[The diagnosis and operative treatment of solitary thyroid nodule: a prospective study]

The aim of the paper is to evaluate the usefulness of pre- and intraoperative examination methods in the diagnostics of solitary thyroid nodules, as well as the assessment of the histologic structure of these nodules. From 1.12.1997 to 15.06.1998 in the Clinic of Endocrinological and General Surgery at the Medical University of Lodz, 102 patients were operated for a solitary nodule. The solitary nodule was diagnosed on the basis of the clinical and ultrasound examination. A fine needle aspiration biopsy (FNAB) was performed in all patients. During the operation the presence of the solitary nodule was confirmed on the basis of macroscopic examination. If malignancy was suspected on intraoperative macroscopic examination, intraoperative histologic examination was carried out. In 82 patients with the solitary nodule, the benign nodule was diagnosed on the basis of FNAB in 45 (54.9%) patients and malignant one in 8 (9.7%). Malignancy in the nodule (follicular tumour, Hürthle cell tumour, cellulae suspectae) was suspected in 29 (35.4%) patients--in this group the intraoperative histologic examination was conducted. On the basis of postoperative histologic examination a thyroid malignant neoplasm was detected in 18 (21.9%) of 82 patients with the solitary nodule. Finally, out of 18 thyroid cancers, 8 (44.4%) were recognised preoperatively (FNAB), 3 (16.7%) intraoperatively and 7 postoperatively. Since the incidence of malignancy in solitary thyroid nodules is high the authors suggest that their precise pre- and intraoperative diagnostics is necessary. The use of described diagnostic methods enabled to recognise malignancy in the solitary nodule and to perform a primary radical operation in 61.1% patients. On the basis of the obtained results it seems justifiable to search new diagnostic methods which enable better pre- and intraoperative differentiation of benign and malignant thyroid nodules.