn and CEA levels after tumor resection during operation.

    Serology-assisted postoperative management of MTC

    Recommendation 14: Ctn and CEA levels can be considered as important monitoring indexes of postoperative management and prognostic prediction of MTC (grade of recommendation: A).

    Postoperative serum Ctn test can be used to assess the effect of operative treatment in MTC patients, and the normalization of postoperative serum Ctn usually indicates favorable outcome. A previous study showed that serum Ctn value would be even lower than the lower limit of detection after total resection of thyroid tissues46. In view of half-life of Ctn, regarding its metabolism and other factors, it is generally suggested that the optimal time for test of postoperative Ctn minimum value be 3 months after the operation47. However, considering the different tumor burden in various patients, the test time of postoperative serum Ctn and CEA can be 1 week, 1 month, 3 months, and half a year. Regular postoperative re-examination shall be carried out if test values are less than the lower limit of detection or the normal reference range. Initial reexamination period is half a year and can be gradually prolonged to once per year if the condition is stable.

    A study of postoperative long-term observation and follow-up of MTC demonstrated that48the 3-year and 5-year survival rates were 94% and 90%, respectively, if postoperative serum Ctn value was less than 10 pg/mL.Moreover, the 3-year and 5-year survival rates were reduced to 78% and 61%, respectively, if postoperative serum Ctn value was more than 10 pg/mL. If patients exhibit abnormal postoperative basal serum Ctn values after total thyroidectomy, this might indicate the presence of residual lymph nodes or lesions, or that recurrence risk may exist,even if serum Ctn value is less than 150 pg/mL. Therefore,the expert group recommends that neck ultrasound examination shall be performed if postoperative serum Ctn level increases but is less than 150 pg/mL, and Ctn, CEA, and neck ultrasound shall be repeated semiannually for monitoring if test results are negative. If postoperative serum Ctn value is more than 150 pg/mL, neck ultrasound, chest and abdomen CT/MRI, and whole body bone examination must be carried out, and PET/CT examination should be performed when necessary, in order to discover the lesions early.

    Prospect

    Continuous exploration of new methods and new markers for laboratory diagnosis of thyroid cancer: We hope that more molecular makers are used for diagnosis, prognosis assessment, and confirmation of therapeutic targets.

    How to use Tg to assess the treatment response in patients without total thyroidectomy: For patients without total thyroidectomy, serum Tg level is greatly affected and assessment of treatment response cannot entirely rely on it,and new markers or new methods might be used for followup in patients who did not undergo total thyroidectomy.

    Exploration of serum Ctn value in evaluating efficacy of targeted drug treatment of MTC: Serum Ctn levels in MTC patients can greatly reduce after receiving some drug therapies, while those declines have no significant correlation with the changes in tumor size and regression; hence, further studies are needed to verify the feasibility of using serum Ctn as a reliable index for drug effect assessment.

    Exploration of optimum clinical cutoff value of serum markers of thyroid cancer to achieve the optimal clinical specificity and sensitivity: Along with the continuous development of test methodology, the accuracy of reagents constantly improves, and more studies are needed to find the optimal cutoff value and apply that to clinical practice in future, so as to enhance the predictive value in the assessment of tumor stage and tumor recurrence.

    Acknowledgements

    This article was published originally in Chinese Journal of Clinical Oncology 2017; 48: 7-13 (in Chinese).

    Conflict of interest statement

    No potential conflicts of interest are disclosed.

