Paschke Ralf, Schmid Kurt Werner, Gärtner Roland, Mann Klaus, Dralle Henning, Reiners Christian
Medizinische Klinik und Poliklinik III, Universitätsklinikum Leipzig, Leipzig, Germany.
Med Klin (Munich). 2010 Feb;105(2):80-7. doi: 10.1007/s00063-010-1011-9. Epub 2010 Feb 20.
Clinically relevant thyroid carcinomas can be found in 5-6% of nodular goiters which undergo surgery. Moreover, multinodular goiters fre- quently contain hot areas. Therefore, efficient and rational methods for the differential diagnosis and decision are required to identify those nodules with an increased cancer risk or those which are hot among the many thyroid nodules.
Description of a newly revised and further guidelines and consensus statements as well as selected literature search.
Already history, ultrasound and TSH (thyroid-stimulating hormone) determination do allow a first risk assessment for the further diagnostic work-up. Fine-needle biopsy (FNB) offers the best sensitivity and specificity for the distinction between benign and malignant thyroid nodules. The combination of several clinical and ultrasound criteria and laboratory determinations (calcitonin) can help with the selection of thyroid nodules with scintigraphically normal or decreased uptake > 1 cm for FNB. However, the efficiency of FNB requires sufficient training and experience of both the cytopathologist and the person performing FNB.
Whereas solitary thyroid nodules with a suspicion for malignancy should be referred to the surgeon, euthyroid thyroid nodules without clinical ultrasound or cytological indicators of malignancy may be followed up - possibly under medication -, if surgery is not indicated by local complaints, tracheal or mediastinal involvement.
在接受手术的结节性甲状腺肿中，5% - 6%可发现具有临床意义的甲状腺癌。此外，多结节性甲状腺肿常包含热结节区域。因此，需要高效且合理的方法来进行鉴别诊断和决策，以在众多甲状腺结节中识别出癌症风险增加的结节或热结节。
描述新修订的进一步指南和共识声明以及进行选定的文献检索。
病史、超声检查和促甲状腺激素（TSH）测定已经能够对进一步的诊断检查进行初步风险评估。细针穿刺活检（FNB）在区分甲状腺良性和恶性结节方面具有最佳的敏感性和特异性。多种临床和超声标准以及实验室检测（降钙素）的组合有助于选择闪烁扫描摄取正常或降低且直径>1 cm的甲状腺结节进行FNB。然而，FNB的有效性需要细胞病理学家和进行FNB的人员都具备充分的培训和经验。
对于怀疑为恶性的孤立性甲状腺结节，应转诊给外科医生；对于甲状腺功能正常且无临床、超声或细胞学恶性指标的甲状腺结节，如果局部症状、气管或纵隔受累未提示需要手术，则可进行随访观察（可能需药物治疗）。
