분화된 유두상 갑상선암 환자에서 경부림프절 전이의 진단을 위한 미세침세척액의 티로글로불린 측정법 = Thyroglobulin Measurement in the Fine-Needle Aspiration Washout for Diagnosing Cervical Lymph Node Metastasis in the Patients with Differentiated Papillary Thyroid Cancer

국문 초록 (Abstract)

목적: 분화된 유두상 갑상선암에서 경부림프절 전이의 진단을 위한 미세침세척액의 티로글로불린 측정법의 유용성을 알아보고자 한다.
대상과 방법: 총 45명의 분화된 유두상 갑상선암 환자에서 초음파검사상 전이가 의심되는 50개의 림프절에서 미세침흡인생검술과 함께 미세침세척액 티로글로불린 값을 측정하였다. 대상 환자 중 18명은 이전에 갑상선절제술을 시행 받았고, 나머지 27명의 환자는 수술 전이었다. 최종진단은 절제된 림프절의 조직학적 검사결과나(n=21) 최소 12개월 이상의 추적검사에 의해 결정되었다.
결과: 대상환자 중 19명에서 림프절 전이가 최종진단 되었다. 미세침흡인생검술에서는 14명의 환자에서 14개의 림프절 전이가 밝혀졌고, 미세침세척액 티로글로불린 측정법에서는 18명의 환자에서 18개의 림프절 전이가 발견되었다. 미세침흡인생검술에서는 3개의 낭성 림프절 전이를 하나도 발견하지 못하였지만, 미세침세척액 티로글로불린 검사법에서는 3개 모두에서 전이를 진단할 수 있었다. 전이 림프절 발견에 미세침흡인생검술의 민감도와 특이도는 각각 73.6%(14/19)와 100%(27/27)였고, 미세침세척액 티로글로불린 측정법의 민감도와 특이도는 각각 94.7%(18/19)와 96.3%(26/27)였다.
결론: 미세침세척액 티로글로불린 측정법은 유두상 갑상선암 환자에서 경부림프절 전이, 특히 낭성의 전이림프절 진단에서 유용한 검사법이다.

다국어 초록 (Multilingual Abstract)

Purpose: We wanted to evaluate the utility of thyroglobulin measurement in the washout of the needle (FNATg) used for fine needle biopsy for detecting lymph node metastasis in patients with differentiated papillary thyroid carcinoma (DPTC).
Materials and Methods: We performed ultrasonography-guided fine-needle aspiration cytology (FNAC) and FNA-Tg for 50 ultrasonographically suspicious lymph nodes in 45 DPTC patients. Eighteen patients underwent thyroidectomy before FNA and the remaining 27 patients underwent fine-needle aspiration prior to surgery. The final diagnoses were determined based on the results of histological examination of the excised specimens (n=21) or on the follow-up examination that was done least 12 months after surgery.
Results: Lymph node metastases were confirmed in 19 patients. FNAC detected 14 metastatic lymph nodes in 14 patients, and FNA-Tg detected 18 metastatic lymph nodes in 18 patients. While none of 3 cystic lymph nodes metastasis was detected via FNAC, they all revealed positive results via FNA-Tg. One patient with a negative result on both methods had one metastatic lymph node among 9 excised lymph nodes, and this one node had not been sampled via FNAC or FNA-Tg. The sensitivities and specificities of FNAC and FNA-Tg were 73.6% (14/19) and 100% (27/27), and 94.7% (18/19) and 96.2% (26/27), respectively.
Conclusion: FNA-Tg is a useful technique for the early detection of lymph node metastasis, and especially for detecting cystic lymph node metastasis in patients with DPTC.

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