    亚洲欧美精品综合久久99| 可以免费在线观看a视频的电影网站| 十八禁人妻一区二区| 夜夜爽天天搞| 精品免费久久久久久久清纯| 久久久久久大精品| 欧美成人性av电影在线观看| 69av精品久久久久久| 成人三级黄色视频| 欧美一级a爱片免费观看看 | 欧美色欧美亚洲另类二区| 亚洲精品美女久久久久99蜜臀| av免费在线观看网站| 亚洲精品国产一区二区精华液| 搡老妇女老女人老熟妇| 无遮挡黄片免费观看| 韩国av一区二区三区四区| 免费在线观看亚洲国产| 1024视频免费在线观看| 天堂√8在线中文| 欧美av亚洲av综合av国产av| 757午夜福利合集在线观看| 精品第一国产精品| 黄色片一级片一级黄色片| 国内毛片毛片毛片毛片毛片| 国产精品久久久久久精品电影| 亚洲精品中文字幕在线视频| 精品高清国产在线一区| 亚洲精品国产一区二区精华液| 亚洲一卡2卡3卡4卡5卡精品中文| 一个人免费在线观看电影 | 国产精品香港三级国产av潘金莲| 国产午夜福利久久久久久| 国产伦一二天堂av在线观看| 精品久久久久久久久久久久久| 亚洲人成伊人成综合网2020| 国产精品 国内视频| 90打野战视频偷拍视频| 国产主播在线观看一区二区| ponron亚洲| 白带黄色成豆腐渣| 麻豆一二三区av精品| 一卡2卡三卡四卡精品乱码亚洲| 一级作爱视频免费观看| 成人午夜高清在线视频| 天堂√8在线中文| 日本 av在线| 日韩精品青青久久久久久| 精品少妇一区二区三区视频日本电影| 国产成人精品久久二区二区免费| 午夜成年电影在线免费观看| 免费在线观看日本一区| 热99re8久久精品国产| 免费搜索国产男女视频| 亚洲精品国产精品久久久不卡| 久久人人精品亚洲av| 国产午夜福利久久久久久| 亚洲专区字幕在线| 淫妇啪啪啪对白视频| 婷婷丁香在线五月| 别揉我奶头~嗯~啊~动态视频| 亚洲aⅴ乱码一区二区在线播放 | xxx96com| 欧美成人免费av一区二区三区| 日韩有码中文字幕| 18美女黄网站色大片免费观看| 免费看美女性在线毛片视频| 一个人观看的视频www高清免费观看 | 国产精品久久视频播放| 香蕉丝袜av| 人成视频在线观看免费观看| 亚洲激情在线av| 欧美av亚洲av综合av国产av| 91字幕亚洲| 国产精品久久久久久久电影 | 久久精品国产亚洲av高清一级| 99精品欧美一区二区三区四区| 国产在线观看jvid| 久久久久亚洲av毛片大全| 在线观看www视频免费| 不卡av一区二区三区| 久久国产精品人妻蜜桃| 成年女人毛片免费观看观看9| 国产成人aa在线观看| 国产成人影院久久av| 亚洲精品中文字幕一二三四区| 国产三级黄色录像| 又紧又爽又黄一区二区| 亚洲一区二区三区色噜噜| 国产精品久久久久久亚洲av鲁大| 在线观看www视频免费| 欧美日韩瑟瑟在线播放| 看免费av毛片| 精品久久久久久成人av| 99久久国产精品久久久| 嫁个100分男人电影在线观看| 日日干狠狠操夜夜爽| 九九热线精品视视频播放| 美女免费视频网站| 亚洲一区二区三区不卡视频| 亚洲人成网站高清观看| 国产成人影院久久av| 九色成人免费人妻av| 亚洲国产高清在线一区二区三| 又黄又粗又硬又大视频| 亚洲欧美日韩高清在线视频| 日日爽夜夜爽网站| x7x7x7水蜜桃| 一级片免费观看大全| 麻豆国产97在线/欧美 | 琪琪午夜伦伦电影理论片6080| 国产一区在线观看成人免费| 妹子高潮喷水视频| 好看av亚洲va欧美ⅴa在| 成人18禁在线播放| 久久人妻av系列| 国产精品一区二区免费欧美| e午夜精品久久久久久久| 