Skip to main content
Erschienen in: Der Pathologe 4/2015

01.07.2015 | Übersichten

Intraoperativer Gefrierschnitt der Schilddrüse

verfasst von: S. Synoracki, S. Ting, U. Siebolts, H. Dralle, O. Koperek, Univ.-Prof. Dr. K. W. Schmid

Erschienen in: Die Pathologie | Ausgabe 4/2015

Einloggen, um Zugang zu erhalten

Zusammenfassung

Der intraoperative Gefrierschnitt der Schilddrüse hat das Ziel, in kürzestmöglicher Zeit eine definitive Diagnose, die das weitere operative Management bestimmt, zu erhalten. Aufgrund der Besonderheiten der intraoperativen Diagnostik von Schilddrüsenläsionen ist eine bereits intraoperativ definitive Diagnose jedoch nur bei einem Teil der Fälle möglich. Falls intraoperativ keine definitive Diagnose gestellt werden kann, gelingt durch entsprechend bevorzugte Bearbeitung des Materials mit wenigen Ausnahmen eine abschließende Diagnosestellung spätestens innerhalb von 48 h. Diese Vorgehensweise setzt beim Pathologen und Chirurgen ein hohes Maß an Kommunikation und Kenntnis der Besonderheiten der Diagnostik und Therapie insbesondere von Schilddrüsenmalignomen voraus, da in Abhängigkeit vom histologischen Tumortyp unterschiedliche Operationsstrategien verfolgt werden.
Literatur
1.
Zurück zum Zitat Bronner MP, Hamilton R, LiVolsi VA (1994) Utility of frozen section analysis on follicular lesions of the thyroid. Endocr Pathol 5:154–161CrossRef Bronner MP, Hamilton R, LiVolsi VA (1994) Utility of frozen section analysis on follicular lesions of the thyroid. Endocr Pathol 5:154–161CrossRef
2.
Zurück zum Zitat Caraci P, Aversa S, Mussa A, Pancani G, Ondolo C, Conticello S (2002) Role of fine-needle aspiration biopsy and frozen-section evaluation in the surgical management of thyroid nodules. Br J Surg 89:797–801PubMedCrossRef Caraci P, Aversa S, Mussa A, Pancani G, Ondolo C, Conticello S (2002) Role of fine-needle aspiration biopsy and frozen-section evaluation in the surgical management of thyroid nodules. Br J Surg 89:797–801PubMedCrossRef
3.
Zurück zum Zitat Chadwick DR, Harrison BJ (1998) The role of fine-needle aspiration cytology and frozen section histology in management of differentiated thyroid cancer: the UK experience. Langenbecks Arch Surg 383:164–166PubMedCrossRef Chadwick DR, Harrison BJ (1998) The role of fine-needle aspiration cytology and frozen section histology in management of differentiated thyroid cancer: the UK experience. Langenbecks Arch Surg 383:164–166PubMedCrossRef
4.
Zurück zum Zitat Callcut RA, Selvaggi SM, Mack E, Ozgul O, Warner T, Chen H (2004) The utility of frozen section evaluation for follicular thyroid lesions. Ann Surg Oncol 11:94–98PubMedCrossRef Callcut RA, Selvaggi SM, Mack E, Ozgul O, Warner T, Chen H (2004) The utility of frozen section evaluation for follicular thyroid lesions. Ann Surg Oncol 11:94–98PubMedCrossRef
5.
Zurück zum Zitat Chen H, Nicol TL, Udelsman R (1995) Follicular lesions of the thyroid. Does frozen section evaluation alter operative management? Ann Surg 222:101–106PubMedCentralPubMedCrossRef Chen H, Nicol TL, Udelsman R (1995) Follicular lesions of the thyroid. Does frozen section evaluation alter operative management? Ann Surg 222:101–106PubMedCentralPubMedCrossRef
6.
Zurück zum Zitat DeMay RM (1998) Frozen section of thyroid? Just say no. Am J Clin Pathol 110:423–424PubMed DeMay RM (1998) Frozen section of thyroid? Just say no. Am J Clin Pathol 110:423–424PubMed
