장경 1 cm 이하 갑상선 결절의 초음파 유도하 세침흡인생검 = Ultrasound-Guided Fine-Needle Aspiration Biopsy in Infracentimetric Thyroid Nodules

다국어 초록 (Multilingual Abstract)

Purpose: The aim of this study is to determine the efficacy of ultrasound-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules that are equal to or less than 1 cm at the maximum diameter.
Materials and Methods: The US-FNABs performed on thyroid nodules from March to August 2009 were included in this study. We retrospectively evaluated the cytopathologic results as well as any complications associated with the procedure.
Results: Of the 241 thyroid nodules (range: 0.1 - 1.0 cm, mean size: 5.8 mm) in 184 patients (female: male = 164:20, mean age: 49.0 years, age range: 18 - 77 years old), the incidence of an inadequate sample was 14.1% (34/241) for the US-FNABs.
Eighty six nodules were surgically removed in 62 patients, of which 15 were confirmed to be benign nodules and 71 were confirmed to be malignant nodules. The number of true positive, false positive, true negative and false negative results for US-FNAB were 59, 0, 10 and 3%, respectively, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 95.2%, 100%, 100%, 76.9% and 95.8%, respectively. All the false negative cases were less than 3 mm at the maximal diameter. There were no serious complications in all the patients.
Conclusion: US-FNAB was effective for the cases of thyroid nodule under 1 cm at the maximal diameter. However, a false negative result of US-FNAB should be considered for the cases of very small nodules that are less than 3 mm at the maximal diameter.

국문 초록 (Abstract)

목적: 장경 1 cm 이하인 갑상선 결절에 대한 초음파 유도하 세침흡인생검의 효율성을 알아 보고자 하였다.
대상 및 방법: 2009년 3월부터 8월까지 갑상선 결절의세침흡인생검을 받은 환자 중 결절의 장경이 1 cm 이하인결절을 대상으로 세포진단결과와 수술 후 확진된 병리결과를 비교 분석하고 세침흡인생검에 따른 합병증 발생을조사하였다.
결과: 총 184명의 환자에서 (여자 : 남자 = 164 : 20,평균 연령 : 49세, 범위 : 18-77세) 장경 1 cm 이하인 갑상선 결절 241개 중에서 (평균 : 0.58 cm, 범위 : 0.1 -1.0 cm) 첫 번째 세침흡인생검에서 불충분한 검체로 확인된 경우가 14.1% (34개) 였다. 62명의 환자가 수술을 받았고 86개의 결절이 조직학적으로 확진되었는데, 71개의결절은 갑상선 유두암이었고 15개는 양성이었다. 86개의결절에 대한 첫 번째 세침흡인생검은 진양성 59, 위양성0, 진음성 10, 위음성 3을 보였으며, 민감도 95.2%, 특이도 100%, 양성예측도 100%, 음성예측도 76.9% 및 정확성 95.8% 이었다. 3건의 위음성의 경우 모두 장경 3 mm 미만의 결절이었고 모든 환자에서 중대한 합병증은 관찰되지 않았다.
결론: 장경 1 cm 이하 갑상선 결절에 대한 세침흡인생검은 효율적이다. 하지만 장경이 3 mm 이하인 미세 갑상선유두암에 있어서는 위음성의 결과가 초래될 수도 있으므로 첫 번째 세침흡인생검에서 음성의 결과를 보이더라도추가적인 세침흡인생검을 시행하는 등의 주의가 필요하다.

참고문헌 (Reference)

• 1 Kim DW, "Ultrasound-guided fineneedle aspiration biopsy of thyroid nodules: comparison in efficacy according to nodule size" 19 (19): 27-31, 2009
• 2 김성준, "Ultrasound-Guided Fine-Needle Aspiration Biopsy in Nonpalpable Thyroid Nodules: Is It Useful in Infracentimetric Nodules?" 연세대학교의과대학 44 (44): 635-640, 2003
• 3 Rausch P, "Ultrasonographically guided thyroid biopsy: a review with emphasis on technique" 20 (20): 79-85, 2001
• 4 O’Malley ME, "US-guided fineneedle aspiration biopsy of thyroid nodules: adequacy of cytologic material and procedure time with and without immediate cytologic analysis" 222 (222): 383-387, 2002
• 5 Tomoda C, "Transient vocal cord paralysis after fine-needle aspiration biopsy of thyroid tumor" 16 (16): 697-699, 2006
• 6 Berker D, "The value of fine-needle aspiration biopsy in subcentimeter thyroid nodules" 18 (18): 603-608, 2008
• 7 Słowinska-Klencka D, "The fine-needle aspiration biopsy efficacy of small thyroid nodules in the area of recently normalized iodine supply" 159 (159): 747-754, 2008
• 8 Cooper DS, "Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer" 19 (19): 1167-1214, 2009
• 9 Ito Y, "Needle tract implantation of papillary thyroid carcinoma after fine-needle aspiration biopsy" 29 (29): 1544-1549, 2005
• 10 Frates MC, "Management of thyroid nodules detected at US: society of radiologists in ultrasound consensus conference statement" 237 (237): 794-800, 2005
• 11 Leenhardt L, "Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules" 84 (84): 24-28, 1999
• 12 Gharib H, "Fine-needle aspiration biopsy of the thyroid: an appraisal" 118 (118): 282-289, 1993
• 13 Hor T, "Bilateral thyroid hematomas after fineneedle aspiration causing acute airway obstruction" 18 (18): 567-569, 2008
• 14 Gharib H, "American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules" 12 (12): 63-102, 2006
• 15 Yokozawa T, "Accurate and simple method of diagnosing thyroid nodules the modified technique of ultrasound-guided fine needle aspiration biopsy" 5 (5): 141-145, 1995