Download PDF
Zentralbl Chir 2001; 126(12): 964-968
DOI: 10.1055/s-2001-19644
Endokrine Chirurgie

© Georg Thieme Verlag Stuttgart · New York

Das Prinzip der Hemithyreoidektomie bei unklaren Schilddrüsenbefunden

Hemithyroidectomy on Principle in Cases of Unclear Fine Needle Biopsy and Frozen Section FindingsJ. Jonas1 , S. Blaich1 , A. Nagel2 , R. Bähr1
  • 1Klinik für Allgemein- und Thoraxchirurgie des Städtischen Klinikums Karlsruhe
  • 2Pathologisches Institut des Städtischen Klinikums Karlsruhe
Further Information

Publication History

Publication Date:
22 January 2002 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die präoperative Feinnadelbiopsie (FNB) und die intraoperative Schnellschnittuntersuchung (SS) sollen helfen, die Dignität einer morphologischen Veränderung der Schilddrüse zu klären. Wertigkeiten und Unsicherheiten beider Verfahren müssen bei der Planung der Operation berücksichtigt werden. Von 7/96-6/00 wurden bei 82 Patienten sowohl präoperativ eine FNB als auch intraoperativ eine SS durchgeführt. Die Sensitivität beider Verfahren ist gering. In der FNB wurden lediglich 5/11 der Malignome (45,5 %) erkannt. Bei 22 suspekten Befunden (26,8 %) fanden sich 6 weitere Malignome in der endgültigen Histologie. Lediglich eines dieser primär nicht erkannten Malignome wurde intraoperativ in der SS identifiziert, während 5 Malignome als benigne beurteilt wurden. Der positive Vorhersagewert eines Malignoms durch die FNB beträgt > 90 %. Primär nicht erkannte Malignome können nur in Einzelfällen intraoperativ durch die SS erfaßt werden. Eine routinemäßige Anwendung des SS zur Überprüfung des FNB-Ergebnisses ist nicht zu empfehlen, kann dem Operateur aber Hinweise auf Tumorgröße, Lymphknotenstatus und Dignität bisher nicht erfaßter Veränderungen der Schilddrüse geben. Das Operationsverfahren der Wahl bei suspekten Schilddrüsenbefunden ist die Hemithyreoidektomie mit zentraler Lymphknotendissektion, um das erhöhte Risko der Rekurrensparesen und Hypoparathyreoidismus beim Rezidiveingriff zu vermeiden.

Summary

 Fine needle aspiration biopsy (FNB) and frozen section (FS) may help to vali­date pre- and intraoperatively dignity of thyroid nodules. Credibility and clinical valuation of both methods have to be taken into consideration of surgical treatment. Between 7/96 and 6/00 82 patients were operated for thyroid lesions using both diagnostic methods to verify thyroid lesions. The sensitivity of both methods is low. With FNB only 5/11 malignancies (45.5 %) were recognized. Within the group of “suspicious” FNB findings (22/82; 26.8 %) definitive histology demonstrated another 6 carcinomas. Only 1 of these initially not recognized carcinomas was verified by FS intraoperatively whereas 5 carcinomas were judged to be benign lesions. Follicular carcinomas and follicular variants of papillary carcinomas could not be assessed by FNB in 6/8 and by FS in 8/9 cases. Only very few malignancies, which are not found by FNB, can be verified by FS. A routine use of intraoperative FS to verify FNB results is not justified, but can give additional information about tumor size, lymph node status and extra-/intrathyroid nodules, which are not examined by FNB preoperatively. Hemithyroidectomy with lymph node dissection represents the operation of choice in cases with unclear FNB results to avoid a second operation with increased risk of recurrent nerve palsy and hypoparathyroidism.

