Schenke Simone Agnes, Kreissl Michael C, Grunert Michael, Hach Anja, Haghghi Sarvar, Kandror Tatjana, Peppert Eckhard, Rosenbaum-Krumme Sandra, Ruhlmann Verena, Stahl Alexander, Wanjura Dieter, Zaplatnikov Konstantin, Zimny Michael, Gilman Elena, Herrmann Ken, Görges Rainer
Klinik und Institut für Nuklearmedizin, Klinikum Bayreuth GmbH, Bayreuth, Germany.
Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany.
Nuklearmedizin. 2022 Oct;61(5):376-384. doi: 10.1055/a-1856-4052. Epub 2022 Aug 2.
Thyroid scintigraphy enables the depiction of the functional status of thyroid nodules (TNs) with both, Tc-pertechnetate and Iodine. The functional status is relevant for diagnostic procedures for the differentiation of benign and malignant TNs. The aim of this study was to examine the current frequencies of hyper-, hypo- and isofunctioning TNs in Germany and to estimate the risk of malignancy with regard to functional status.
In 11 study centers, a minimum of 100 nodules per center were consecutively enrolled between July 2019 and April 2020. Inclusion criteria were: newly diagnosed nodule, nodule' size of 10 mm or more, thyroid scintigraphy. Exclusion criteria were: completely cystic TNs, patients with prior radioiodine therapy or thyroid surgery. The risk of malignancy was estimated for hyper- and hypofunctioning TNs.
Overall, 849 patients (72 % women) with 1262 TNs were included. Patients' age ranged from 18 to 90 years. Most TNs were hypofunctioning (n=535, 42%) followed by isofunctioning TNs (n=488, 39%) and hyperfunctioning TNs (n=239, 19%). When only TNs with a maximum size of 2 cm or more were considered the rate of hyperfunctioning and hypofunctioning TNs increased (to 27% and 49%) while isofunctioning TNs decreased. Only one of all hyperfunctioning TNs was malignant. In hypofunctioning nodules, the malignancy rate was estimated at 10%.
In Germany, the proportion of hyperfunctioning TNs is approximately 20% and increases in larger TNs to up to 27%. Due to the low risk of malignancy in hyperfunctioning TNs, no further procedures to rule out malignancy are necessary. The risk of malignancy of hypofunctioning TNs is significantly higher. Thus, a thyroid scintigraphy is a useful diagnostic tool in Germany.
甲状腺闪烁扫描术可利用高锝酸盐和碘描绘甲状腺结节（TNs）的功能状态。该功能状态与鉴别良性和恶性TNs的诊断程序相关。本研究的目的是调查德国目前高功能、低功能和等功能TNs的发生频率，并评估与功能状态相关的恶性风险。
在11个研究中心，于2019年7月至2020年4月期间，每个中心至少连续纳入100个结节。纳入标准为：新诊断的结节、结节大小为10毫米或更大、甲状腺闪烁扫描术。排除标准为：完全囊性TNs、既往接受过放射性碘治疗或甲状腺手术的患者。评估高功能和低功能TNs的恶性风险。
总体而言，纳入了849例患者（72%为女性），共1262个TNs。患者年龄范围为18至90岁。大多数TNs为低功能（n = 535，42%），其次是等功能TNs（n = 488，39%）和高功能TNs（n = 239，19%）。仅考虑最大尺寸为2厘米或更大的TNs时，高功能和低功能TNs的比例增加（分别增至27%和49%），而等功能TNs的比例下降。所有高功能TNs中只有1个为恶性。在低功能结节中，恶性率估计为10%。
在德国，高功能TNs的比例约为20%，在较大的TNs中增至27%。由于高功能TNs的恶性风险较低，无需进一步进行排除恶性的检查。低功能TNs的恶性风险显著更高。因此，甲状腺闪烁扫描术在德国是一种有用的诊断工具。
