Increasing Importance

Fine Needle Aspiration in the Investigation of Thyroid Nodules—Indications, Procedures, and Interpretation by PD Dr. med. Joachim Feldkamp, Prof. Dr. Dr. med. Dagmar Führer, Prof. Dr. med. Markus Luster, Prof. Dr. med. Thomas J. Musholt, Prof. Dr. med. Christine Spitzweg, and Prof. Dr. med. Matthias Schott in issue 20/2016

Feldkamp et al. emphasized the importance of the cytological investigation of thyroid nodules for their potential surgical treatment and define indications for and the validity of fine needle aspiration biopsy with a degree of clarity that is much welcomed, and while taking into consideration ultrasonographic and scintigraphic criteria (1). It is to be hoped that their article will find a wide readership among outpatient primary care providers too. I wish to comment on two issues.

• The statement that methoxyisobutylisonitrile (MIBI) scintigraphy is not useful in the routine work-up of thyroid nodules is too much of a generalization. At least this statement should be qualified by adding that this investigation can make a great contribution to reaching a decision in favor of or against surgery in cases where the cytology finding is non-diagnostic. According to recent relevant publications (2–4) it would not be surprising if in future MIBI scintigraphy increased in importance, since the accuracy of cytopathology within the outpatient setting is moderate at best.
• Because of the close correlation between tumor volume and calcitonin concentrations on the one hand and the now low-threshold access to molecular genetic diagnostic evaluation on the other hand, the benefit of fine needle aspiration cytology for the primary diagnostic evaluation of medullary thyroid cancer (MTC) has become mostly undetectable. For example, cytology in a scenario of a known germline mutation in the RET gene does not contribute to the decision on the extent or timing of thyroid surgery. The same is true for typical cases of sporadic MTCs, which become noticeable because of massively increased serum concentrations of calcitonin when investigating solitary or dominant hypoechoic nodules >1 cm in diameter. In this setting too, the surgeon who is familiar with the tumor entity will not make his or her strategy dependent on the results of fine needle aspiration cytology (5).

DOI: 10.3238/arztebl.2017.0025a

Dr. med. Tim Scholz

Brandenburg an der Havel

References

1. Feldkamp J, Führer D, Luster M, Musholt TJ, Spitzweg C, Schott M: Fine needle aspiration in the investigation of thyroid nodules—indications, procedures and interpretation. Dtsch Arztebl Int 2016; 113: 353–9

2. Wale A, Miles KA, Young B, et al.: Combined (99m)Tc-methoxyisobutylisonitrile scintigraphy and fine-needle aspiration cytology offers an accurate and potentially cost-effective investigative strategy for the assessment of solitary or dominant thyroid nodules. Eur J Nucl Med Mol Imaging 2014; 41: 105–15

3. Riazi A, Kalantarhormozi M, Nabipour I, et al.: Technetium-99m methoxyisobutylisonitrile scintigraphy in the assessment of cold thyroid nodules: is it time to change the approach to the management of cold thyroid nodules? Nucl Med Commun 2014; 35: 51–7

4. Giovanella L, Suriano S, Maffioli M, Ceriani L, Spriano G: (99m)Tc-sestamibi scanning in thyroid nodules with nondiagnostic cytology. Head Neck 2010; 32: 607–11

5. Machens A, Dralle H: Biomarker-based risk stratification for previously untreated medullary thyroid cancer. J Clin Endocrinol Metab 2010; 95: 2655–63