Bochum, 4. Juli 2020:

Kürzlich erschien in Clinical Endocrinology (1) eine Arbeit, welche den diagnostischen Wert einer Feinnadelbiopsie mit dem einer Stanzbiopsie bei Ultraschall-basiertem Verdacht auf ein  follikuläres Schilddrüsenkarzinom untersuchte. Im Folgenden soll der Text des Abstracts der Arbeit wiedergegeben werden.

Abstract

Objective
We evaluated the preoperative diagnostic values of ultrasound (US), fine‐needle aspiration (FNA) and core needle biopsy (CNB) leading to surgery in patients with FTC (follicular thyroid carcinoma).

Methods
From October 1994 to July 2016, 298 patients with FTC who had preoperative US images and underwent US‐guided FNA or CNB and surgery were included in this study. We evaluated the results of preoperative FNA or CNB based on the Bethesda system and the US findings according to the Korean thyroid imaging reporting and data system (K‐TIRADS).

Results
Predominant US features of FTC showed solid, hypo‐ or iso‐echogenicity, oval smooth margin and halo with no calcification. Based on K‐TIRADS, 140 (47.0%) patients with FTC were categorized as low suspicion, 133 (44.63%) as intermediate suspicion and 25 (8.4%) as high suspicion at US. Considering only Fine-Needle Aspiration cytology (n = 230), 6.9% were revealed as Bethesda class I, 16.1% as class II, 37.0% as class III, 29.1% as class IV and 10.9% as class V. Considering the 68 cases with Core Needle Biopsy results, 2.9% were revealed as class I, 4.4% as class II, 20.6% as class III and 72.1% as class IV. Despite multiple FNAs, 16.7% of the 84 patients with FTC still obtained Bethesda class I or class II. CNB results in patients with FTC had a significantly higher rate of Bethesda class IV compared to the FNA results (P  < .001). FTCs with distant metastasis exhibited a significantly higher rate of Bethesda classes IV and V compared to those without distant metastasis (P  = .004).

Conclusion
Surgery for FTC is deferred only with preoperative US and FNA. CNB in patients with FTC can lead to surgery better than FNA. Therefore, if the US feature is characteristic and a serially growing large nodule is suspected, the first attempt of CNB may be helpful in selecting a surgical candidate.

Kommentar

Eine telefonische Umfrage bei  Mitgliedern der DGE ergab, dass die TIRADS-Klassifikation  auch  in Deutschland vielfach angewendet wird, eine Stanzbiopsie jedoch kaum erfolgt. Die in der Arbeit von Ko Woon Park et al. (1) präsentierten Resultate mit einer Stanzbiopsie zur präoperativen Diagnose eines follikulären Schilddrüsenkarzinoms sprechen für deren Treffsicherheit bei höher- bis hochgradigem Verdacht im Ultraschall-Bild nach TIRADS.

Frage an alle Leser dieses Blogbeitrags: Führt jemand statt einer Feinnadelbiopsie eine Stanzbiopsie durch, wenn im Ultraschallbild nach TIRADS ein höher- bis hochgradiger Verdacht auf ein follikuläres Schilddrüsenkarzinom besteht?