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Inzidentalome der Schilddrüse

Überdiagnostik und -therapie gesunder Schilddrüsenkranker?

Thyroid incidentaloma

Overdiagnosis and overtreatment of healthy persons with thyroid illness?

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Zusammenfassung

Bei sonographischen Screeninguntersuchungen des Halses werden bei ca. 20% der Untersuchten Schilddrüsenknoten als Zufallsbefunde festgestellt, asymptomatische Schilddrüsenkarzinome finden sich in Autopsieserien in bis zu 10%. Die Inzidenz klinisch behandelter Schilddrüsenkarzinome ist auch in Deutschland steigend, ohne dass die krebsbedingte Mortalität zunimmt, sie beträgt ca. 4500 pro Jahr (3000 Frauen, 7,3/100.000). Die Früherkennung und -behandlung klinisch relevanter Schilddrüsenkarzinome erfordert somit eine selektierende Stufendiagnostik, bei der der ultraschallgeführten Feinnadelpunktion und Zytologie sonographisch malignitätsverdächtiger Läsionen eine entscheidende Bedeutung zukommt.

Bei malignitätsverdächtigen Knoten ist die Hemithyreoidektomie das Verfahren der Wahl, um im Fall des erst postoperativen Karzinomnachweises das erhöhte Komplikationsrisiko der Reoperation zu vermeiden. Da jedoch die Karzinominzidenz nur bei ca. 3–5% liegt, haben auch subtotale Resektionen ihre Berechtigung, insbesondere bei ventral gelegenen Knoten ohne Hilusbeteiligung. Zur bestmöglichen Vermeidung zweizeitiger Karzinomoperationen sollten die Möglichkeit des intraoperativen Schnellschnittes und/oder der Schnelleinbettung mit früher Definitivdiagnose zur Verfügung stehen.

Abstract

Thyroid incidentalomas have been found in about 20% of cases screened by neck ultrasound, and asymptomatic thyroid cancer is detected in about 10% of autopsies. The incidence of clinically treated thyroid cancer in Germany is increasing without an increase in cancer-specific mortality. Presently the incidence is about 4500 cases per year (7.3/100,000, 3000 females). For early detection and treatment of clinical thyroid cancer ultrasonography-guided fine needle aspiration cytology of suspicious nodules therefore is crucial. Thyroid lobectomy is the treatment of choice for suspicious nodules to lower the risk of morbidity in case of reoperation due to a postoperative diagnosis of cancer. However, subtotal lobectomy may also be justified, especially with nodules in anterior position, because the risk of malignancy is only 3–5%. Frozen selection and/or early final histopathology should be available to avoid two-stage thyroid cancer operations.

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  1. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06097, Halle (Saale), Deutschland

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Dralle, H. Inzidentalome der Schilddrüse. Chirurg 78, 677–686 (2007). https://doi.org/10.1007/s00104-007-1376-7

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