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Mini-Review

Nutzen molekularer Analysen beim Schilddrüsenkarzinom

Published Online:June 11, 2019https://doi.org/10.1024/1661-8157/a003240

Abstract

Zusammenfassung. Im klinischen Alltag ist es eine Herausforderung, in einer steigenden Anzahl nachgewiesener Schilddrüsenknoten die therapiebedürftigen herauszufiltern. In den vergangenen Jahren hat sich ein Trend zur Deeskalation von Abklärung und Therapie gezeigt. Aktuelle Bestrebungen gehen dahin, Patienten mit wenig aggressiven Schilddrüsenkarzinomen einer aktiven Überwachung anstelle einer ablativen Therapie zu unterziehen, wobei dafür eine verlässliche Risikostratifizierung wichtig ist. Wissenschaftliche Fortschritte haben zu einem besseren Verständnis der molekularen Veränderungen bei Schilddrüsenneoplasien geführt. Welche Rolle die Mutationsanalyse in der Dignitätsbeurteilung von Schilddrüsenknoten als Ergänzung zur Zytologie sowie zur Risikoeinschätzung von differenzierten Schilddrüsenkarzinomen und damit zur Festlegung des notwendigen Therapieausmasses spielen kann, ist aktuell noch unklar.


Benefits of Molecular Analyses in Thyroid Carcinoma

Abstract. The widespread access to neck ultrasonography has led to high detection rates of thyroid nodules, whose vast majority will remain clinically silent. In daily practice it is a challenge to filter out the thyroid nodules that require medical attention. This is usually achieved by a combination of sonomorphologic criteria and fine-needle aspiration cytology. In recent years, there is a trend toward deescalation in diagnostic and therapeutic measures for thyroid nodules. Some authors even advocate active surveillance instead of surgical approaches for very low-risk thyroid carcinoma. This approach requires an accurate assessment of the malignant potential of each thyroid nodule. As recent studies have allowed better understanding of molecular pathogenesis of thyroid cancer, the mutational profile of thyroid nodules has emerged as a new tool for assessment of thyroid nodules. Its exact clinical application in daily routine remains, however, unclear.


Résumé. L’augmentation des ultrasonographies cervicales de routine a conduit à une augmentation de la détection de nodules thyroïdiens, dont la vaste majorité pourtant ne se manifestera jamais cliniquement. Il est donc important de différencier les nodules thyroïdiens qui nécessitentnt un traitement. Ceci est habituellement effectué à l’aide de critères sonomorphologiques et de la cytologie de l’aspiration à l’aiguille fine. Récemment, une tendance vers une réduction des mesures diagnostiques et thérapeutiques pour les nodules thyroïdiens a été observée. Certains auteurs préconisent même la surveillance active plutôt que la chirurgie dans certains cas de carcinome thyroïdien à bas risque. Ceci requiert une estimation exacte du profil de risque de chaque nodule. S’appuyant sur les progrès dans la compréhension de la pathogenèse moléculaire du cancer thyroïdien, la recherche de mutations génétiques a été proposée pour améliorer l’estimation du profil de risque de chaque nodule. Bien que prometteuse, l’utilité de cette technique dans la pratique quotidienne reste à prouver.

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