久久久久精品国产欧美久久久| 两个人看的免费小视频| 精品久久蜜臀av无| 午夜精品在线福利| 久久精品国产亚洲av高清一级| 中文字幕人妻丝袜一区二区| 美女大奶头视频| 一进一出抽搐gif免费好疼| 三级男女做爰猛烈吃奶摸视频| 韩国av一区二区三区四区| 亚洲欧美日韩高清在线视频| 国产单亲对白刺激| 欧美人与性动交α欧美精品济南到| 欧美日韩乱码在线| 亚洲18禁久久av| 97人妻精品一区二区三区麻豆| 亚洲国产高清在线一区二区三| 欧美日韩乱码在线| 无遮挡黄片免费观看| 成人av一区二区三区在线看| 国产精品久久久久久久电影 | 精品久久久久久久末码| 狠狠狠狠99中文字幕| 午夜亚洲福利在线播放| 俄罗斯特黄特色一大片| 九九热线精品视视频播放| av有码第一页| 欧美性猛交黑人性爽| 久久香蕉国产精品| 亚洲中文av在线| 国产欧美日韩精品亚洲av| 亚洲熟妇中文字幕五十中出| 亚洲精品色激情综合| 中文字幕人妻丝袜一区二区| 亚洲av美国av| www.999成人在线观看| 日本精品一区二区三区蜜桃| 午夜免费观看网址| 88av欧美| 18禁美女被吸乳视频| 美女大奶头视频| 亚洲欧美日韩无卡精品| 美女免费视频网站| 搡老岳熟女国产| 五月伊人婷婷丁香| 啦啦啦免费观看视频1| 国产精品香港三级国产av潘金莲| 午夜a级毛片| 欧美黑人精品巨大| 99re在线观看精品视频| 欧美黑人精品巨大| 久久精品国产清高在天天线| 国产精品久久久人人做人人爽| 久久精品国产清高在天天线| 99热只有精品国产| 亚洲18禁久久av| 国产亚洲欧美在线一区二区| 久久精品综合一区二区三区| 久久久精品欧美日韩精品| 99国产综合亚洲精品| 51午夜福利影视在线观看| 国产成人av教育| 高潮久久久久久久久久久不卡| 搞女人的毛片| 女人高潮潮喷娇喘18禁视频| 女生性感内裤真人,穿戴方法视频| 日韩精品青青久久久久久| 午夜视频精品福利| 亚洲色图av天堂| 中文亚洲av片在线观看爽| 亚洲电影在线观看av| 欧美+亚洲+日韩+国产| 亚洲欧美日韩无卡精品| 少妇被粗大的猛进出69影院| 五月玫瑰六月丁香| 舔av片在线| 国产成人精品无人区| 桃红色精品国产亚洲av| 操出白浆在线播放| 久久久久国产一级毛片高清牌| 日本一本二区三区精品| 亚洲av片天天在线观看| 欧美日韩瑟瑟在线播放| 一区二区三区激情视频| 亚洲全国av大片| 欧美av亚洲av综合av国产av| 亚洲激情在线av| 淫秽高清视频在线观看| videosex国产| 两个人视频免费观看高清| 国产精品久久视频播放| 别揉我奶头~嗯~啊~动态视频| 首页视频小说图片口味搜索| 高清在线国产一区| 亚洲av中文字字幕乱码综合| 在线十欧美十亚洲十日本专区| 全区人妻精品视频| 国内少妇人妻偷人精品xxx网站 | 国产99白浆流出| 午夜福利在线在线| 国产精品av视频在线免费观看| 波多野结衣高清作品| 丝袜美腿诱惑在线| 亚洲精品久久国产高清桃花| 三级毛片av免费| 国内久久婷婷六月综合欲色啪| 国产精品野战在线观看| 亚洲av五月六月丁香网| 亚洲av成人不卡在线观看播放网| 亚洲成人中文字幕在线播放| 美女黄网站色视频| 丝袜美腿诱惑在线| 禁无遮挡网站| 欧美一级毛片孕妇| 午夜精品一区二区三区免费看| 91九色精品人成在线观看| 久久香蕉精品热| 婷婷精品国产亚洲av在线| 久久亚洲真实| 久久九九热精品免费| 欧美黄色淫秽网站| 国产又黄又爽又无遮挡在线| 91九色精品人成在线观看| 小说图片视频综合网站| 午夜福利在线在线| 午夜免费观看网址| 极品教师在线免费播放| 