Wie werden Schilddrüsenknoten diagnostiziert?

ZUSAMMENFASSUNG

Die Prävalenz von Schilddrüsenknoten liegt in Deutschland – je nach Untersuchungstechnik – bei 20–50 %. Die Inzidenz steigt, denn durch moderne Ultraschalltechniken können immer kleinere morphologische Veränderungen entdeckt werden. Die meisten Knoten sind asymptomatisch – und daher häufig Zufallsbefunde. In diesem Beitrag erfahren Sie, wie Sie mithilfe verschiedener diagnostischer Methoden Schilddrüsenknoten erkennen und differenzieren können.

• Literatur

• 1 Reiners C, Schumm-Draeger PM, Geling M. et al [Thyroid gland ultrasound screening (Papillon Initiative). Report of 15 incidentally detected thyroid cancers]. Internist (Berl) 2003; 44: 412-419
• 2 Völzke H, Lüdemann J, Robinson DM. et al The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area. Thyroid 2003; 13: 803-810
• 3 Frates MC, Benson CB, Charboneau JW. et al Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 2005; 237: 794-800
• 4 Wiest PW. Thyroid palpation versus high-resolution thyroid ultrasonography in the detection of nodules. J Ultrasound Med 1998; 17: 487-496
• 5 Ruhlmann M, Stebner V, Görges R. et al Diagnostik hyperfunktioneller Schilddrüsenknoten. Bedeutung der US-Elastographie. Nuklearmedizin 2014; 53: 173-177
• 6 Dietlein M, Eschner W, Lassmann M. et al DGN-Handlungsempfehlung (S1-Leitlinie) Schilddrüsenszintigraphie (Version 4). Stand:10/2014, AWMF-Registrieringsnummer: 031–011
• 7 Schicha H, Hellmich M, Lehmacher W. et al Should all patients with thyroid nodules ≥ 1 cm undergo fine-needle aspiration biopsy?. Nuklearmedizin 2009; 48: 79-83
• 8 Brito JP, Morris JC, Montori VM. Thyroid cancer: zealous imaging has increased detection and treatment of low risk tumours. BMJ 2013; 347: f4706
• 9 Ross DS, Tuttle RM. Observing micopapillary thyroid cancers. Thyroid 2014; 24: 3-6
• 10 Ito Y, Miyauchi A, Kihara M. et al Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid 2014; 24: 27-34
• 11 Sugitani I, Toda K, Yamada K. et al Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg 2010; 34: 1222-1231
• 12 Luster M, Weber T, Verburg FA. Differentiated thyroid cancer-personalized therapies to prevent overtreatment. Nat Rev Endocrinol 2014; 10: 563-574
• 13 Theissen P, Schmidt M, Ivanova T. et al MIBI scintigraphy in hypofunctioning thyroid nodules-can it predict the dignity of the lesion?. Nuklearmedizin 2009; 48: 144-152
• 14 Cooper DS, Doherty GM, Haugen BR. et al Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2009; 19: 1167-1214
• 15 Gharib H, Papini E, Paschke R. et al American Association of Clinical Endocrinologists, Assoziatione Medici Endocrinologi, European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract 2010; 16 1 1-43
• 16 Nikiforov YE, Nikiforova MN. Molecular genetics and diagnosis of thyroid cancer. Nat Rev Endocrinol 2011; 7: 569-580
• 17 Alexander EK, Kennedy GC, Baloch ZW. et al Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. N Engl J Med 2012; 367: 705-715
• 18 Harrell RM, Bimston DN. Surgical utility of Afirma: effects of high cancer prevalence and oncocytic cell types in patients with indeterminate thyroid cytology. Endocrine Practice 2014; 20: 364-369
• 19 Schneider C, Kobe C, Schmidt M. et al Calcitonin screening in patients with thyroid nodules. Diagnostic value. Nuklearmedizin 2012; 51: 228-223
• 20 Friedrich-Rust M, Sperber A, Holzer K. et al Real-time elastography and contrast-enhanced ultrasound for the assessment of thyroid nodules. Exp Clin Endocrinol Diabetes 2010; 118: 602-609
• 21 Russ G, Bonnema SJ, Erdogan MF. et al European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. Eur Thyroid J 2017; 6: 225-237
• 22 Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid 2017; 27: 1341-1346
• 23 Seo JY, Park JH, Pyo JY. et al A Multi-institutional Study of Prevalence and Clinicopathologic Features of NON-invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP) in Korea. J Pathol Transl Med 2019 Oct 21, doi: 10.4132/jptm.2019.09.18. [Epub]
• 24 Suh CH, Choi YJ, Baek JH. et al The diagnostic performance of shear wave elastography for malignant cervical lymph nodes: A systematic reviwe and meta-analysis. Eur Radiol 2017; 27: 222-230
• 25 Frank-Raue K, Schott M, Raue F. Empfehlung zum Calcitonin-Screening bei Struma nodosa. Dtsch med Wochenschr 2018; 143: 1065-1069