7.
Zurück zum Zitat Dosen D, Turic M, Smalcelj J, Janusic R, Grgic MP, Separovic V (2003) The value of frozen section in intraoperative surgical management of thyroid follicular carcinoma. Head Neck 25:521–528PubMedCrossRef Dosen D, Turic M, Smalcelj J, Janusic R, Grgic MP, Separovic V (2003) The value of frozen section in intraoperative surgical management of thyroid follicular carcinoma. Head Neck 25:521–528PubMedCrossRef
8.
Zurück zum Zitat Dralle H, Lorenz K, Machens A (2011) State of the art: surgery for endemic goiter – a plea for individualizing the extent of resection instead of heading for routine total thyroidectomy. Langenbecks Arch Surg 396:1137–1143PubMedCrossRef Dralle H, Lorenz K, Machens A (2011) State of the art: surgery for endemic goiter – a plea for individualizing the extent of resection instead of heading for routine total thyroidectomy. Langenbecks Arch Surg 396:1137–1143PubMedCrossRef
9.
Zurück zum Zitat Dralle H, Musholt TJ, Schabram J et al (2013) German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbecks Arch Surg 398:347–375PubMedCrossRef Dralle H, Musholt TJ, Schabram J et al (2013) German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbecks Arch Surg 398:347–375PubMedCrossRef
10.
Zurück zum Zitat Franc B (1995) Les aspects anatomo-pathologique actuels des cancers thyroidiens différenciés de souche folliculaire (vésiculaire): interet et necessité d’un langage commun. Ann Chir 49:909–921PubMed Franc B (1995) Les aspects anatomo-pathologique actuels des cancers thyroidiens différenciés de souche folliculaire (vésiculaire): interet et necessité d’un langage commun. Ann Chir 49:909–921PubMed
11.
Zurück zum Zitat Frank-Raue K, Machens A, Leidig-Bruckner G et al (2013) Prevalence and clinical spectrum of nonsecretory medullary thyroid carcinoma in a series of 839 patients with sporadic medullary thyroid carcinoma. Thyroid 23:294–300PubMedCrossRef Frank-Raue K, Machens A, Leidig-Bruckner G et al (2013) Prevalence and clinical spectrum of nonsecretory medullary thyroid carcinoma in a series of 839 patients with sporadic medullary thyroid carcinoma. Thyroid 23:294–300PubMedCrossRef
12.
Zurück zum Zitat Gibb GK, Pasieka JL (1995) Assessing the need for frozen sections: still a valuable tool in thyroid surgery. Surgery 118:1005–1009PubMedCrossRef Gibb GK, Pasieka JL (1995) Assessing the need for frozen sections: still a valuable tool in thyroid surgery. Surgery 118:1005–1009PubMedCrossRef
13.
Zurück zum Zitat Grannan K, Snyder J, McDonough S, Engel A, Farnum J (2011) Operative decision-making for follicular thyroid lesions: a community hospital system experience. Am Surg 77:443–446PubMed Grannan K, Snyder J, McDonough S, Engel A, Farnum J (2011) Operative decision-making for follicular thyroid lesions: a community hospital system experience. Am Surg 77:443–446PubMed
14.
Zurück zum Zitat Kingston GW, Bugis SP, Davis N (1992) Role of frozen section and clinical parameters in distinguishing benign from malignant follicular neoplasms of the thyroid. Am J Surg 164:603–605PubMedCrossRef Kingston GW, Bugis SP, Davis N (1992) Role of frozen section and clinical parameters in distinguishing benign from malignant follicular neoplasms of the thyroid. Am J Surg 164:603–605PubMedCrossRef
15.
