Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2001; 40(05): 148-154
DOI: 10.1055/s-0038-1623880

Originalarbeiten – Original Articles

Schattauer GmbH

Results of preoperative ultrasound guided fine needle aspiration biopsy of solitary thyroid nodules as compared with the histology

A retrospective analysis of 538 patientsErgebnisse ultraschallgezielter Feinnadelpunktionen von solitären SchilddrüsenknotenEine retrospektive Analyse von 538 operierten Patienten

P. Mikosch

¹Department of Nuclear Medicine and Endocrinology, State Hospital Klagenfurt, Austria (Head of the department: Univ.-Doz. Dr. P lind)

,

U. Wartner

²Department of Pathology, State Hospital Klagenfurt, Austria (Head of the department: Univ.-Prof. Dr. H. P. Dinges)

,

E. Kresnik

¹Department of Nuclear Medicine and Endocrinology, State Hospital Klagenfurt, Austria (Head of the department: Univ.-Doz. Dr. P lind)

,

H. J. Gallowitsch

¹Department of Nuclear Medicine and Endocrinology, State Hospital Klagenfurt, Austria (Head of the department: Univ.-Doz. Dr. P lind)

,

M. Heinisch

¹Department of Nuclear Medicine and Endocrinology, State Hospital Klagenfurt, Austria (Head of the department: Univ.-Doz. Dr. P lind)

,

H. P. Dinges

²Department of Pathology, State Hospital Klagenfurt, Austria (Head of the department: Univ.-Prof. Dr. H. P. Dinges)

,

P. Lind

¹Department of Nuclear Medicine and Endocrinology, State Hospital Klagenfurt, Austria (Head of the department: Univ.-Doz. Dr. P lind)

› Author Affiliations

Summary

Aim: The goal of this study was to assess the accuracy and limitations of ultrasound guided fine-needle aspiration biopsy (ug-FNAB) of solitary thyroid nodules. Methods: The ug-FNAB results of 538 patients with solitary thyroid nodules, who afterwards underwent thyroid surgery, were compared retrospectively with the histology. Patients with multinodular goiter were excluded from the study. Ug-FNAB was performed on growing and/or hypoechoic and/or hypofunctional nodules. The ug-FNAB results were grouped as follows: group 1: malignant (n = 44); group 2: malignancy cannot be ruled out (n = 173); group 3: non-malignant (n = 296), group 4: inadequate (n = 25). Results: When the cytological results of group 1 and group 2 were interpreted os being malignant and those of group 3 as being benign, sensitivity, specificity and accuracy of ug-FNAB were 96.7%, 65.8% and 69.5% respectively. The 62 thyroid carcinomas (TO biopsied presented in 59 cases a suspicious or malignant cytology (95.2%). The smallest TC diagnosed by ug-FNAB had a diameter of 0.5cm and 36.4% of all papillary TC ≤ 1 cm displayed stage pT4. The histology verified a TC in 18 cases out of the 173 ug-FNABs in group 2. Non-malignant ug-FNABs were confirmed by histology in 294 patients (99.3%) in group 3. In 4.65% of the ug-FNABs inadequate material was aspirated. Conclusion: Nodules with non-suspicious ug-FNAB results can be safely followed-up by sonography, as the cytological diagnoses were verified in more than 99% by histology. Papillary TC can be diagnosed with ug-FNAB very accurately. As stage pT4 was present in more than one third of patients with papillary TC ≤ T cm, ug-FNAB is also recommended for thyroid nodules 0.5-1 cm in diameter located adjacent to the thyroid capsule. However, microfollicular proliferations remain the limitation of ug-FNAB, as the cytology cannot distinguish between benign adenoma and follicular TC.

Zusammenfassung

Ziel: Evaluierung von Effektivität und Grenzen der Ultraschall-gezielten Feinnadelaspirationsbiopsie (ug-FNAB) von solitären Schilddrüsenknoten. Methodik: Die präoperativen ug-FNAB-Ergebnisse von 538 Patienten mit sonographisch beschriebener Struma uninodosa wurden retrospektiv mit der Histologie verglichen. Multinodöse Strumen wurden aus der Studie exkludiert. Die ug-FNAB wurde bei Knoten mit Wachstumstendenz bzw. bei echoarmen und/oder hypofunktionellen Schilddrüsenknoten durchgeführt. Einteilung der ug-FNAB-Ergebnisse: Gruppe 1: maligne (n = 44), Gruppe 2: suspekt, Malignität nicht ausgeschlossen (n = 173), Gruppe 3: benigne (n =296), Gruppe 4: nicht beurteilbar (n = 25) Ergebnisse: Bei Bewertung der Gruppen 1 und 2 als maligne und Gruppe 3 als benigne Resultate ergaben sich folgende Werte für Sensit», Spezifität, Effektivität der ug-FNAB: 96,7%, 65,8%, 69,5%. Von 62 punktierten Schilddrüsenkarzinomen (TC) wiesen 59 TC eine maligne oder suspekte Zytologie auf (95,2%). Das kleinste punktierte TC hatte einen Durchmesser von 0,5 cm und 36,4% aller papillären TC ≤ lern stellten ein pT4-Stadium dar. Unter 173 suspekten ug-FNABs fanden sich 18 TC. Benigne ug-FNAB-Ergebnisse wurden histologisch in 294 Fällen (99,3%) bestätigt, 4,65% der ug-FNAB waren nicht beurteilbar. Schlussfolgerungen: Da sich benigne ug-FNAB-Ergebnisse in über 99% histologisch bestätigten, gestattet der Einsatz der ug-FNAB für solche Fälle ein konservatives Vorgehen mit sonographischen Verlaufskontrollen. Papilläre TC können präoperativ mit hoher Sicherheit erkannt werden. Da mehr als ein Drittel aller Patienten mit papillären TC ≤ 1 cm ein pT4-Stodium aufwiesen, wird die ug-FNAB auch bei Schilddrüsenknoten von 0,5-1 cm mit kapselnaher Lage empfohlen. Als eine der wesentlichen Einschränkungen der ug-FNAB bleiben jedoch zytologische Befunde mit mikrofollikulären Proliferationen bestehen, die zytologisch eine Unterscheidung, zwischen benignen Adenomen und follikulären TC nicht gestatten.

Keywords

Keywords

Thyroid carcinoma - thyroid nodules - fine needle aspiration biopsy - sonographic guidance - preoperative management of thyroid nodules

Schlüsselwörter

Schlüsselwörter

Schilddrüsenkarzinom - Schilddrüsenknoten - Feinnadelpunktion - sonographisch gezielte Punktion - präoperatives Management von Schilddrüsenknoten

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