Schlüsselwörter

Schilddrüse - Diagnose - Feinnadelbiopsie - Schnellschnitt

Key words

Thyroid - Diagnosis - Fine needle aspiration biopsy - Frozen section

Literatur

  • 1 Aguilar M. Use of aspiration cytology and frozen section examination for the management of benign and malignant thyroid nodules.  Cancer. 1992;  70 903-904
    PubMedSearch in Google Scholar
  • 2 Aguilar M, Contreras A, Gavilan I, Escobar-Jimenez L, Giron J A, Escribano J C, Beltran M, Garcia-Curiel A, Vazquez J M. Thyroid nodules: Role of fine-needle aspiration and intraoperative frozen section examination.  Act Cytol. 1997;  41 677-682
    PubMedSearch in Google Scholar
  • 3 Al-Fakhri N, Schwartz A, Runkel N, Buhr H J. Die Komplikationsrate bei systematischer Darstellung des Nervus recurrens und der Epithelkörperchen für Operationen benigner Schilddrüsenerkrankungen.  Zentralbl Chir. 1998;  123 21-24
    PubMedSearch in Google Scholar
  • 4 Boey J, Hsu C, Collins R J. False-negative errors in fine-needle aspiration biopsy of dominant thyroid nodules: A prospective follow-up study.  World J Surg. 1986;  10 623-630
    CrossrefPubMedSearch in Google Scholar
  • 5 Borman K R, Hume A T. Credibility and clinical utility of thyroid fine-needle aspiration biopsy in a teaching hospital.  Am J Surg. 1995;  170 638-642
    CrossrefPubMedSearch in Google Scholar
  • 6 Bronner M P, Hamilton R, Livolski V A. Utility of frozen section analysis on follicular lesions of the thyroid.  Endocrin Pathol. 1994;  5 154-161
    PubMedSearch in Google Scholar
  • 7 Bugis S P, Young J EM, Archibald S D, Chen V SM. Diagnostic accuracy of fine-needle aspiration biopsy versus frozen section in solitary thyroid nodules.  Am J Surg. 1986;  152 411-416
    CrossrefPubMedSearch in Google Scholar
  • 8 Buhr H J, Mann B. Thyreoidektomie und Lymphadenektomie.  Chirurg. 1999;  70 987-989
    CrossrefPubMedSearch in Google Scholar
  • 9 Chadwick D R, Harrison B J. The role of fine-needle aspiration cytology and frozen section histology in management of differentiated thyroid cancer: the UK experience.  Langenbecks Arch Chir. 1998;  383 164-166
    PubMedSearch in Google Scholar
  • 10 Chang H Y, Lin J D, Huang B Y, Hsueh C, Jeng L B, Tsai J S. Correlation of fine needel aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules.  J Clin Pathol. 1997;  50 1005-1009
    PubMedSearch in Google Scholar
  • 11 Chen H, Nicol T L, Udelsman R. Follicular lesions of the thyroid: Does frozen section evaluation alter operative management?.  Ann Surg. 1995;  222 101-106
    PubMedSearch in Google Scholar
  • 12 Chen H, Zeiger M A, Clark D P, Westra W H, Udelsman R. Papillary carcinoma of the thyroid. Can operative management be based solely on fine-needle aspirations?.  J Am Coll Surg. 1997;  184 605-610
    PubMedSearch in Google Scholar
  • 13 Davoudi M M, Yeh K A, Wei J P. Utility of fine-needle aspiration cytology and frozen-section examination in the operative management of thyroid nodules.  Am Surg. 1997;  63 1084-1090
    PubMedSearch in Google Scholar
  • 14 DeMay R M. Frozen section of thyroid? Just say no.  Am J Clin Pathol. 1998;  110 423-424
    PubMedSearch in Google Scholar
  • 15 Emerick G T, Duh Q Y, Siperstein A E, Burrow G N, Clark O H. Diagnosis, treatment, and outcome of follicular thyroid carcinoma.  Cancer. 1993;  72 3287-3295
    PubMedSearch in Google Scholar
  • 16 Gibb G K, Pasieka J L. Assessing the need for frozen sections: Still a valuable tool in thyroid surgery.  Surgery. 1995;  118 1005-1010
    PubMedSearch in Google Scholar
  • 17 Goretzki P, Dotzenrath C. Differenzierte Schilddrüsenkarzinome. In: Rothmund M (Hrsg). Endokrine Chirurgie. Springer, Berlin, Heidelberg, New York 2000; 148-158
  • 18 Grant C S, Hay I D, Gough I R. Long-term follow-up of patients with benign thyroid fine-needle cytologic diagnosis.  Surgery. 1989;  106 980-986
    PubMedSearch in Google Scholar
  • 19 Hamburger J I, Hamburger S W. Declining role of frozen section in surgical planning for thyroid nodules.  Surgery. 1985;  98 307-312
    PubMedSearch in Google Scholar
  • 20 Jen-Der Lin, Hsueh C, Chao T C, Wenig H F, Huang B Y. Thyroid follicular neoplasms diagnosed by high-resolution ultrasonography with fine needle aspiration cytology.  Acta Cytol. 1997;  41 687-691
    PubMedSearch in Google Scholar
  • 21 Joseph K. Schnittbildverfahren. In: Rothmund M (Hrsg). Endokrine Chirurgie. Springer, Berlin, Heidelberg, New York 2000; 47-51