Zurück zum Zitat Koperek O, Scheuba C, Cherenko M et al (2008) Desmoplasia in medullary thyroid carcinoma: a reliable indicator of metastatic potential. Histopathology 52:623–630PubMedCrossRef Koperek O, Scheuba C, Cherenko M et al (2008) Desmoplasia in medullary thyroid carcinoma: a reliable indicator of metastatic potential. Histopathology 52:623–630PubMedCrossRef
16.
Zurück zum Zitat Lang W, Choritz H, Hundeshagen H (1986) Risk factors in follicular thyroid carcinomas. A retrospective follow-up study covering a 14-year period with emphasis on morphological findings. Am J Surg Pathol 10:246–255PubMedCrossRef Lang W, Choritz H, Hundeshagen H (1986) Risk factors in follicular thyroid carcinomas. A retrospective follow-up study covering a 14-year period with emphasis on morphological findings. Am J Surg Pathol 10:246–255PubMedCrossRef
17.
Zurück zum Zitat Lee S, Han BK, Ko EY, Oh YL, Choe JH, Shin JH (2011) The ultrasonography features of hyalinizing trabecular tumor of the thyroid are more consistent with its benign behavior than cytology or frozen section readings. Thyroid 21:253–259PubMedCrossRef Lee S, Han BK, Ko EY, Oh YL, Choe JH, Shin JH (2011) The ultrasonography features of hyalinizing trabecular tumor of the thyroid are more consistent with its benign behavior than cytology or frozen section readings. Thyroid 21:253–259PubMedCrossRef
18.
Zurück zum Zitat Lee TI, Yang HJ, Lin SY et al (2002) The accuracy of fine-needle aspiration biopsy and frozen section in patients with thyroid cancer. Thyroid 12:619–626PubMedCrossRef Lee TI, Yang HJ, Lin SY et al (2002) The accuracy of fine-needle aspiration biopsy and frozen section in patients with thyroid cancer. Thyroid 12:619–626PubMedCrossRef
19.
Zurück zum Zitat Leteurtre E, Leroy X, Pattou F et al (2001) Why do frozen sections have limited value in encapsulated or minimally invasive follicular carcinoma of the thyroid? Am J Clin Pathol 115:370–374PubMedCrossRef Leteurtre E, Leroy X, Pattou F et al (2001) Why do frozen sections have limited value in encapsulated or minimally invasive follicular carcinoma of the thyroid? Am J Clin Pathol 115:370–374PubMedCrossRef
20.
Zurück zum Zitat LiVolsi VA (1990) Surgical pathology of the thyroid. Major problems in pathology, Bd 22. W.B. Saunders Company, Philadelphia LiVolsi VA (1990) Surgical pathology of the thyroid. Major problems in pathology, Bd 22. W.B. Saunders Company, Philadelphia
21.
Zurück zum Zitat Lorenz K, Gimm O, Holzhausen HJ et al (2007) Riedel’s thyroiditis: impact and strategy of a challenging surgery. Langenbecks Arch Surg 392:405–412PubMedCrossRef Lorenz K, Gimm O, Holzhausen HJ et al (2007) Riedel’s thyroiditis: impact and strategy of a challenging surgery. Langenbecks Arch Surg 392:405–412PubMedCrossRef
22.
Zurück zum Zitat McHenry CR, Thomas SR, Slusarczyk SJ, Khiyami A (1999) Follicular or Hurthle cell neoplasm of the thyroid: can clinical factors be used to predict carcinoma and determine extent of thyroidectomy? Surgery 126:798–802PubMedCrossRef McHenry CR, Thomas SR, Slusarczyk SJ, Khiyami A (1999) Follicular or Hurthle cell neoplasm of the thyroid: can clinical factors be used to predict carcinoma and determine extent of thyroidectomy? Surgery 126:798–802PubMedCrossRef
23.
Zurück zum Zitat de Micco C (1997) Anatomo-pathologie et histopronostic des carcinomes thyroidiens différenciés d’origine folliculaire. Ann Endocrinol (Paris) 58:172–182 de Micco C (1997) Anatomo-pathologie et histopronostic des carcinomes thyroidiens différenciés d’origine folliculaire. Ann Endocrinol (Paris) 58:172–182
