甲状腺癌组织病理学与分子病理学整合诊断的2025年新进展OA

In recent years,breakthrough progress has been made in the pathological diagnosis and molecular testing of thyroid carcinoma.The release of the 5th edition World Health Organization(WHO)classification of endocrine and neuroendocrine tumors,the update of the 2025 American Thyroid Association(ATA)management guidelines for adult patients with differentiated thyroid carcinoma,and the publication of the Chinese Medical Association Expert consensus on postoperative pathological diagnosis of thyroid carcinoma(version 2025)mark the entry of thyroid carcinoma diagnosis and treatment into a new era of"integrated histopathological and molecular pathological diagnosis".This review is grounded in the latest international classification systems,clinical practice guidelines,and domestic expert consensus statements,and is supplemented by evidence from the published literature.It summarizes and critically analyzes key updates in the pathological diagnosis and molecular testing of thyroid carcinoma.The principal advances covered in this review are highlighted in the following aspects:① The 5th edition WHO classification categorizes follicular cell-derived thyroid tumors into differentiated thyroid carcinoma,high-grade non-anaplastic thyroid carcinoma and anaplastic thyroid carcinoma,and for the first time systematically introduces a molecular subtyping framework(BRAF-like and RAS-like tumors);② Although histological criteria are identical in children and adults,molecular profiles differ markedly,with kinase fusions(RET,NTRK,ALK)being predominant in children and strongly associated with the diffuse sclerosing and infiltrative follicular variants of papillary thyroid carcinoma;③ The 2025 ATA guidelines have clarified the indications for germline genetic testing in hereditary syndromes associated with pathological features such as cribriform-morular thyroid carcinoma;④ The Chinese expert consensus emphasizes the importance of quantification of vascular invasion,assessment of extranodal extension,and recognizing the spatiotemporal heterogeneity of molecular testing in postoperative pathological reports.The integrated diagnostic model combining histomorphology,immunophenotype and molecular testing represents the future direction of precision diagnosis and treatment of thyroid carcinoma.Pathologists should master the latest classification system,appropriately apply molecular testing techniques,and play a central decision-making role in multidisciplinary treatment teams.