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Nuklearmedizin 2017; 56(06): 201-210
DOI: 10.3413/Nukmed-0924-17-08
Original Article
Schattauer GmbH

Preoperative diagnostics in differentiated thyroid carcinoma

Differenzierte Schilddrüsenkarzinome – Analyse der präoeprativen Diagnostik
Philipp Seifert
1   Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
,
Martin Freesmeyer
1   Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
› Author Affiliations
Further Information

Publication History

Received: 11 August 2017

accepted in revised form: 21 September 2017

Publication Date:
11 January 2018 (online)

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Summary

Aim: The preoperative diagnosis of differentiated thyroid carcinomas (DTC) is particularly challenging in view of the high prevalence of thyroid nodules in the general population. Incidental diagnosis of DTC, on the other hand, can lead to reoperations and increased risk of morbidity. This study aimed to assess the prediction value of preoperative DTC dignity assessment and it’s impact on surgical approaches. Methods: We retrospectively reviewed 107 cases of DTC and subdivided them in three groups based on the preoperative dignity assessment: suspected malignancy (SM), unclear dignity (UD), and incidental findings (IF). The group differences were investigated in terms of diagnostic methods, findings, and impact on the subsequent surgical approach. Results: The patient groups consisted of n = 51 (SM), n = 32 (UD), and n = 24 (IF). The tumor size, T staging, and ultrasound (US) assessment had the largest impact on the dignity classification (each p < 0.001). Scintigraphy was performed in 80 % of the patients, fine-needle aspiration cytology (FNAC) in 28 %. Hypofunction at scintigraphy (p < 0.001) and cytology results (p < 0.01) were identified as significant predictors for group assignment. Other significant factors were the frequency of the US documentation of nodule characteristics (p < 0.001) and malignancy criteria (p < 0.01) as well as reduced thyroid-stimulating hormone (TSH) levels (p < 0.01). Frozen section (p < 0.001) and total thyroidectomy (p < 0.01) at initial surgery were performed significantly more often in the MV group. Reoperations were significantly more frequent in the IF group (p < 0.001). Conclusions: A relevant number of DTC cases was diagnosed incidentally, leading to significantly more frequent reoperations. A more systematic diagnostic approach with complete documentation of the findings according to current guidelines should be pursued.

Zusammenfassung

Hintergrund: Die hohe Prävalenz von Schilddrüsenknoten stellt vor dem Hintergrund des geringen Anteils thyreoidaler Malignome besondere Herausforderungen an die Diagnostik. Der inzidentelle Nachweis differenzierter Schilddrüsenkarzinome (DTC) kann zu Nachoperationen mit erhöhter Morbidität führen. Methoden: Auf Grundlage der präoperativen Dignitätsbeurteilung wurden 107 DTC in drei Gruppen eingeteilt: Malignitätsverdacht (MV), unklare Dignität (UD) und Zufallsbe-fund (ZB). Untersucht wurden die Unterschiede der präoperativen Diagnostik zwischen diesen Gruppen sowie die Abhängigkeit der chirurgischen Versorgung von der präoperativen Dignitätsbeurteilung. Ergebnisse: Den Gruppen wurden 51 (MV), 32 (UD) und 24 (ZB) Patienten zugeordnet. Die Tumorgröße und das T-Stadium sowie die Beurteilung der Sonographie zeigten den größten Einfluss auf die präoperative Dignitätsbeurtei-lung (jeweils p < 0,001). Szintigraphien und Feinnadelaspirationszytologien erfolgten bei 80 % bzw. 28 % aller Patienten, wobei der Nachweis von Hypofunktionalität (p < 0,001) und der Zytologiebefund (p < 0,01) als Prädiktoren identifiziert wurden. Weitere Einflussfaktoren waren die Häufigkeit der Dokumentation sonographischer Knotenmerkmale (p < 0,001) und Malignitätskriterien (p < 0,01) sowie ein erniedrigter TSH-Wert (p < 0,01). In der MV-Gruppe erfolgten häufiger Schnellschnittuntersuchungen (p < 0,001) und primär totale Resektionsverfahren (p < 0,01). Komplettierungsoperationen waren in der ZB-Gruppe öfter notwendig (p < 0,001). Schlussfolgerung: Ein relevanter Teil der DTC tritt inzidentell auf. Bei diesen Patienten finden gehäuft Komplettierungsoperationen statt. Daher sollte auf den konsequenten Einsatz und die vollständige Dokumentation der in den Leitlinien empfohlenen Diagnostikverfahren hingewirkt werden.

Keywords

Differentiated thyroid carcinoma - DTC - thyroid diagnostics - thyroid surgery - incidental DTC - thyroid incidentaloma

Schlüsselwörter

Differenzierte Schilddrüsenkarzinome - DTC - Schilddrüsendiagnostik - Zufallsbefund - Schilddrüsenoperation
 

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