Die chirurgische Perspektive: Bedeutung der FDG-PET/CT-Diagnostik in der Rezidivchirurgie der differenzierten Schilddrüsenkarzinome

Zusammenfassung

Die PET-Bildgebung hat im diagnostischen und therapeutischen Management der differenzierten Schilddrüsenkarzinome (DTC) eine wichtige Rolle eingenommen. Insbesondere in der Rezidivsituation, bei residuellem Tumor und in der Nachsorge bei ansteigendem Tumormarker Thyreoglobulin und fehlender Iodspeicherung des Karzinoms ist die PET/CT-Lokalisation der Tumorläsionen wesentlich. Eine exakte Tumorlokalisation ist gerade aus chirurgischer Perspektive von entscheidender Bedeutung, um die chirurgisch therapeutischen Optionen zu prüfen und in ihrem Umfang abschätzen zu können. Dabei sind die Identifikation der Tumorläsionen und die sichere Abgrenzung gegenüber nicht-tumorigenen Läsionen der PET, aber auch die anatomisch-topografische Korrelation mit der CT für den Chirurgen gleichermaßen wichtig. Mithilfe der FDG-PET/CT-Diagnostik können die Lokalisation iodnegativer Rezidive verbessert und Rezidivoperationen befundgerecht ausgerichtet werden, Lymphknoten- und Weichteilrezidive gezielt angegangen und Fernmetastasen identifiziert werden.

Key words

PET imaging evolved to be an important tool in the diagnostic and therapeutic management of differentiated thyroid cancer (DTC). Mainly in the situation of residual or recurrent tumor with rising thyroglobulin levels and iodine negative DTC, PET/CT-localization of tumor lesions seems to be an important diagnostic tool. From the surgical perspective accurate localization of recurrent DTC plays a key role in order to evaluate therapeutic surgical options and to plan the extent of necessary surgical interventions. Moreover, for the surgeon it is not only important to identify tumor lesions with PET scan but also to differentiate these from benign lesions. In addition, PET/CT scans allow for perceiving a detailed anatomical correlation. The advantage of FDG-PET/CT-diagnostic is an improved localization of iodine-negative tumor recurrence, guiding remedial surgery according to the relevant PET-findings, a selective approach to lymph node and soft tissue recurrences and enabling identification of distant metastases.

Schlüsselwörter

differenzierte Schilddrüsenkarzinome - chirurgische Therapie - Schilddrüsenkarzinomrezidiv - PET/CT-Diagnostik - Rezidivchirurgie

Key words

differentiated thyroid carcinoma - surgical therapy - thyroid carcinoma recurrence - PET/CT diagnostic - recurrent surgery

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