Subscribe to RSS
DOI: 10.1055/s-0031-1301350
Feinnadelbiopsie (FNB) der Schilddrüse
Fine Needle Biopsy (FND) of the ThyroidPublication History
Publication Date:
15 March 2012 (online)
![](https://www.thieme-connect.de/media/nuklmed/201201/lookinside/thumbnails/10.1055-s-0031-1301350-1.jpg)
Zusammenfassung
Die Feinnadelbiopsie (FNB) der Schilddrüse dient dem Erkennen operationsbedürftiger Läsionen, aber auch der Reduktion der in Deutschland nach wie vor zu hohen Schilddrüsenoperationszahlen. Dazu weist die FNB eine Reihe von zytologischen Besonderheiten auf, deren Kenntnis und Akzeptanz eine maßgebliche Voraussetzung für den erfolgreichen Einsatz beim klinischen Management von Patienten mit szintigrafisch hypofunktionellen und sonografisch auffälligen Schilddrüsenknoten darstellt. Der vorliegende Übersichtsartikel beschreibt den gegenwärtigen Standard der Gewinnung, Verarbeitung und zytopathologischen Beurteilung mittels FNB gewonnenen Materials. Besonderes Augenmerk wird der rasant wachsenden Bedeutung der Molekularpathologie zur Verbesserung der diagnostischen Treffsicherheit der FNB gewidmet.
Abstract
The major goals of fine needle biopsy (FNB) of the thyroid are the cytological identification of thyroid lesions requiring surgical removal as well as reduction of the exceptionally high rate of thyroid operation in Germany. Both the knowledge and acceptance of several peculiarities are prerequisites for a successful application of the method for the clinical management of patients with scintigraphically hypofunctional and sonographically suspicious thyroid nodules. This overview describes the present standards in the acquisition, technical workup and cytopathological interpretation of thyroid material obtained by FNB, particularly focusing on the rapidly growing relevance of molecular pathology to increase the diagnostic accuracy of FNB of the thyroid.
-
Literatur
- 1 AACE/AME Task Force on Thyroid Nodules . American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 2006; 12: 63-102
- 2 Afify AM, Liu J, al-Khafaji BM. Cytologic artifacts and pitfalls of thyroid fine-needle aspiration using ThinPrep: a comparative retrospective review. Cancer 2001; 93: 179-186
- 3 Barwad A, Dey P, Nahar Saikia U et al. Fine needle aspiration cytology of insular carcinoma of thyroid. Diagn Cytopathol 2011; DOI: 10.1002/dc.21634. [Epub ahead of print]
- 4 Chen YT, Kitabayashi N, Zhou XK et al. MicroRNA analysis as a potential diagnostic tool for papillary thyroid carcinoma. Mod Pathol 2008; 21: 1139-1146
- 5 Choi YL, Kim MK, Suh JW et al. Immunoexpression of HBME-1, high molecular weight cytokeratin, cytokeratin 19, thyroid transcription factor-1, and E-cadherin in thyroid carcinomas. J Korean Med Sci 2005; 20: 853-859
- 6 Cochand-Priollet B, Prat JJ, Polivka M et al. Thyroid fine needle aspiration: the morphological features on ThinPrep slide preparations. Eighty cases with histological control. Cytopathology 2003; 14: 343-349
- 7 Cochand-Priollet B, Schmitt FC, Tötsch M et al. The Bethesda terminology for reporting thyroid cytopathology: from theory to practice in Europe. Acta Cytol 2011; 55: 507-511
- 8 Cooper DS, Doherty GM, Haugen BR et al. The American Thyroid Association Guidelines Taskforce: Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006; 16: 109-142
- 9 DeMay RM. Follicular lesions of the thyroid. W(h)ither follicular carcinoma?. Am J Clin Pathol 2000; 114: 681-683
- 10 Droese M. Punktionszytologie der Schilddrüse. 2. Auflage. Stuttgart, New York: Schattauer; 1995
- 11 Dwight T, Thoppe SR, Foukakis T et al. Involvement of the PAX8/peroxisome proliferator-activated receptor gamma rearrangement in follicular thyroid tumors. J Clin Endocrinol Metab 2003; 88: 4440-4445
- 12 Ferraz C, Rehfeld C, Krogdahl A et al. Detection Of Point Mutations And Rearrangements In Routine Air Dried Fine Needle Aspiration (FNA) Smears. Thyroid 2011; 21 (S1) A-118
