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Präoperative Punktionszytologie beim Schilddrüsenkarzinom

Role of preoperative fine-needle aspiration in thyroid cancer

  • Leitthema
  • Published:
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Zusammenfassung

Die Punktionszytologie/Feinnadelaspiration (FNA) ist derzeit die verlässlichste diagnostische Methode zur präoperativen Evaluation von Knoten der Schilddrüse. Sie ist kosteneffektiv und bietet in der Metaanalyse eine Sensitivität von 83% und eine Spezifität von 92%. Die FNA der Schilddrüse ist in 70% der Untersuchungen diagnostisch, in 20% unklar oder verdächtig und in 10% der Fälle diagnostisch nicht verwertbar. Die Rate falsch-negativer Befunde beträgt weniger als 5%, die falsch-positiver Befunde unter 3%. Die Diagnose eines papillären, medullären und anaplastischen Karzinoms stellt im Regelfall kein Problem dar; insbesondere in zellarmen Punktaten oder bei gleichzeitig bestehender Entzündung kann aber auch bei diesen Tumoren die definitive Diagnose nicht immer möglich sein. Es muss mit Nachdruck darauf hingewiesen werden, dass die zytologische Unterscheidung eines (minimal-invasiven) follikulären Karzinoms von Adenomen nicht möglich ist. Die FNA der Schilddrüse (und ggf. deren Wiederholung) ist als unabdingbare Standarddiagnostik vor der Operation von kalten Knoten zu fordern.

Abstract

Fine-needle aspiration (FNA) of the thyroid is currently the most reliable diagnostic method in the clinical work-up of thyroid nodules. It is a very cost-effective procedure with a sensitivity of 83% and a specificity of 92%. In general FNA results are diagnostic in 70%, indeterminate/suspicious in 20%, and non-diagnostic in 10% of the cases. The false-negative rate is less than 5%, the false-positive rate less than 3%. Usually the cytological diagnosis of papillary carcinoma, medullary carcinoma, and anaplastic carcinoma does not cause problems; however, a decreased number of cells or a concomitant thyroid inflammation may hamper the definite diagnosis even of those malignancies. It has to be emphasized that (minimally invasive) follicular carcinoma cannot be distinguished from adenoma by FNA. FNA should be regarded as a standard procedure for the evaluation of cold thyroid nodules.

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Authors and Affiliations

  1. Institut für Pathologie, Universitätsklinikum Essen

    M. Tötsch & K. W. Schmid

  2. Westdeutsches Tumorzentrum Essen (WTZE)

    M. Tötsch & K. W. Schmid

  3. Klinik für Endokrinologie, Universitätsklinikum Essen

    B. Quadbeck

  4. Klinik für Nuklearmedizin, Universitätsklinikum Essen

    R. Görges

  5. Institut für Pathologie, Universitätsklinikum, Hufelandstraße 55, 45122 , Essen

    M. Tötsch

Authors
  1. M. Tötsch
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  2. B. Quadbeck
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  3. R. Görges
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  4. K. W. Schmid
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Correspondence to M. Tötsch.

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Tötsch, M., Quadbeck, B., Görges, R. et al. Präoperative Punktionszytologie beim Schilddrüsenkarzinom. Onkologe 11, 40–49 (2005). https://doi.org/10.1007/s00761-004-0810-4

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  • DOI: https://doi.org/10.1007/s00761-004-0810-4

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