갑상선암 예측에 있어 초음파적 변수 분석 (Analysis of the ultrasonographic parameters in predicting thyroid cancer)

서지정보

· 발행기관 : 고신대학교(의대) 고신대학교 의과대학 학술지
· 수록지 정보 : 고신대학교 의과대학 학술지 / 19권 / 1호 / 133 ~ 140페이지
· 저자명 : 임현정, 최영식, 박요한, 오경승, 이강대

초록

Background : The introduction of high resolution sonography has made it possible to detect nodules in the thyroid gland. However, there has been no reliable sonographic sign for distinguishing between benign and malignant thyroid conditions. The aim of present study was to evaluate ultrasonographic (US) parameters in predicting thyroid cancer.
Methods : One hundred fifty three patients who underwent thyroidectomy at Kosin Medical Center from January, 2000 to April, 2002 were included in the study. All patients were checked high resolutional US before surgery. Of the 153 patients 89 were malignant tumors and 64 benign. Malignant US parameters were defined as calcification, irregular margin, more taller than wide, and fat line obliteration. Calcification pattern was classified with single, punctated, and amorphous calcification. The US characteristics to predict malignancy were evaluated by means of multiple logistic regression analysis.
Results : All of the malignant sonographic parameters such as calcification, irregular margin, and more taller than wide were significant. Of 59 patients whose ultrasounds showed calcification, 53 (89.8%) were thyroid carcinoma. The incidence rate of malignancy was 55.9% in solitary nodules and 65.7% in multiple nodules (p=0.303). Even though nodule size was less than 1.5cm, the incidence of malignant tumor was 69.5% (p=0.04). Of 53 malignant nodules with calcification, the incidence of single, punctated, and amorphous calcification pattern was 6 (11.3%), 22 (41.5%), 25 (47.2%), respectively. The sensitivity, specificity, positive and negative predictive value, and accuracy of sonographic parameters were 76.4%, 87.5%, 89.5%, 72.7% and 81.0%, respectively. Upon the correlation of US-guided FNA cytology with pathologic diagnosis, the sensitivity of ultrasound-guided FNA cytology in differentiating benign and malignant nodule was 85.9%, the specificity 100% and overall diagnostic accuracy was 91.2%. The sensitivity, specificity, and accuracy of US parameters associated to follicular neoplasm, all were 75.0%.
Conclusion : All the malignant US parameters including calcification, irregular margin, and more tall than wide showed high level of sensitivity, specificity and accuracy. Of these parameter, calcification and irregular margin were more significants. The more presence of calcifications with punctated and amorphous pattern could suggest the higher possibility of malignancy. However, further study is needed for clinical application of malignant US parameters in the thyroid tumors.

영어초록

Background : The introduction of high resolution sonography has made it possible to detect nodules in the thyroid gland. However, there has been no reliable sonographic sign for distinguishing between benign and malignant thyroid conditions. The aim of present study was to evaluate ultrasonographic (US) parameters in predicting thyroid cancer.
Methods : One hundred fifty three patients who underwent thyroidectomy at Kosin Medical Center from January, 2000 to April, 2002 were included in the study. All patients were checked high resolutional US before surgery. Of the 153 patients 89 were malignant tumors and 64 benign. Malignant US parameters were defined as calcification, irregular margin, more taller than wide, and fat line obliteration. Calcification pattern was classified with single, punctated, and amorphous calcification. The US characteristics to predict malignancy were evaluated by means of multiple logistic regression analysis.
Results : All of the malignant sonographic parameters such as calcification, irregular margin, and more taller than wide were significant. Of 59 patients whose ultrasounds showed calcification, 53 (89.8%) were thyroid carcinoma. The incidence rate of malignancy was 55.9% in solitary nodules and 65.7% in multiple nodules (p=0.303). Even though nodule size was less than 1.5cm, the incidence of malignant tumor was 69.5% (p=0.04). Of 53 malignant nodules with calcification, the incidence of single, punctated, and amorphous calcification pattern was 6 (11.3%), 22 (41.5%), 25 (47.2%), respectively. The sensitivity, specificity, positive and negative predictive value, and accuracy of sonographic parameters were 76.4%, 87.5%, 89.5%, 72.7% and 81.0%, respectively. Upon the correlation of US-guided FNA cytology with pathologic diagnosis, the sensitivity of ultrasound-guided FNA cytology in differentiating benign and malignant nodule was 85.9%, the specificity 100% and overall diagnostic accuracy was 91.2%. The sensitivity, specificity, and accuracy of US parameters associated to follicular neoplasm, all were 75.0%.
Conclusion : All the malignant US parameters including calcification, irregular margin, and more tall than wide showed high level of sensitivity, specificity and accuracy. Of these parameter, calcification and irregular margin were more significants. The more presence of calcifications with punctated and amorphous pattern could suggest the higher possibility of malignancy. However, further study is needed for clinical application of malignant US parameters in the thyroid tumors.

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