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Minimal-invasives follikuläres Schilddrüsenkarzinom

Eine Thyreoidektomie ist nicht obligat

Minimally invasive follicular thyroid carcinoma

Not always total thyroidectomy

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Zusammenfassung

Das leitliniengerechte Therapiekonzept des follikulären Schilddrüsenkarzinoms (FTC) bestand bisher in einer totalen Thyreoidektomie mit Lymphknotendissektion und Radiojodtherapie. In Anbetracht des geringen Malignitätspotenzials scheint beim minimal-invasiven follikulären Schilddrüsenkarzinom (MIFTC) ein eingeschränkt radikales Operationsverfahren adäquat. Das MIFTC ist allerdings in der Literatur eine inhomogene Gruppe und unterschiedlich definiert. Daher hat Rosai im Jahr 2005 eine klinisch prognoseorientierte Klassifikation vorgeschlagen, die auf dem Ausmaß von Kapsel- und Gefäßinvasion beruht: das MIFTC mit ausschließlicher Kapselinvasion und mit limitierter Gefäßinvasion (≤3), das gekapselte FTC mit ausgedehnter Gefäßinvasion (>3) und das weit invasive FTC mit grob invasivem Wachstum.

Voraussetzung für die Diagnose MIFTC ist die Aufarbeitung des gesamten gekapselten follikulären Knotens oder von mindestens 10 Tumorblöcken der Tumorkapsel; der Pathologie kommt somit eine wesentliche therapierelevante Rolle zu. Aufgrund der exzellenten Prognose stellt die Hemithyreoidektomie für das MIFTC mit ausschließlicher Kapselinvasion ein adäquates Operationsverfahren dar, bei limitierter Gefäßinvasion ist es ebenso in Erwägung zu ziehen, unterliegt jedoch noch einer klinischen Prüfung. Es besteht keine Indikation zur Durchführung einer systematischen Lymphadenektomie.

Abstract

Current treatment guidelines for follicular thyroid carcinoma (FTC) recommend total thyroidectomy, lymphadenectomy and radioiodine ablation. Considering the low malignant potential of minimally invasive follicular thyroid carcinoma (MIFTC), a limited radical therapeutic procedure may be adequate. MIFTC is an intensely discussed group of tumors and a review of the literature reveals disagreement among experts concerning the criteria for a distinct definition. Therefore, in 2005 Rosai proposed a clinically more significant classification of FTC based on the extent of capsular and vascular invasion: MIFTC with capsular invasion only, with limited (≤3) vascular invasion, encapsulated FTC with extensive (>3) vascular invasion and broadly invasive FTC with extensive invasive growth.

For the diagnosis of MIFTC a complete investigation of the encapsulated follicular lesion should be performed by the pathologist and examination of at least 10 tissue blocks is mandatory. Due to the excellent prognosis hemithyroidectomy constitutes an adequate therapeutic approach in MIFTC with capsular invasion only and may also be considered for MIFTC with limited vascular invasion. There are no indications for systematic lymphadenectomy.

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Authors and Affiliations

  1. Chirurgische Abteilung, Kaiserin-Elisabeth-Spital der Stadt Wien, Huglgasse 1–3, 1150, Wien, Österreich

    M. Hermann, K. Tonninger, F. Kober & E.-M. Furtlehner

  2. Pathologisch-Bakteriologisches Institut, Kaiserin-Elisabeth-Spital der Stadt Wien, Wien, Österreich

    A. Schultheis & N. Neuhold

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  1. M. Hermann
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  2. K. Tonninger
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  4. E.-M. Furtlehner
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  5. A. Schultheis
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  6. N. Neuhold
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Correspondence to M. Hermann.

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Hermann, M., Tonninger, K., Kober, F. et al. Minimal-invasives follikuläres Schilddrüsenkarzinom. Chirurg 81, 627–635 (2010). https://doi.org/10.1007/s00104-009-1884-8

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