  • 22 Keller M P, Crabbe M M, Norwood S H. Accuracy and significance of fine-needle aspiration and frozen section in determining the extent of thyroid resection.  Surgery. 1987;  101 632-635
    PubMedSearch in Google Scholar
  • 23 Kendall C H. Fine needle aspiration of thyroid nodules: Three years experience.  J Clin Pathol. 1989;  42 23-27
    PubMedSearch in Google Scholar
  • 24 Köbberling J, Hintze G. Differentialindikation zur Schilddrüsenoperation.  Chirurg. 1999;  70 971-979
    CrossrefPubMedSearch in Google Scholar
  • 25 Kopald K H, Leyfield L J, Mohrmann R, Foshag L J, Giuliano A E. Clarifying the role of fine-needle aspiration cytology evaluation and frozen section examination in the operative management of thyroid cancer.  Arch Surg. 1989;  124 1201-1205
    PubMedSearch in Google Scholar
  • 26 Kraemer B B. Frozen section diagnosis and the thyroid.  Sem Diagn Pathol. 1987;  4 169-189
    PubMedSearch in Google Scholar
  • 27 Lang W, Atay Z, Banse A. Schilddrüsencytologie.  Langenbecks Arch Chir (Kongreßbericht). 1985;  366 55-59
    PubMedSearch in Google Scholar
  • 28 Layfield L J, Mohrmann R L, Kopals K H, Giuliano A E. Use of aspiration cytology and frozen section examination for management of benign and malignant thyroid nodules.  Cancer. 1991;  68 130-134
    PubMedSearch in Google Scholar
  • 29 Linder R, Sahin G, Grimm H. Die Wertigkeit der präoperativen Diagnostik in der Strumachirurgie. Langenbecks Arch Chir Suppl II (Kongreßbericht) 1997; 1142-1144
  • 30 Lukacs G L, Miko T L, Fabian E, Nagy I Z, Balazs G. The validity of some morphologic methods in the diagnosis of thyroid malignancy.  Acta Chir Scand. 1983;  149 759-766
    PubMedSearch in Google Scholar
  • 31 Mazzaferri E L, Jhiang S M. Long term impact of initial surgical management and medical therapy on papillary and follicular thyroid cancer.  Am J Med. 1994;  97 418
    CrossrefPubMedSearch in Google Scholar
  • 32 Martin H E, Ellis E B. Biopsy by needle puncture and aspiration.  Ann Surg. 1930;  92 169-181
    PubMedSearch in Google Scholar
  • 33 McHenry C R, Rosen I B, Walfish P G, Bedard Y. Influence of fine-needle aspiration biopsy and frozen section examination on th management of thyroid cancer.  Am J Surg. 1993;  166 353-356
    PubMedSearch in Google Scholar
  • 34 McHenry C R, Walfish P G, Rosen I B. Non-diagnostic fine needle aspiration biopsy: A dilemma in management of nodular thyroid disease.  Am Surg. 1993;  59 415-419
    PubMedSearch in Google Scholar
  • 35 McHenry C R, Raeburn C, Strickland T, Marty J J. The utility of routine frozen section examination for intraoperative diagnosis of thyroid cancer.  Am J Surg. 1996;  172 658-661
    CrossrefPubMedSearch in Google Scholar
  • 36 Rodriguez J M, Parrilla P, Sola J, Bas A, Aguilar J, Moreno A, Soria T. Comparison between preoperative cytology and intraoperative frozen-section biopsy in the diagnosis of thyroid cancer.  Br J Surg. 1994;  81 1151-1154
    PubMedSearch in Google Scholar
  • 37 Sabel M S, Staren D, Gianakakis L M, Dwarakanatha S, Prinz R A. Use of fine-needle aspiration biopsy and frozen section in the management of the solitary thyroid nodule.  Surgery. 1997;  122 1021-1027
    CrossrefPubMedSearch in Google Scholar
  • 38 Schmid K W, Ladurner D, Zechmann W, Feichtinger H. Clinicopathologic management of tumors of the thyroid gland in an endemic goiter area. Combined use of preoperative fine-needle aspiration biopsy and intraoperative frozen section.  Acta Cytol. 1989;  33 27-30
    PubMedSearch in Google Scholar
  • 39 Schmid K W, Ladurner D. Die intraoperative Gefrierschnittdiagnostik der Schilddrüse.  Pathologe. 1997;  18 98-101
    PubMedSearch in Google Scholar
  • 40 Shaha A R, DiMaio T, Webber C, Jaffe B M. Intraoperative decision making during thyroid surgery based on the results of preoperative needle biopsy and frozen section.  Surgery. 1990;  108 964-971
    PubMedSearch in Google Scholar
  • 41 Tworek J A, Giordano T J, Michael C W. Comparison of intraoperative cytology with frozen sections in the diagnosis of thyroid lesions.  Am J Clin Pathol. 1998;  110 456-461
    PubMedSearch in Google Scholar
  • 42 Wang C, Vickery A l, Maloof F. Needle biopsy of the thyroid.  Surg Gynecol Obstet. 1976;  143 356-358
    PubMedSearch in Google Scholar

Dr. J. Jonas

Klinik für Allgemein- und Thoraxchirurgie

des Städtischen Klinikums Karlsruhe

Moltkestraße 90

76133 Karlsruhe

Phone: 0721/9 74-21 02

Fax: 0721/9 74-21 19