24.
Zurück zum Zitat Multanen M, Haapiainen R, Leppaniemi A, Voutilainen P, Sivula A (1999) The value of ultrasound-guided fine-needle aspiration biopsy (FNAB) and frozen section examination (FS) in the diagnosis of thyroid cancer. Ann Chir Gynaecol 88:132–135PubMed Multanen M, Haapiainen R, Leppaniemi A, Voutilainen P, Sivula A (1999) The value of ultrasound-guided fine-needle aspiration biopsy (FNAB) and frozen section examination (FS) in the diagnosis of thyroid cancer. Ann Chir Gynaecol 88:132–135PubMed
25.
Zurück zum Zitat Musholt TJ, Clerici T, Dralle H, et al, The Interdisciplinary Task Force „Guidelines“ of the German Association of Endocrine Surgeons (2011) German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease. Langenbecks Arch Surg 396:639–649 Musholt TJ, Clerici T, Dralle H, et al, The Interdisciplinary Task Force „Guidelines“ of the German Association of Endocrine Surgeons (2011) German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease. Langenbecks Arch Surg 396:639–649
26.
Zurück zum Zitat Paphavasit A, Thompson GB, Hay ID et al (1997) Follicular and Hurthle cell thyroid neoplasms. Is frozen-section evaluation worthwhile? Arch Surg 132:674–678PubMedCrossRef Paphavasit A, Thompson GB, Hay ID et al (1997) Follicular and Hurthle cell thyroid neoplasms. Is frozen-section evaluation worthwhile? Arch Surg 132:674–678PubMedCrossRef
27.
Zurück zum Zitat Proye C, Lecomte-Houcke M, Da Couto Ferreira-Branco et al (1989) Examen cytologique et examen extemporané du nodule thyroidien, point de vue du consommateur, les abandonner ou les associer? Rev Fr Endocrinol Clin 30:275–278 Proye C, Lecomte-Houcke M, Da Couto Ferreira-Branco et al (1989) Examen cytologique et examen extemporané du nodule thyroidien, point de vue du consommateur, les abandonner ou les associer? Rev Fr Endocrinol Clin 30:275–278
28.
Zurück zum Zitat Richards ML, Chisholm R, Bruder JM, Strodel WE (2002) Is thyroid frozen section too much for too little? Am J Surg 184:510–514PubMedCrossRef Richards ML, Chisholm R, Bruder JM, Strodel WE (2002) Is thyroid frozen section too much for too little? Am J Surg 184:510–514PubMedCrossRef
29.
Zurück zum Zitat Rosai J, Carcangiu ML, DeLellis RA (1992) Tumors of the Thyroid Gland. Atlas of Tumor Pathology, Third Series, Bd 5. AFIP, Washington, D.C. Rosai J, Carcangiu ML, DeLellis RA (1992) Tumors of the Thyroid Gland. Atlas of Tumor Pathology, Third Series, Bd 5. AFIP, Washington, D.C.
30.
Zurück zum Zitat Rosen Y, Rosenblatt P, Saltzman E (1990) Intraoperative pathologic diagnosis of thyroid neoplasms. Report on experience with 504 specimens. Cancer 66:2001–2006PubMedCrossRef Rosen Y, Rosenblatt P, Saltzman E (1990) Intraoperative pathologic diagnosis of thyroid neoplasms. Report on experience with 504 specimens. Cancer 66:2001–2006PubMedCrossRef
31.
Zurück zum Zitat Scheuba C, Kaserer K, Kaczirek K, Asari R, Niederle B (2006) Desmoplastic stromal reaction in medullary thyroid cancer-an intraoperative „marker“ for lymph node metastases. World J Surg 30:853–859PubMedCrossRef Scheuba C, Kaserer K, Kaczirek K, Asari R, Niederle B (2006) Desmoplastic stromal reaction in medullary thyroid cancer-an intraoperative „marker“ for lymph node metastases. World J Surg 30:853–859PubMedCrossRef
32.
