Schäfer and Schmidt in their response discuss thyroid nodules with a diameter of >1 cm and normal findings. In order to keep the Figure showing our diagnostic algorithm as simple as possible we did not discuss this aspect. Similarly, because of restrictions on word count and cited literature, we did not include any further studies on the validity of fine needle aspiration (FNA). We agree with our correspondents that the current recommendations of the American Thyroid Association (ATA) cannot unconditionally be generalized to the European setting. Independently of these issues, however, we wish to reiterate that FNA biopsy of the thyroid if undertaken by an experienced examiner and an experienced cytologist has a high degree of accuracy in the diagnostic evaluation of thyroid cancer and can also help prevent surgical procedures without a clear indication.
All three letters mention MIBI scintigraphy as a method for the differential diagnostic evaluation of thyroid nodules. Our review article aimed to focus on FNA (1). To date, the number of studies on MIBI scintigraphy that have been conducted is too small, and the procedure has not been approved for the diagnostic evaluation of thyroid nodules. For these reasons, MIBI scintigraphy has not been included in current guidelines. Our colleagues point out that in the studies published to date, a negative MIBI result is highly likely to indicate a benign thyroid nodule. The future role of MIBI scintigraphy as a complementary approach will need to be investigated in prospective studies.
Scholz explains the primary diagnostic evaluation of medullary thyroid nodules (MTC). We agree with him that cytology is of secondary importance in this setting. Calcitonin measurement is the most sensitive method and should be done at the very least before surgery for a thyroid nodule/(multi)nodular goiter.
On behalf of the authors:
Prof. Dr. Matthias Schott
Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists.
|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 VOLLTEXT|