Artikel
Problems in clinically determining dignity of thyroid nodules – aids in the decision for surgery
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Veröffentlicht: | 8. August 2007 |
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Gliederung
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The decision to operate on a thyroid nodule is often difficult, especially in case of negative fine needle aspiration. Two retrospective studies describe different risk factors to identify differentiated thyroid carcinomas.
Results: The first study included 107 operated patients with the risk criterions “scintigraphic completely cold” and “sonographical hypoechogenic or echocomplex”. The second study shows different risk markers of malignant nodules of 110 patients with thyroid cancer. All malignant nodules have been hypoechogenic or echocomplex. Scintigraphic completely cold nodules have a risk of being carcinoma of about 20% (in 90% size more than 3 cm). Malignant nodules with a size smaller than 2 cm could not be differentiated by scintigraphy in many cases. About 30% of papillary carcinomas could not be detected by scintigraphy because size was smaller than 2 cm. The studies demonstrated, that sonographical risk factors are important in detecting suspi-cious nodules. Microcalcifications as well as the more rare macrocalcifications are often found in papillary thyroid carcinomas. Vascularisation in the centre of a suspicious nodule was confirmed to be a risk factor as well as an irregular or poorly defined lesion margin. Additional risk factors have been detected by fine needle aspiration. Cytologic diagnosis of “follicular neoplasia” and “microfollicular proliferation” represent a risk of about 25% to find a carcinoma. Cytologic descriptions of focal lymphocytic thyreoiditis, often in combination with high TPO-antibody levels, were found in about 30% of papillary, not however in follicu-lar tumors.
Conclusion: The two studies demonstrated different risk factors of differentiated thyroid carcinomas. Sensitivity of one factor alone does not represent a high risk. The simultaneous presence of several risk criterions however shows a significant higher risk of thyroid carcinoma, even in case of negative fine needle aspiration.