Background: Reported results for thyroid nodule fine-needle aspiration (FNA) cytology mainly originate from
tertiary centers. However, thyroid nodule FNA cytology is mainly performed in primary care settings for which
the distribution of FNA Bethesda categories and their respective malignancy rates are largely unknown.
Therefore, this study investigated FNA cytology malignancy rates of a large primary care setting to determine
to what extent current evidence-based strategies for the malignancy risk stratification of thyroid nodules are
applied and applicable in such primary care settings.
Methods: In a primary care setting, 9460 FNAs of thyroid nodules were retrospectively analyzed from 8380
patients evaluated by one cytologist (I.R.) during a period of two years. The 8380 FNA cytologies were
performed by 64 physicians in different private practices throughout Germany in primary care settings.
Results: The cytopathologic results were classified according to theBethesda Systemas non-diagnostic in 19%, cyst/
cystic nodule in 21%, benign (including thyroiditis) in 48%, atypia of undetermined significance/follicular lesion of
undetermined significance (AUS/FLUS) in 6%, follicular neoplasms/suspicious for follicular neoplasm (FN/SFN) in
4%, suspicious for malignancy (SFM) in 1%, and malignant in 1%. The proportion of patients proceeding to surgery
or with a follow-up of at least one year and the observed risks of malignancy were 22%/8% for AUS/FLUS, 69%/
17% for FN/SFN, 78%/86% for SFM, and 71%/98% for malignant. For 112 cytologically suspicious and malignant
FNAs, there were 102 true positives and 10 false positives, considering histology as gold standard.
Conclusion: At variance with other data mostly originating from tertiary centers, these data demonstrate low
percentages for malignant, SFM, FN/SFN, and AUS/FLUS, and high percentages for cysts/cystic nodules in this primary care setting in Germany. The risks of malignancy for malignant, SFM, AUS/FLUS, and FN/SFN FNA
cytologies are according to Bethesda recommendations.:1 ABKÜRZUNGSVERZEICHNIS ............................................................................................................... 1
2 EINFÜHRUNG .......................................................................................................................................... 2
2.1 DAS ORGAN SCHILDDRÜSE ................................................................................................................................ 3
2.1.1 Anatomie der Schilddrüse ......................................................................................................................... 3
2.1.2 Funktion der Schilddrüse .......................................................................................................................... 3
2.2 SCHILDDRÜSENKNOTEN ..................................................................................................................................... 4
2.2.1 Epidemiologie der Schilddrüsenknoten .............................................................................................. 4
2.2.2 Ätiologie der Schilddrüsenknoten ......................................................................................................... 4
2.2.3 Jodversorgung in Deutschland ................................................................................................................ 5
2.2.4 Symptomatik der Schilddrüsenknoten ................................................................................................ 5
2.2.5 Diagnostik von Schilddrüsenknoten ..................................................................................................... 6
2.2.6 Die Feinnadelaspirationszytologie (FNA) ......................................................................................... 9
2.2.7 Therapeutisches Management ............................................................................................................ 11
2.3 DIE ABLEITUNG DER RATIONALE .................................................................................................................. 13
3 PUBLIKATIONSMANUSKRIPT ........................................................................................................ 14
4 ZUSAMMENFASSUNG ......................................................................................................................... 22
4.1 SCHLUSSFOLGERUNG ....................................................................................................................................... 26
5 LITERATURVERZEICHNIS ................................................................................................................ 28
6 ANLAGEN ............................................................................................................................................... 33
6.1 TABELLE 1: MALIGNITÄTSRISIKO NACH SONOGRAPHISCHEM ERSCHEINUNGSBILD UND FNA
INDIKATION FÜR SCHILDDRÜSENKNOTEN (36) ........................................................................................................... 33
6.2 TABELLE 2: DAS BETHESDA SYSTEM FOR REPORTING THYROID CYTHOPATHOLOGY. DIAGNOSTISCHE
KATEGORIEN UND MALIGNITÄTSRISIKEN (36) ........................................................................................................... 34
6.3 ABBILDUNG 1: ALGORITHMUS FÜR PATIENTEN MIT SCHILDDRÜSENKNOTEN NACH DER AMERICAN
THYROID ASSOCIATION (36) .......................................................................................................................................... 35
6.4 DARSTELLUNG DES EIGENEN BEITRAGS AN DER PUBLIKATION ............................................................... 36
6.5 ERKLÄRUNG ÜBER DIE EIGENSTÄNDIGE ABFASSUNG DER ARBEIT .......................................................... 54
6.6 LEBENSLAUF ..................................................................................................................................................... 55
6.7 VERZEICHNIS WISSENSCHAFTLICHER VERÖFFENTLICHUNGEN ................................................................ 56
6.8 DANKSAGUNG ................................................................................................................................................... 57
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:75411 |
| Date | 13 July 2021 |
| Creators | Ullmann, Maha Saida |
| Contributors | Universität Leipzig |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | German |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:doctoralThesis, info:eu-repo/semantics/doctoralThesis, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
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