Die Wertigkeit des intraoperativen Ultraschalls bei der benignen Knotenstruma

Background

In treating benign nodular goiter, selective surgery taking into account morphology and function is better than standard subtotal resection for reducing the frequency of nodules in the thyroid remnant. Intraoperative ultrasound (IOPUS) may additionally influence operative radicality and also the incidence of remaining nodules.

Methods

One hundred consecutive patients with benign nodular goiter were operated on with IOPUS; the specimens were compared with results of preoperative ultrasound and intraoperative palpation. Of these patients, 80 were reinvestigated after 3±1.6 years. A series of 80 patients with the same operative strategy but without IOPUS was used as control group, having been reinvestigated sonographically 1 year postoperatively, and was compared to the IOPUS group with respect to operative procedures, size of remnants, and sonography of lesions in thyroid remnants.

Results

In 35% of the thyroid lobes, preoperatively undetected nodules could be identified additionally by IOPUS, which also provided information on extent and structure in a further 20%. It resulted in the indication for more radical surgery in 24% and greater tissue preservation in 10%. Compared to surgery without IOPUS, IOPUS-guided surgery was more radical (total lobectomy in 40% vs 24%, nonresected lobes in 16% vs 26%, P<0.05) and showed a lower incidence of nodules in remnants at follow-up (2.5% vs 12.5%, P<0.05).

Conclusions

With IOPUS, more nodules are detectable, size and structure of the remnants are optimized, and the number of nodular lesions in thyroid remnants is lower. Thus, an even lower risk of recurrence can be expected for long-term follow-up. All in all, the routine use of IOPUS can be advocated, with maintenance of the selective operative strategy.