갑상선 유두암의 크기에 따른 초음파 특징 분류
Ultrasonographic Findings of Papillary Carcinoma of the Thyroid According to the Size: Especially Less Than 0.5cm
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대한갑상선학회는 0.5cm 보다 큰 경우에만 미세침흡인술을 권고하고 있으나, 본원에서는 0.5cm 이하의 결절에서도 갑상선 유두암이 많이 발견되고 있다. 이 연구는 건강의학센터에서 미세침흡인술을 시행하여 갑상선 유두암으로 확진된 결절을 토대로 크기에 따른 초음파 특징을 분류해 보고자 한다. 결절의 크기를 장경 0.5cm 이하, 0.5∼1cm, 1cm 보다 큰 결절의 세 그룹으로 나누어 각각에서의 악성을 시사하는 초음파 소견에 차이가 있는지 알아보았다. 288개의 악성결절 중 0.5cm 이하 크기는 21.5% (62/288), 0.5∼1cm 54.9% (158/288), 1cm 보다 큰 결절은 23.6% (68/288)로 나타났다. 앞뒤가 긴모양의 특징은 0.5cm 이하 그룹 90.3% (56/62), 1cm 보다 큰 그룹 48.5% (33/68)로 나타나 통계적으로 유의한 차이를 보였다(p<0.001). 0.5cm 이하 그룹에서 well defined smooth 결절은 1예도 없었으며, 침상(spiculated) 혹은 불규칙한 경계는 크기가 클수록 빈도가 증가하였다(p=0.024). 내부에코는 0.5cm 이하 그룹에서 고에코(hyperechogenicity)와 동에코(isoechogenicity)의 결절은 1예도 없었으며, 각 그룹별로 현저한 저에코(marked hypoechogenicity)보다 저에코(hypoechogenicity)가 많았다(p=0.034). 미세 혹은 거대석회화는 0.5cm 이하에서 77.4% (48/62)가 관찰되지 않았으며, 0.5cm 이하 그룹부터 21.0% (13/62), 48.1% (76/158), 64.7% (44/68)로 결절 크기가 증가할수록 관찰빈도가 증가하였다(p<0.001). 초음파에서 0.5cm 이하의 결절은 앞뒤가 긴 모양과 침상 혹은 불규칙한 경계, 불분명한 경계를 보였고, 저에코 혹은 현저한 저에코가 많았다. 그러나 미세 혹은 거대석회화는 없는 것이 특징적이었다. 따라서 0.5cm 이하의 작은 크기의 결절에서 악성을 시사하는 초음파적 특징은 미세침흡인술이나 추적검사에 대한 유용한 지침을 제공할 수 있을 것으로 사료된다.
Abstract
The Korean Thyroid Association recommends fine-needle aspiration biopsy (FNAB) for nodules more than 0.5cm in diameter. But nodules, smaller than 0.5cm have been found in papillary carcinomas of the thyroid (PTC) at the health promotion center at SMC. We wanted to evaluate the ultrasonographic findings according to size of nodule in proven PTCs by FNAB, especially less than 0.5cm. All nodules were classified into three groups by their longest diameter : less than 0.5cm, more than 0.5cm but less than 1cm, and more than 1cm. Sonographic findings suggesting malignancy were analyzed according to their size groups. Of 288 malignant nodules, 21.5% (62/288) were less than 0.5cm , 54.9% (158/288) were more than 0.5cm but less than 1 cm, 23.6% (68/288) exceeded 1cm. A taller-than-wide shape was observed in 90.3% (56/62) of nodules less than 0.5cm, and 48.5% (33/68) of nodules exceeding 1cm (p<0.001). There were no well-defined smooth nodules among nodules less than 0.5cm, and spiculated or irregular margin nodules increased as the size increased (p=0.024). Nodules of size less than 0.5cm did not showed hyper or isoechogenicity. Hypoechogenicity was greater than the marked hypoechogenicity in each group (p=0.034). Micro- or macro-calcifications were not founded in 77.4% (48/62) of the nodule group sized less than 0.5cm. From the small size of the group, micro- or macrocalcifications were observed 21.0% (13/62), 48.1% (76/158), 64.7% (44/68), so the number of nodules containing micro- or macro-calcification increased as size increased (p<0.001). PTCs less than 0.5cm in size on ultrasonography had taller than-wide shape, spiculated or irregular and ill-defined margins, and exhibited hypo and markedly hypoechogenicity, but micro- or macro-calcifications were not common. These ultrasonographic features of nodules less than 0.5 cm can be useful in reporting and guiding FNABs or follow-up exams.
참고문헌 (13)
- Ka Hee Yi, "Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer", November J Korean Thyroid Assoc, 3(2) (2011)
- Endocr pract, "American Association of Clinical Endocrinologists and Associazione Medici Endo− crinology medical guidelines for clinical practice for diagnosis and management of thyroid nodules", Endocr pract, 12(1), pp.63~102 (2006)
- Tae Yong Kim, "Diagnosis of Impalpable Thyroid Nodule Detected by High-resolution Ultrasonography, Endocrinology", Journal of Korean Society of Endocrinology, 20(3), pp.200~203 (2005)
- Hyun-Min Lee, MD, "Comparison of Tumor Size in Papillary Thyroid Carcinoma: Between Preoperative Ultrasonographic and Postoperative Histopathologic Finding", J Korean Thyroid Assoc, 2(2) (2009)
- Kwang-Won Kim, "Clinical Characteristics of Papillary Thyroid Cancer", J Korean Thyroid Assoc, 3(2) (2010)
- Eun-Kyung Kim, "New sonographic criteria for recommending Fine-Needle Aspiration Biopsy of nonpalpable solid nodules of thyroid", AJR, 178, pp.687~691 (2002)
- Carlo Cappelli, "Thyroid nodule shape suggests malignancy", European Journal of Endocrinology, 155, pp.27~31 (2006)
- Cappelli C, "Is the anterioposterior and transverse diameter ratio of nonpalpable thyroid nodules a sonographic criteria for recommending fine-needle aspiration cytology", Clinical Endocrinology, (6), pp.689~693 (2005)
- Katz JF, "Thyroid nodules: sonographic-pathologic correlation", Radiology, 151, pp.741~745 (1984)
- 장홍, "갑상선 유두상 암종의 크기에 따른 초음파 소견", ULTRASONOGRAPHY, 23(4), pp.203~211 (2004), 대한초음파의학회
- Solbiati L, "Microclacification: a clue in the diagnosis of thyroid malignancies(abstr)", Radiology, 177(suppl), pp.140~ (1990)
- Won-Jin Moon, "Benign and Malignant Thyroid Nodules: US Differentiation -Multicenter Restrospective study", Radiology, 247, pp.762~770 (2008)
- Tae Sik Jung, "Tumor Size Is Still a Useful Prognostic Factor for the Therapeutic Plan of Papillary Thyroid Carcinoma", 대한갑상선학회지, 4(1), pp.47~53 (2011), 대한갑상선학회