37. Kalter Strumaknoten ? eine absolute Operationsindikation?

Frilling, Andrea; Autschbach, Rüdiger; Gómez, José R Arrieta; Kremer, K

doi:10.1007/bf01274354

Cited by 3 publications

(2 citation statements)

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“…This value is still rather low and probably goes back to the small size of two (of five) carcinomas around one centimetre in center A. Bearing in mind this resolution limit of thyroid scintigraphy and taking into account the published malignancy risk for hypofunctioning nodules as 5% to 10%, the finding of a hypofunctioning and solid and ttw nodule should prompt FNB [23,28]. Radionuclide scans are the standard method for the evaluation of the function of TNs.…”

Section: Discussionmentioning

confidence: 99%

Thyroid Imaging Reporting and Data Systems: Applicability of the “Taller than Wide” Criterium in Primary/Secondary Care Units and the Role of Thyroid Scintigraphy

Petersen,

Schenke,

Veit

et al. 2024

JCM

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Background: To examine the applicability of the “taller than wide” (ttw) criterium for risk assessment of thyroid nodules (TNs) in primary/secondary care units and the role of thyroid scintigraphy therein. Methods: German bicenter study performed in a setting of primary/secondary care. Patient recruitment and analysis in center A was conducted in a prospective manner. In center B, patient data were retrieved from a database that was originally generated by prospective data collection. TNs were assessed by ultrasound and thyroid scans, mostly fine needle biopsy and occasionally surgery and others. In center A, only patients who presented for the first time were included. The inclusion criterion was any TN ≥ 10 mm that had at least the following two sonographic risk features: solidity and a ttw shape. In center B, consecutive patients who had at least ttw and hypofunctioning nodules ≥ 10 mm were retrieved from the above-mentioned database. The risk of malignancy was determined according to a mixed reference standard and compared with literature data. Results: In center A, 223 patients with 259 TNs were included into the study. For further analysis, 200 nodules with a reference standard were available. The overall malignancy rate was 2.5% (upper limit of the 95% CI: 5.1%). After the exclusion of scintigraphically hyperfunctioning nodules, the malignancy rate increased slightly to 2.8% (upper limit of the 95% CI: 5.7%). Malignant nodules exhibited sonographic risk features additional to solidity and ttw shape more often than benign ones. In addition to the exclusion of hyperfunctioning nodules, when considering only nodules without additional US risk features, i.e., exclusively solid and ttw-nodules, the malignancy rate decreased to 0.9% (upper limit 95% CI: 3.7%). In center B, from 58 patients, 58 ttw and hypofunctioning TNs on thyroid scans with a reference standard were available. Malignant nodules from center B were always solid and hypoechoic. The overall malignancy rate of hypofunctioning and ttw nodules was 21%, with the lower limit of the 95% CI (one-sided) being 12%. Conclusions: In primary/secondary care units, the lowest TIRADS categories for indicating FNB, e.g., applying one out of five sonographic risk features, may not be appropriate owing to the much lower a priori malignancy risk in TNs compared to tertiary/quaternary care units. Even the combination of two sonographic risk features, “solidity” and “ttw”, may only be appropriate in a limited fashion. In contrast, the preselection of TNs according to hypofunctioning findings on thyroid scans clearly warranted FNB, even when applying only one sonographic risk criterion (“ttw”). For this reason, thyroid scans in TNs may not only be indicated to rule out hyperfunctioning nodules from FNB but also to rule in hypofunctioning ones.

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Section: Discussionmentioning

confidence: 99%

Thyroid Imaging Reporting and Data Systems: Applicability of the “Taller than Wide” Criterium in Primary/Secondary Care Units and the Role of Thyroid Scintigraphy

Petersen,

Schenke,

Veit

et al. 2024

JCM

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“…In contrast to the scintigraphic recognition of hyperfunctioning nodules, the finding of a hypofunctioning nodule is not viewed as a helpful diagnostic contribution to assessing the risk of malignancy by some authors. In older retrospective evaluations of surgical patients from the 1960s to 1980s in Germany, malignancy rates of only 3 to 6 % were described for surgical resections on hypofunctioning TNs ( [35] with the consequent recommendation that the finding of a scintigraphically hypofunctioning nodule alone is not an indication for surgery [36]. Significantly higher malignancy rates in hypofunctioning TNs have been described in prospective and retrospective international studies: 12.3 % (Italy), 22 % (Scandinavia), 31 % (India), 22.6 % (Italy), 38.5 % (Brazil) or 9.8 % (Indonesia) ( [37,38,39,40,41,42]).…”

Section: Malignancy Rate Of Hypo-and Hyperfunctioning Thyroid Nodulesmentioning

confidence: 99%

Distribution of Functional Status of Thyroid Nodules and Malignancy Rates of Hyperfunctioning and Hypofunctioning Thyroid Nodules in Germany

et al. 2022

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Aim Thyroid scintigraphy enables the depiction of the functional status of thyroid nodules (TNs) with both, 99mTc-pertechnetate and 123Iodine. 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. Methods 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. Results 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%. Conclusion 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.

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Schilddrüse

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2000

Zytopathologie

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37. Kalter Strumaknoten ? eine absolute Operationsindikation?

Cited by 3 publications

References 4 publications

Thyroid Imaging Reporting and Data Systems: Applicability of the “Taller than Wide” Criterium in Primary/Secondary Care Units and the Role of Thyroid Scintigraphy

Thyroid Imaging Reporting and Data Systems: Applicability of the “Taller than Wide” Criterium in Primary/Secondary Care Units and the Role of Thyroid Scintigraphy

Distribution of Functional Status of Thyroid Nodules and Malignancy Rates of Hyperfunctioning and Hypofunctioning Thyroid Nodules in Germany

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