- 13 Führer D, Schmid KW. Gutartiger Schilddrüsenknoten oder Schilddrüsenmalignom?. Internist (Berl) 2010; 51: 611-619
- 14 Gharib H, Goellner JR, Johnson DA. Fine-needle aspiration cytology of the thyroid. A 12-year experience with 11 000 biopsies. Clin Lab Med 1993; 13: 699-709
- 15 Gharib H, Papini E, Paschke R et al. AACE/AME/ETA Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. J Endocrinol Invest 2010; 33 (Suppl) 1-50
- 16 Goellner JR, Gharib H, Grant CS et al. Fine needle aspiration cytology of the thyroid, 1980 to 1986. Acta Cytol 1987; 31: 587-590
- 17 Görges R, Eising EG, Fotescu D et al. Diagnostic value of high-resolution B-mode and power-mode sonography in the follow-up of thyroid cancer. Eur J Ultrasound 2003; 16: 191-206
- 18 Guidelines of the Papanicolaou Society of Cytopathology for the Examination of Fine-Needle Aspiration Specimens from Thyroid Nodules . The Papanicolaou Society of Cytopathology Task Force on Standards of Practice. Mod Pathol 1996; 9: 710-715
- 19 Guiter GE, Auger M, Ali SZ et al. Cytopathology of insular carcinoma of the thyroid. Cancer 1999; 87: 196-202
- 20 Ito Y, Yoshida H, Tomoda C et al. HBME-1 expression in follicular tumor of the thyroid: an investigation of whether it can be used as a marker to diagnose follicular carcinoma. Anticancer Res 2005; 25: 179-182
- 21 Karger S, Engelhardt C, Eszlinger M et al. Cytology and mRNA expression analysis of fine needle aspirates of thyroid nodules in an East German region with borderline iodine deficiency. Horm Metab Res 2006; 38: 662-667
- 22 Karger S, Krause K, Gutknecht M et al. DM3, TFF3 and LGALS3 are discriminative molecular markers in fine-needle aspiration biopsies of benign and malignant thyroid tumours. Br J Cancer 2012; 106: 562-568
- 23 Kim TY, Kim WB, Gong G et al. Metastasis to the thyroid diagnosed by fine-needle aspiration biopsy. Clin Endocrinol (Oxf) 2005; 62: 236-241
- 24 Kini SR. Thyroid Cytopathology. An Atlas and Text. Wolter Kluwer Lippincott Williams & Wilkins Philadephia; 2008
- 25 Krause M, Eszlinger M, Gimm O et al. TTF3-based candidate gene discrimination of benign and malignant thyroid tumors in a region with borderline iodine deficiency. J Clin Endocrinol Metab 2008; 93: 1390-1393
- 26 Layfield LJ, Cibas ES, Gharib H et al. Thyroid aspiration cytology: current status. CA Cancer J Clin 2009; 59: 99-110
- 27 Luze T, Tötsch M, Bangerl I et al. Fine needle aspiration cytodiagnosis of anaplastic carcinoma and malignant haemangioendothelioma of the thyroid in an endemic goitre area. Cytopathology 1990; 1: 305-310
- 28 Maruta J, Hashimoto H, Yamashita H et al. Immunostaining of galectin-3 and CD44v6 using fine-needle aspiration for distinguishing follicular carcinoma from adenoma. Diagn Cytopathol 2004; 31: 392-396
- 29 Mazeh H, Mizrahi I, Halle D et al. Development of a microRNA-based molecular assay for the detection of papillary thyroid carcinoma in aspiration biopsy samples. Thyroid 2011; 21: 111-118
- 30 Mikuz G, Hofstädter F, Schwarzlmüller B. Feulgencytophotometric DNA-investigations on false and correct positive fine needle biopsies of the thyroid gland. Verh Dtsch Ges Pathol 1977; 61: 290-294
- 31 Musholt TJ, Fottner C, Weber MM et al. Detection of papillary thyroid carcinoma by analysis of BRAF and RET/PTC1 mutations in fine-needle aspiration biopsies of thyroid nodules. World J Surg 2010; 34: 2595-2603
- 32 Nagarajah J, Sheu-Grabellus SY, Leitzen C et al. Optimization of the fine needle aspiration biopsy (FNAB) of thyroid nodules – automatic aspirator versus manual technique. Nuklearmedizin 2011; 50: 189-194
- 33 Nasser SM, Pitman MB, Pilch BZ et al. Fine-needle aspiration biopsy of papillary thyroid carcinoma: diagnostic utility of cytokeratin 19 immunostaining. Cancer 2000; 90: 307-311
- 34 Nayar R, Ivanovic M. The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer 2009; 117: 195-202