成人手机av| www国产在线视频色| 免费在线观看日本一区| 国产精品亚洲美女久久久| 久久精品91蜜桃| 美女午夜性视频免费| 老汉色av国产亚洲站长工具| 成人午夜高清在线视频| 免费在线观看亚洲国产| 精品一区二区三区av网在线观看| 日韩欧美在线乱码| 精品国产亚洲在线| 午夜福利欧美成人| 久久久久久国产a免费观看| 久久精品国产亚洲av高清一级| 精品熟女少妇八av免费久了| 在线播放国产精品三级| 国产成+人综合+亚洲专区| 色哟哟哟哟哟哟| 天堂√8在线中文| a级毛片在线看网站| 一进一出抽搐动态| 级片在线观看| 国产成+人综合+亚洲专区| 三级国产精品欧美在线观看 | 国产高清视频在线播放一区| 日韩精品免费视频一区二区三区| 久久精品综合一区二区三区| 久久久久国内视频| 人妻久久中文字幕网| 久久 成人 亚洲| 777久久人妻少妇嫩草av网站| 国产精品影院久久| 深夜精品福利| 国产精品久久久久久人妻精品电影| 国产真实乱freesex| 午夜久久久久精精品| 99国产精品一区二区三区| 久久久久久九九精品二区国产 | 又爽又黄无遮挡网站| 日韩大尺度精品在线看网址| 成人高潮视频无遮挡免费网站| 伊人久久大香线蕉亚洲五| 美女黄网站色视频| 欧美zozozo另类| www国产在线视频色| 久久久久久久久中文| 免费在线观看影片大全网站| 国产精品久久久人人做人人爽| 精品免费久久久久久久清纯| 一进一出抽搐动态| 国产在线精品亚洲第一网站| 老司机在亚洲福利影院| 男女午夜视频在线观看| 久久久国产精品麻豆| 亚洲成av人片免费观看| www.精华液| 91九色精品人成在线观看| 一进一出抽搐gif免费好疼| 18禁国产床啪视频网站| 亚洲国产精品成人综合色| 欧美丝袜亚洲另类 | 精品久久久久久久毛片微露脸| 又大又爽又粗| 欧美极品一区二区三区四区| 午夜日韩欧美国产| 男人舔女人的私密视频| 丰满人妻一区二区三区视频av | 黑人欧美特级aaaaaa片| 精品福利观看| 一a级毛片在线观看| 欧美日韩乱码在线| 老司机午夜十八禁免费视频| 一级毛片女人18水好多| 麻豆久久精品国产亚洲av| 美女高潮喷水抽搐中文字幕| 这个男人来自地球电影免费观看| 亚洲国产中文字幕在线视频| 免费在线观看视频国产中文字幕亚洲| 国产av在哪里看| 淫秽高清视频在线观看| 国产成人aa在线观看| 成人欧美大片| 中文亚洲av片在线观看爽| 国产精品av视频在线免费观看| 亚洲黑人精品在线| 亚洲第一欧美日韩一区二区三区| 亚洲国产欧美网| 18禁观看日本| 日韩三级视频一区二区三区| 青草久久国产| 最近最新中文字幕大全电影3| 国产精品98久久久久久宅男小说| 国产又色又爽无遮挡免费看| 亚洲av熟女| 亚洲欧美精品综合久久99| 老司机深夜福利视频在线观看| 色在线成人网| 男女之事视频高清在线观看| 国产97色在线日韩免费| 亚洲av片天天在线观看| 午夜福利在线在线| 午夜福利免费观看在线| 狂野欧美白嫩少妇大欣赏| 成人精品一区二区免费| 亚洲全国av大片| 91国产中文字幕| 少妇的丰满在线观看| 两性午夜刺激爽爽歪歪视频在线观看 | 久久久国产欧美日韩av| 成在线人永久免费视频| bbb黄色大片| 看黄色毛片网站| 日本五十路高清| av在线天堂中文字幕| 亚洲欧美激情综合另类| 亚洲av成人一区二区三| 亚洲精品一区av在线观看| 黄色视频,在线免费观看| 亚洲一区高清亚洲精品| 99国产精品一区二区三区| 99re在线观看精品视频| 男女视频在线观看网站免费 | 无遮挡黄片免费观看| 18禁美女被吸乳视频| 