Zurück zum Zitat Schmid KW, Ladurner D, Zechmann W, Feichtinger H (1989) Clinicopathologic management of tumors of the thyroid gland in an endemic goiter area. Combined use of preoperative fine needle aspiration biopsy and intraoperative frozen section. Acta Cytol 33:27–30PubMed Schmid KW, Ladurner D, Zechmann W, Feichtinger H (1989) Clinicopathologic management of tumors of the thyroid gland in an endemic goiter area. Combined use of preoperative fine needle aspiration biopsy and intraoperative frozen section. Acta Cytol 33:27–30PubMed
33.
Zurück zum Zitat Schmid KW, Ladurner D (1997) Die intraoperative Gefrierschnittdiagnostik der Schilddrüse. Pathologe 18:98–101PubMedCrossRef Schmid KW, Ladurner D (1997) Die intraoperative Gefrierschnittdiagnostik der Schilddrüse. Pathologe 18:98–101PubMedCrossRef
34.
Zurück zum Zitat Schmid KW, Sheu SY, Tötsch M, Görges R, Bockisch A, Mann K (2005) Pathologie des Schilddrüsenkarzinoms. Onkologe 11:29–39CrossRef Schmid KW, Sheu SY, Tötsch M, Görges R, Bockisch A, Mann K (2005) Pathologie des Schilddrüsenkarzinoms. Onkologe 11:29–39CrossRef
35.
Zurück zum Zitat Schmid KW, Farid NR (2006) How to define follicular thyroid carcinoma? Virchows Arch 448:385–393PubMedCrossRef Schmid KW, Farid NR (2006) How to define follicular thyroid carcinoma? Virchows Arch 448:385–393PubMedCrossRef
36.
Zurück zum Zitat Schmidt RJ, Wang C (1986) Encapsulated follicular carcinoma of the thyroid: diagnosis, treatment, and results. Surgery 100:1068–1075PubMed Schmidt RJ, Wang C (1986) Encapsulated follicular carcinoma of the thyroid: diagnosis, treatment, and results. Surgery 100:1068–1075PubMed
37.
Zurück zum Zitat Schwaegerle SM, Bauer TW, Esselstyn CB (1988) Riedel’s thyroiditis. Am J Clin Pathol 90:715–722PubMed Schwaegerle SM, Bauer TW, Esselstyn CB (1988) Riedel’s thyroiditis. Am J Clin Pathol 90:715–722PubMed
38.
Zurück zum Zitat Shaha A, Gleich L, Di Maio T, Jaffe BM (1990) Accuracy and pitfalls of frozen section during thyroid surgery. J Surg Oncol 44:84–92PubMedCrossRef Shaha A, Gleich L, Di Maio T, Jaffe BM (1990) Accuracy and pitfalls of frozen section during thyroid surgery. J Surg Oncol 44:84–92PubMedCrossRef
39.
Zurück zum Zitat Shaha AR (2000) Controversies in the management of thyroid nodule. Laryngoscope 110:183–193PubMedCrossRef Shaha AR (2000) Controversies in the management of thyroid nodule. Laryngoscope 110:183–193PubMedCrossRef
40.
Zurück zum Zitat Sheu SY, Frilling A, Betzler M, Peitsch W, Schmid KW (2005) Der intraoperative Gefrierschnitt von Schilddrüsenknoten. lndikation – Verlässlichkeit – Grenzen. Viszeralchirurgie 40:174–179CrossRef Sheu SY, Frilling A, Betzler M, Peitsch W, Schmid KW (2005) Der intraoperative Gefrierschnitt von Schilddrüsenknoten. lndikation – Verlässlichkeit – Grenzen. Viszeralchirurgie 40:174–179CrossRef
41.
42.
Zurück zum Zitat Simpson PR (1998) Frozen section? Just do it. Am J Clin Pathol 112:124–126 Simpson PR (1998) Frozen section? Just do it. Am J Clin Pathol 112:124–126
43.
Zurück zum Zitat Sung SY, Shen HY, Hsieh CB et al (2014) Hyalinizing trabecular tumor of thyroid: does frozen section prevent unnecessarily aggressive operation? Six new cases and a literature review. J Chin Med Assoc 77:573–577PubMedCrossRef Sung SY, Shen HY, Hsieh CB et al (2014) Hyalinizing trabecular tumor of thyroid: does frozen section prevent unnecessarily aggressive operation? Six new cases and a literature review. J Chin Med Assoc 77:573–577PubMedCrossRef
