거대석회화를 동반한 갑상선 결절에서 갑상선암의 빈도
Prevalence of Thyroid Cancer in Thyroid Nodules with Dense Calcification
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목적:갑상선 결절은 흔하게 발견되며 약 5%에서 갑상선암으로 진단되므로 악성 결절과 양성 결절을 구분하는 것이 중요하다. 최근 고해상도 갑상선 초음파의 발달로 악성을 시사하는 초음파 소견을 예측하고자 다양한 연구가 진행되었고, 미세석회화와 악성화의 연관성이 확립된 반면, 거대석회화와 갑상선암의 연관성에 대한 논란이 있어 다수를 대상으로 후향적 연구를 시행하였다. 방법:5년 동안 갑상선 결절로 인하여 화순전남대병원을 방문하여 갑상선 초음파를 시행하였던 환자들 중에서 갑상선적출술을 받았거나, 갑상선암의 위험인자로 잘 알려진 미세석회화를 동반하는 경우를 제외하고, 거대석회화 유ㆍ무에 따라 두 군으로 구분하여 갑상선 초음파, 미세침흡인세포검사 결과 및 수술을 통한 병리 결과를 확인하였다. 결과:거대석회화를 동반하는 군에서 악성의 빈도는 22.7% (37/163)로 석회화가 불분명하거나 없는 군의 악성 결절의 빈도가 13.4% (271/2,021)인 것과 비교하여 통계학적으로 유의하게 높았고(p < 0.01), 비정형 및 악성의심 결절의 빈도도 유의하게 높았다(p < 0.01). 거친석회화 군에서 변연부석회화군에 비해 통계학적 의의는 없었지만 악성의 빈도가 높았다(30.1% vs. 16.2%). 결론: 거대석회화를 동반한 갑상선 결절은 악성의 빈도가 높으며, 부적절한 검체를 얻을 확률이 높으므로 주의 깊은 미세침흡인세포검사 및 추적검사가 필요하다.
Abstract
Background/Aims:High-resolution ultrasonography has made it possible to predict thyroid cancers without invasive procedures. Densely calcified nodules are difficult to image on ultrasound, and considering them to be high risk features for thyroid cancers has been controversial. The aim of this study was to evaluate the prevalence of malignancy in patients with densely calcified nodules using an analysis of clinical parameters related to the development of thyroid cancer. Methods:We retrospectively reviewed the thyroid sonographic findings and clinical characteristics of patients with thyroid nodules who attended Chonnam National University Hwasun Hospital during a 5-year period (2,387 cases). Dense calcifications included coarse dense calcification and peripheral calcification (163 cases). Nodules with microcalcification (< 2 mm) were excluded from this analysis (154 cases). Ultrasonography-guided fine needle aspiration (FNA) was performed for all nodules with dense calcification. Results:Among the densely calcified nodules, 37 (22.7%) were malignant. The prevalence of malignancy in patients with densely calcified thyroid nodules was higher than that in patients without calcification (p < 0.01). The incidence of malignancy was greater in coarse calcified thyroid nodules than in nodules with peripheral (egg-shell) calcification, but this difference was not statistically significant (30.1% vs. 16.2%, p = 0.101). Conclusions:Nodules with dense calcification carry a higher risk for malignancy than non-calcified nodules. Further, it is more difficult to obtain an adequate or diagnostic sample for nodules with dense calcification. Therefore, careful evaluation is necessary to diagnose malignancy in densely calcified nodules. (Korean J Med 2012;83:322-327)
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