Der intraoperative Gefrierschnitt von Schilddrüsenknoten

Zusammenfassung

Über die Wertigkeit und Akkuranz des intraoperativen Gefrierschnittes (IOG) der Schilddrüse bestehen kontroverse Ansichten. Insbesondere in Mitteleuropa wird der IOG neben der präoperativen Feinnadelaspirationsbiopsie (FNA) als das Wichtigste Instrument des chirurgischen Managements von Schilddrüsenknoten angesehen. Bei der intraoperativen Beurteilung von (gekapselten) follikulären Neoplasien wird der IOG allerdings nur in einem Teil der Fälle zur bereits intraoperativen Dignitätsfestlegung führen. Das entscheidende Argument für die Durchführung eines IOG liegt in diesen Fällen darin, dass auch bei problematischen Tumoren eine definitive Diagnose innerhalb von 48 Stunden durch den Pathologen erstellt werden kann, um eine eventuell notwendige Komplettierungsoperation zeitnah (maximal 72 Stunden nach dem Ersteingriff) mit entsprechend geringer postoperativer Morbidität durchführen zu können. Der folgende Übersichtsartikel nimmt zu Indikationen, Verlässlichkeit und Grenzen des IOG der Schilddrüse Stellung.

Abstract

There is substantial controversy regarding the value and accuracy of intraoperative frozen section of the thyroid gland. Particularly in Central Europe frozen section examination is considered beside preoperative fine-needle aspiration biopsy as the most useful tool in managing thyroid nodules. However, in encapsulated follicular neoplasia intraoperative frozen section examination contributes only little to prove or exclude malignancy. The most striking argument for the performance of thyroid frozen section is that a final diagnosis can be made by the pathologist within 48 hours enabling the surgeon to perform completion operation with low morbidity risk (not later than 72 hours after the primary operation). The following review deals with the indications, reliability and limits of intraoperative frozen section of the thyroid.

Feinnadel-Aspirationsbiopsie - Serumkalzitonin - Jodmangelgebiet

fine-needle aspiration biopsy - serum calcitonin - iodine deficiency area

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