44.
Zurück zum Zitat Ting S, Puttinger C, Schmid KW, Sheu-Grabellus SY (2012) Hyalinizing trabecular tumor of the thyroid: An overcautious designation of a benign thyroid tumour? Pathologe 33:135–141PubMedCrossRef Ting S, Puttinger C, Schmid KW, Sheu-Grabellus SY (2012) Hyalinizing trabecular tumor of the thyroid: An overcautious designation of a benign thyroid tumour? Pathologe 33:135–141PubMedCrossRef
45.
Zurück zum Zitat Ting S, Bockisch A, Führer D, Tötsch M, Schmid KW (2012) Feinnadelbiopsie (FNB) der Schilddrüse. Nuklearmediziner 35:1–8CrossRef Ting S, Bockisch A, Führer D, Tötsch M, Schmid KW (2012) Feinnadelbiopsie (FNB) der Schilddrüse. Nuklearmediziner 35:1–8CrossRef
46.
Zurück zum Zitat Tworek JA, Giordano TJ, Michael CW (1998) Comparison of intraoperative cytology with frozen sections in the diagnosis of thyroid lesions. Am J Clin Pathol 110:456–461PubMed Tworek JA, Giordano TJ, Michael CW (1998) Comparison of intraoperative cytology with frozen sections in the diagnosis of thyroid lesions. Am J Clin Pathol 110:456–461PubMed
47.
Zurück zum Zitat Volante M, Collini P, Nikiforov YE et al (2007) Poorly differentiated thyroid carcinoma: the Turin proposal for the use of uniform diagnostic criteria and an algorithmic diagnostic approach. Am J Surg Pathol 31:1256–1264PubMedCrossRef Volante M, Collini P, Nikiforov YE et al (2007) Poorly differentiated thyroid carcinoma: the Turin proposal for the use of uniform diagnostic criteria and an algorithmic diagnostic approach. Am J Surg Pathol 31:1256–1264PubMedCrossRef
48.
Zurück zum Zitat WHO histological classification of thyroid and parathyroid tumours (2004) World Health Organization Classification of Tumours. Pathology & Genetics. Tumours of Endocrine Organs. In: DeLellis RA, Lloyd RV, Heitz PU, Eng C (Hrsg). IARC Press, Lyon, S 49–123 WHO histological classification of thyroid and parathyroid tumours (2004) World Health Organization Classification of Tumours. Pathology & Genetics. Tumours of Endocrine Organs. In: DeLellis RA, Lloyd RV, Heitz PU, Eng C (Hrsg). IARC Press, Lyon, S 49–123
49.
Zurück zum Zitat Wong Z, Muthu C, Craik J, Carter J, Harman CR (2004) Role of intraoperative frozen section in the management of thyroid nodules. ANZ J Surg 74:1052–1055PubMedCrossRef Wong Z, Muthu C, Craik J, Carter J, Harman CR (2004) Role of intraoperative frozen section in the management of thyroid nodules. ANZ J Surg 74:1052–1055PubMedCrossRef
Metadaten
Titel
Intraoperativer Gefrierschnitt der Schilddrüse
verfasst von
S. Synoracki
S. Ting
U. Siebolts
H. Dralle
O. Koperek
Univ.-Prof. Dr. K. W. Schmid
Publikationsdatum
01.07.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Pathologie / Ausgabe 4/2015
Print ISSN: 2731-7188
Elektronische ISSN: 2731-7196
DOI
https://doi.org/10.1007/s00292-015-0038-7

Weitere Artikel der Ausgabe 4/2015

Der Pathologe 4/2015 Zur Ausgabe

CME Zertifizierte Fortbildung

Histologische Befundung enukleierter Augen

Mitteilungen der Schweizerischen Gesellschaft für Pathologie

Mitteilungen der Schweizerischen Gesellschaft für Pathologie

Mitteilungen der Österreichischen Gesellschaft für Pathologie/Österreichischen Abteilung der IAP (ÖGPath/IAP Austria)

Mitteilungen der Österreichischen Gesellschaft für Pathologie/Österreichischen Abteilung der IAP (ÖGPath/IAP Austria)

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.