亚洲欧美精品综合久久99| 久久久久国产精品人妻aⅴ院| 日韩精品免费视频一区二区三区| 欧美在线一区亚洲| 亚洲国产精品久久男人天堂| 一级黄色大片毛片| 免费在线观看完整版高清| 久久午夜亚洲精品久久| 欧美日本视频| 午夜免费成人在线视频| 国产亚洲精品久久久久5区| 亚洲第一欧美日韩一区二区三区| 日本熟妇午夜| 久久久国产欧美日韩av| 丁香欧美五月| 久9热在线精品视频| 欧美日本视频| 亚洲国产欧洲综合997久久,| 成人18禁在线播放| av中文乱码字幕在线| av超薄肉色丝袜交足视频| 亚洲av成人一区二区三| 国产高清激情床上av| 免费在线观看成人毛片| 在线观看免费视频日本深夜| 亚洲人成77777在线视频| 国产aⅴ精品一区二区三区波| 免费看a级黄色片| 久久精品91无色码中文字幕| 91九色精品人成在线观看| 在线免费观看的www视频| 国产亚洲欧美98| 国产一区二区三区视频了| 国产高清有码在线观看视频 | 免费观看精品视频网站| 2021天堂中文幕一二区在线观| 这个男人来自地球电影免费观看| 韩国av一区二区三区四区| 久久天堂一区二区三区四区| 99久久国产精品久久久| 一级黄色大片毛片| 中文字幕熟女人妻在线| 日韩欧美在线二视频| 国产午夜福利久久久久久| 欧美日韩中文字幕国产精品一区二区三区| 亚洲免费av在线视频| 久久久久久免费高清国产稀缺| 国产精品日韩av在线免费观看| 国产69精品久久久久777片 | 一本大道久久a久久精品| 国产精品av视频在线免费观看| 久久九九热精品免费| 9191精品国产免费久久| 日韩 欧美 亚洲 中文字幕| 男插女下体视频免费在线播放| 中文字幕高清在线视频| 午夜a级毛片| 精品熟女少妇八av免费久了| 日韩中文字幕欧美一区二区| 免费观看人在逋| 色综合欧美亚洲国产小说| 国产爱豆传媒在线观看 | 久久午夜综合久久蜜桃| 日韩免费av在线播放| 日韩欧美免费精品| svipshipincom国产片| 亚洲中文字幕一区二区三区有码在线看 | 法律面前人人平等表现在哪些方面| 国产精品亚洲一级av第二区| 哪里可以看免费的av片| 国产日本99.免费观看| 黑人巨大精品欧美一区二区mp4| 久久久久久大精品| 午夜久久久久精精品| 久久人人精品亚洲av| 别揉我奶头~嗯~啊~动态视频| 岛国在线观看网站| 美女黄网站色视频| 久久久久性生活片| 日本成人三级电影网站| 听说在线观看完整版免费高清| 亚洲欧洲精品一区二区精品久久久| 男人舔奶头视频| 十八禁人妻一区二区| 亚洲专区字幕在线| 久久久水蜜桃国产精品网| 成熟少妇高潮喷水视频| 精品电影一区二区在线| 午夜福利在线观看吧| 91在线观看av| 99精品欧美一区二区三区四区| 亚洲av电影不卡..在线观看| 男人舔奶头视频| 成年人黄色毛片网站| 亚洲av五月六月丁香网| 亚洲中文av在线| 伦理电影免费视频| 亚洲av成人不卡在线观看播放网| 色播亚洲综合网| 天堂av国产一区二区熟女人妻 | 90打野战视频偷拍视频| 精品久久久久久久久久免费视频| 男女下面进入的视频免费午夜| 午夜激情福利司机影院| 亚洲中文字幕一区二区三区有码在线看 | 免费观看人在逋| 麻豆一二三区av精品| 欧美黑人精品巨大| 午夜老司机福利片| 一区二区三区高清视频在线| 黄片大片在线免费观看| 亚洲一区中文字幕在线| or卡值多少钱| 日日爽夜夜爽网站| 国产高清视频在线观看网站| 午夜福利成人在线免费观看| 男人舔奶头视频| 一本一本综合久久| 一级黄色大片毛片| 日本 欧美在线| 国产精品国产高清国产av| 久久亚洲真实| 