Klassifikation und klinische Diagnostik des Schilddrüsenkarzinoms – Benigner Knoten oder therapierelevantes Karzinom?

Die klinische Diagnostik von Schilddrüsenkarzinomen entspricht zunächst der Differentialdiagnose von Schilddrüsenknoten. Die Basisdiagnostik umfasst Anamnese, klinische Untersuchung, Schilddrüsensonografie sowie eine Laborchemie für TSH und Calcitonin. Zusätzlich bietet die Szintigrafie mit ⁹⁹Tc-Pertechnetat eine funktionelle Beurteilung von Schilddrüsenknoten. Im Falle eines sonografisch suspekten oder hypofunktionellen („kalten“) Schilddrüsenknotens ist eine weitere Abklärung mittels Feinnadelpunktion und anschließender Cytologie indiziert. Neue Verfahren, wie Elastografie, PET/CT und molekulare Cytogenetik können die etablierte Diagnostik potentiell ergänzen und verbessern. Das gemeinsame Ziel der Diagnostik besteht darin, maligne von benignen Knoten zu differenzieren und einer operativen Therapie zuzuführen. Im Falle eines Schilddrüsenkarzinoms ermöglicht eine präzise präoperative Diagnostik, die notwendige Therapie optimal zu planen und Nachoperationen zu verhindern. Die Prognose des operierten Schilddrüsenkarzinoms hängt entscheidend von der Histologie und vom Tumorstadium ab. In der Tumornachsorge fungiert die Thyreoglobulinkonzentration nach erfolgter Thyreoidektomie und Radioiodtherapie als wertvoller Tumormarker.

The clinical diagnostics for thyroid cancer initially comprise the differential diagnosis of thyroid nodules. The basic diagnostic work-up includes a case history, clinical examination and laboratory tests for TSH and calcitonin. In addition scintigraphy with 99Tc-pertechnetate allows a functional evaluation of thyroid nodules. In the case of a sonographically suspicious or hypofunctional (“cold”) thyroid nodule further clarification by means of fine-needle aspiration biopsy and subsequent cytology is indicated. New procedures such as elastography, PET/CT and molecular cytogenetics have the potential to supplement and improve the established diagnostic methods. The common objective of diagnostic methods is to differentiate between malignant and benign nodules and prepare the way for surgical treatment. In the case of thyroid carcinoma a precise preoperative diagnostic work-up allows an optimal planning of the necessary surgical therapy and helps to avoid reoperation. The prognosis of patients operated for thyroid cancer depends decisively on the histology and tumor stage. In follow-up of tumor patients, the thyroglobulin concentration after successful thyroidectomy and radioiodine therapy serves as a valuable tumor marker.

Key words

thyroid neoplasm - thyroid carcinoma - diagnostics - thyroid ultrasound - fine needle aspiration - guidelines for practice

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