[Differential diagnosis of thyroid nodules. Sonography as a complement to scintigraphy and puncture cytology]

The place of ultrasound in the diagnosis of thyroid nodules was assessed in 384 patients by comparing its findings with those obtained on palpation, scintigraphy, fine-needle cytology and (in 45 cases) histology. Further diagnosis of scintigraphically "cold" nodules is the main indication for ultrasound examination in goitre-endemic areas. In 13 of 69 cases of a cold nodule with complex or echo-poor echo image proved it to be malignant, while in 74 with cold nodules but with a normal or increased echo pattern there was no malignant tumour. Thus, if the echo pattern is "complex" or "echo-poor" urgency of surgical intervention is strengthened, while with echo-normal or echo-rich nodules or cysts indications for operation are relative. In future, a combination of scintigraphy, ultrasound and cytology (ultrasound-guided small-needle biopsy) will give the highest rate of diagnostic accuracy in the differentiation of malignant from benign thyroid lesions.