Zusammenfassung
Die Diagnostik des Schilddrüsenkarzinoms ist in Deutschland vor allem eine Differenzialdiagnostik des weit verbreiteten Schilddrüsenknotens. Mit der Doppler-Sonographie, Labordiagnostik einschließlich Kalzitoninmessung und Szintigraphie existieren gut etablierte Verfahren zur initialen Beurteilung des Malignitätsrisikos. Im Rahmen diagnostischer Algorithmen und im klinischen Kontext sinnvoll eingesetzt, ermöglichen diese Verfahren die Identifizierung von Patienten, die eine weitere invasive Abklärung durch Feinnadelbiopsie benötigen. Ziel der zytologischen Diagnostik ist die verbesserte Unterscheidung benigner und maligner Läsionen, um die hohe Rate diagnostischer, histologisch negativer Schilddrüsenoperationen zu reduzieren.
Abstract
The diagnostics of thyroid cancer in Germany is part of the differential diagnostic management of thyroid nodules which are detectable at very high prevalence in this region. Clinical data, ultrasonography, laboratory tests including calcitonin measurement and thyroid scintigraphy all provide valuable information for the initial assessment of the malignancy risk. When used in the context of rational diagnostic algorithms these methods help to select patients requiring further diagnostic assessment by fine needle biopsy. The ultimate goal of fine needle cytology is to improve the pre-operative distinction of benign and malignant thyroid lesions in order to reduce the high rate of diagnostic surgical interventions.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Brandi ML, Gagel RF, Angeli A et al (2001) Guidelines for diagnosis and therapy of MEN type 1 and type 2. J Clin Endocrinol Metab 86:5658–5671
Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association Management Guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214
Dietlein M, Dressler J, Grunwald F et al (2003) Guideline for in vivo- and in vitro procedures for thyroid diseases (version 2). Nuklearmedizin 42:109–115
Doyle P, Duren C, Nerlich K et al (2009) Potency and tolerance of calcitonin stimulation with high-dose calcium versus pentagastrin in normal adults. J Clin Endocrinol Metab 94:2970–2974
Elisei R, Bottici V, Luchetti F et al (2004) Impact of routine measurement of serum calcitonin on the diagnosis and outcome of medullary thyroid cancer: experience in 10,864 patients with nodular thyroid disorders. J Clin Endocrinol Metab 89:163–168
Friedrich-Rust M, Sperber A, Holzer K et al (2009) Real-time elastography and contrast-enhanced ultrasound for the assessment of thyroid nodules. Exp Clin Endocrinol Diabetes (Epub ahead of print)
Gharib H, Papini E, Paschke R (2008) Thyroid nodules: a review of current guidelines, practices, and prospects. Eur J Endocrinol 159:493–505
http://www.british-thyroid-association.org/news/Docs/Thyroid_cancer_guidelines_2007.pdf
Karges W (2004) Klinische und molekulare Genetik des Schilddrüsenkarzinoms. Onkologe 11:20–28
Karges W, Dralle H, Raue F et al (2004) Calcitonin measurement to detect medullary thyroid carcinoma in nodular goiter: German evidence-based consensus recommendation. Exp Clin Endocrinol Diabetes 112:52–58
Kloos RT, Eng C, Evans DB et al (2009) Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 19:565–612
Luster M, Karges W, Zeich K et al (2010) Clinical value of 18-fluorine-fluorodihydrophenylalanine positron emission tomography/computed tomography in the follow-up of medullary thyroid carcinoma. Thyroid 20:527–533
Machens A, Dralle H (2007) Genotype-phenotype based surgical concept of hereditary medullary thyroid carcinoma. World J Surg 31:957–968
Pacini F, Schlumberger M, Dralle H et al (2006) European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 154:787–803
Papini E, Guglielmi R, Bianchini A et al (2002) Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 87:1941–1946
Reiners C (2008) Scintigraphy or fine-needle aspiration biopsy to exclude thyroid malignancy: what should be done first in iodine deficiency? Eur J Nucl Med Mol Imaging 35:1171–1172
Reiners C, Schumm-Draeger PM, Geling M et al (2003) Thyroid gland ultrasound screening (Papillon Initiative). Report of 15 incidentally detected thyroid cancers. Internist (Berl) 44:412–419
Reiners C, Wegscheider K, Schicha H et al (2004) Prevalence of thyroid disorders in the working population of Germany: ultrasonography screening in 96,278 unselected employees. Thyroid 14:926–932
Tötsch M, Quadbeck B, Görges R et al (2005) Präoperative Punktionszytologie beim Schilddrüsenkarzinom. Onkologe 11:40–49
Vierhapper H, Niederle B, Bieglmayer C et al (2005) Early diagnosis and curative therapy of medullary thyroid carcinoma by routine measurement of serum calcitonin in patients with thyroid disorders. Thyroid 15:1267–1272
Volzke H, Ludemann J, Robinson DM et al (2003) The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area. Thyroid 13:803–810
Interessenkonflikt
Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Karges, W., Brabant, G. Schilddrüsenkarzinom – Klinik und Diagnostik. Onkologe 16, 657–665 (2010). https://doi.org/10.1007/s00761-010-1867-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00761-010-1867-x