在线观看免费视频日本深夜| 99riav亚洲国产免费| 免费在线观看视频国产中文字幕亚洲| 哪里可以看免费的av片| 91大片在线观看| 一区福利在线观看| 欧美中文日本在线观看视频| 日韩精品青青久久久久久| 国产熟女午夜一区二区三区| 国产精品98久久久久久宅男小说| 香蕉丝袜av| 国产1区2区3区精品| 国产精品一及| 色av中文字幕| av中文乱码字幕在线| 99热6这里只有精品| 久久久久久九九精品二区国产 | 欧美 亚洲 国产 日韩一| 成在线人永久免费视频| 免费观看精品视频网站| 日韩精品免费视频一区二区三区| 国内精品久久久久久久电影| 日本黄大片高清| 18禁裸乳无遮挡免费网站照片| 手机成人av网站| 国产成人精品久久二区二区91| 淫妇啪啪啪对白视频| 在线免费观看的www视频| 日韩欧美在线二视频| 天天躁狠狠躁夜夜躁狠狠躁| bbb黄色大片| 日本黄大片高清| 一边摸一边抽搐一进一小说| 欧美激情久久久久久爽电影| 国产精品精品国产色婷婷| 国产精品电影一区二区三区| 1024香蕉在线观看| www.精华液| 国产成人系列免费观看| 亚洲免费av在线视频| 人妻夜夜爽99麻豆av| 制服诱惑二区| 亚洲中文字幕一区二区三区有码在线看 | 在线观看66精品国产| 久久中文字幕一级| 麻豆一二三区av精品| 男女床上黄色一级片免费看| 欧美国产日韩亚洲一区| 97人妻精品一区二区三区麻豆| 一进一出抽搐动态| 不卡一级毛片| 国产成人影院久久av| 曰老女人黄片| 搡老妇女老女人老熟妇| 久久久久久久久中文| 99在线人妻在线中文字幕| 成人18禁高潮啪啪吃奶动态图| av欧美777| 人妻久久中文字幕网| 色在线成人网| aaaaa片日本免费| 日本免费一区二区三区高清不卡| 毛片女人毛片| 国产亚洲av高清不卡| 母亲3免费完整高清在线观看| 少妇熟女aⅴ在线视频| 久久人妻福利社区极品人妻图片| 欧美一级a爱片免费观看看 | 9191精品国产免费久久| 黄频高清免费视频| 777久久人妻少妇嫩草av网站| 在线观看免费日韩欧美大片| 一级毛片女人18水好多| 波多野结衣高清无吗| 国产v大片淫在线免费观看| 男女下面进入的视频免费午夜| 欧美大码av| 亚洲精品美女久久av网站| 欧美乱码精品一区二区三区| 精品免费久久久久久久清纯| 欧美激情久久久久久爽电影| 精品久久久久久久末码| 久久国产精品影院| 国产精华一区二区三区| 三级国产精品欧美在线观看 | 精品日产1卡2卡| 久久久久久久久久黄片| 一区二区三区国产精品乱码| 亚洲一码二码三码区别大吗| 久久 成人 亚洲| 女生性感内裤真人,穿戴方法视频| 日日爽夜夜爽网站| 国产高清有码在线观看视频 | 亚洲乱码一区二区免费版| 成人三级做爰电影| 91麻豆精品激情在线观看国产| 午夜日韩欧美国产| 久久亚洲真实| 我的老师免费观看完整版| 国产精品亚洲av一区麻豆| 久久中文看片网| 91九色精品人成在线观看| 久久精品成人免费网站| 亚洲国产高清在线一区二区三| 久久午夜亚洲精品久久| 亚洲成人精品中文字幕电影| 亚洲欧洲精品一区二区精品久久久| 久久香蕉国产精品| 欧美性长视频在线观看| 十八禁人妻一区二区| 伊人久久大香线蕉亚洲五| 亚洲男人的天堂狠狠| 亚洲精品国产精品久久久不卡| 不卡av一区二区三区| 久久性视频一级片| 999久久久精品免费观看国产| 精品熟女少妇八av免费久了| 久久久国产欧美日韩av| 亚洲第一电影网av| 麻豆国产97在线/欧美 | 亚洲aⅴ乱码一区二区在线播放 | 国产精品自产拍在线观看55亚洲| 在线观看舔阴道视频|