- 35 Nikiforova MN, Tseng GC, Steward D et al. MicroRNA expression profiling of thyroid tumors: biological significance and diagnostic utility. J Clin Endocrinol Metab 2008; 93: 1600-1608
- 36 Oertel YC, Oertel JE. Thyroid cytology and histology. Baillieres Best Pract Res Clin Endocrinol Metab 2000; 14: 541-557
- 37 Ohori NP, Nikiforova MN, Schoedel KE et al. Contribution of molecular testing to thyroid fine-needle aspiration cytology of “follicular lesion of undetermined significance/atypia of undetermined significance”. Cancer (Cancer Cytopathol) 2010; 118: 17-23
- 38 Paschke R, Schmid KW, Gärtner R et al. Epidemiologie, Pathophysiologie, leitliniengerechte Diagnose und Therapie von Schilddrüsenknoten. Med Klin (Munich) 2010; 105: 80-87
- 39 Redman R, Zalaznick H, Mazzaferri EL et al. The impact of assessing specimen adequacy and number of needle passes for fine-needle aspiration biopsy of thyroid nodules. Thyroid 2006; 16: 55-60
- 40 Reiners C, Wegscheider K, Schicha H et al. Prevalence of thyroid disorders in the working population of Germany: ultrasonography screening in 96 278 unselected employees. Thyroid 2004; 14: 926-932
- 41 Rossing M, Kaczkowski B, Futoma-Kazmierczak E et al. A simple procedure for routine RNA extraction and miRNA array analyses from a single thyroid in vivo fine needle aspirate. Scand J Clin Lab Invest 2010; 70: 529-534
- 42 Salvatore G, Giannini R, Faviana P et al. Analysis of BRAF point mutation and RET/PTC rearrangement refines the fine-needle aspiration diagnosis of papillary thyroid carcinoma. J Clin Endocrinol Metab 2004; 89: 5175-5180
- 43 Santos JE, Leiman G. Nonaspiration fine needle cytology. Application of a new technique to nodular thyroid disease. Acta Cytol 1988; 32: 353-356
- 44 Savin S, Cvejic D, Isic T et al. The efficacy of the thyroid peroxidase marker for distinguishing follicular thyroid carcinoma from follicular adenoma. Exp Oncol 2006; 28: 70-74
- 45 Schäffer R. Die Feinnadelpunktion der Schilddrüse im Wandel der Zeit. Verh Dtsch Ges Zyt 2005; 24: 104-121
- 46 Schicha H, Hellmich M, Lehmacher W et al. Should all patients with thyroid nodules >1 cm undergo fine-needle aspiration biopsy?. Nuklearmedizin 2009; 48: 79-83
- 47 Schmid KW, Hittmair A, Ofner C et al. Metastatic tumors in fine needle aspiration biopsy of the thyroid. Acta Cytol 1991; 35: 722-724
- 48 Schmid KW, Reiners C. Wann ist die Feinnadelbiopsie der Schilddrüse am effektivsten?. Pathologe 2011; 32: 169-173
- 49 Shen PU, Kuhel WI, Yang GC et al. Intraoperative touch-imprint cytological diagnosis of follicular variant of papillary thyroid carcinoma. Diagn Cytopathol 1997; 17: 80-83
- 50 Sheu SY, Schmid KW. Multiple endocrine neoplasien type 2. Pathologe 2010; 31: 449-454
- 51 The Bethesda System for Reporting Thyroid Cytopathology . Definitions, Criteria and Explanatory Notes. Ali SZ, Cibas ES. eds. Springer New York Dordrecht Heidelberg London: 2010
- 52 Tötsch M, Öztürk K, Farahati J et al. Evaluation of diagnostic groups in liquid-based-FNA (ThinPrep) of the thyroid [abstract]. Thyroid 2005; 15: 211-212
- 53 Tötsch M, Quadbeck B, Görges R et al. Präoperative Punktionszytologie beim Schilddrüsenkarzinom. Der Onkologe 2005; 11: 40-49
- 54 WHO histological classification of thyroid and parathyroid tumours . In: World Health Organization Classification of Tumours. Pathology & Genetics. Tumours of Endocrine Organs. DeLellis RA, Lloyd RV, Heitz PU, Eng C. eds. IARC Press; Lyon: 2004. pp 49-123
- 55 Wiedemann W, Wurster K, Strohm C. Ultraschallgeführte Feinnadelpunktion der Schilddrüse. Radiologe 1989; 29: 109-118
- 56 Yang J, Schnadig V, Logrono R et al. Fine-needle aspiration of thyroid nodules: a study of 4 703 patients with histologic and clinical correlations. Cancer 2007; 111: 306-315
- 57 Yassa L, Cibas ES, Benson CB et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer 2007; 111: 508-516