Management of nodular goiters and their operative indications

It remains controversial whether or not nodular goiters should be treated s urgically or conservatively. This report reviews our 9-year experience of t reating nodular goiters in 334 patients, 44 of whom underwent surgery, and compares the methods of treatment employed from 1990 to 1999 with those emp loyed from 1971 to 1989 when 171 operations were carried out. In accordance with diagnoses made using fine-needle aspiration biopsy (FNAB) and ultraso nography, patients were treated as follows. Those with cysts were given per cutaneous ethanol injection therapy (PEIT), and those with solid tumors und erwent surgery if cancer of >class 3 was suspected or if the tumors were >3 cm. Consequently, 44 patients with solid tumors underwent surgery and 72 w ith cysts were treated by PEIT. The number of operations performed annually decreased to half of the pre-1990 figure. During the follow-up of those pa tients who did not undergo surgery, four with solid tumors and two with cys ts later required surgery due to suspected carcinoma of >class 3 in 3 patie nts or as a result of personal choice in 3 patients. The growth of solid tu mors was not able to be measured in most cases. These results indicate that the number of operations performed for nodular goiters can be reduced by P EIT. An accurate cytological diagnosis supports this therapeutic strategy.