For assessing the efficacy of intraoperative laser autofluorescent spectroscopy (IOLAS), 46 patients with thyroid diseases of different etiology are examined. The patients ’ aged varied from 30 to 65 years. The following morphological types of diseases were observed: benign nodular formations in 42 patients, thyroid cancer in 4, papillary TINO MO in 2, and follicular cancer TINO MO in 2 cases. Out of benign formations, 36 were multinodular colloid goiter and 6 follicle-cell adenomas. As a result of using IOLAS, thyroid cancer was diagnosed during surgery in 8 (17.4%) out of 36 patients with multinodular colloid goiter; this diagnosis necessitated more extensive intervention than was planned: subtotal resection had to be extended to thyroidectomy. In all the cases IOLAS data were confirmed by urgent and later planned histological analyses. Due to this method, no reoperations were needed, which previously had to be performed because of the data of planned histological analysis, and therefore, the probable complications of reoperations were prevented. Our data indicate that IOLAS more accurately identifies the type and morphology of thyroid involvement and helps choose adequate volume of intervention. The first experience with laser fluorescent study as optic biopsy holds good promise as regards improvement of intraoperative rapid diagnosis of thyroid diseases.

No abstract

Intraoperative ultrasonic examination was carried out in order to improve the efficacy of intraoperative diagnosis (revision), specify the type of thyroid involvement, and choose an adequate volume of surgical intervention. The method was used in 44 patients with nodular euthyroid formations of the thyroid. The technique is described in detail. As a result of intraoperative ultrasonic examinations, the planned volume of surgical intervention was changed in one-third of cases. Intraoperative examinations in surgical treatment of nodular euthyroid formations of the thyroid help specify the type of thyroid involvement, select the optimal volume of intervention, and thus decrease the incidence of relapses.

Different methods for preoperative diagnosis of nodular euthyroid formations of the thyroid gland are compared. The sensitivity and specificity of ultrasonic examination (based on the study of the semeiotics of nodular formations of the thyroid), fine-needle aspiration biopsy (under palpation and ultrasonic control), and complex diagnosis (simultaneous assessment of ultrasonic semeiotics of the nodular formation and controlled biopsy under ultrasonic control followed by cytological examination of puncture biopsy specimens) are assessed. With this aim in view, 342 patients with nodular euthyroid formations were examine^ in 1994-1996. Benign nodular formations were detected in 316 (92.4%)) and thyroid cancer in 26 (7.6%o) patients. In the group with benign formations, colloid goiter was diagnosed in 204 (59.7%), follicular-cell adenomas in 78 (22.8%)), and hypertrophic autoimmune thyroiditis in 34 (9.9%) cases. The authors consider that ultrasonic examination combined with fine-needle aspiration biopsy is the most available, safe, and highly effective complex for the diagnosis of nodular euthyroid formations at the preoperative stage. Complex preoperative ultrasonic examination with fine-needle biopsy help single out the group with suspected malignant involvement of the thyroid with a high probability. Use of this complex and intraoperative ultrasonic examination correctly identified the type of thyroid involvement and its morphology in 92.4%o of cases, and thus helped choose adequate volume of intervention.