Ultrasonography

Korean Society of Ultrasound in Medicine (대한초음파의학회)
권호 표지

Ultrasonographic Findings of Papillary Carcinoma of the Thyroid According to the Size

갑상선 유두상 암종의 크기에 따른 초음파 소견

Jang, Hong;No, Myeong-Ho;Gwon, Jae-Su
장홍;노명호;권재수

  • Published : 20040000
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Abstract

PURPOSE : To evaluate the ultrasonographic findings according to the size of the nodule in a papillary carcinoma of the thyroid(PTC). MATERIALS and METHODS : During a three-year period, 83 patients with a histologically proven PTC were included. All the nodules were classified into small nodules (SN ≤ 1 cm), medium-sized nodules (1 cm < MN ≤ 2cm) and large nodules (LrN > 2 cm). The echogenicity, margin, halo sign, calcification, regional lymph node metastasis( RLNM) in gray scale ultrasonography (US) and vascularity in the color doppler US were analyzed retrospectively according to their sizes. The sensitivity of the US was also assessed. RESULTS : Eleven (91.7%) out of 12 SNs, 45 (86.5%) out of 52 MNs and 12 (63.2%) out of 19 LrNs showed low echogenicity, so the echogenicity increased as the size increased (p < 0.05). An ill-defined or irregular margin was observed in 8 (66.7%) of the SNs, 31 (59.6%) of the MNs and 7 (36.8%) of the LrNs, and a lobulated margin was observed in 1 (8.3%) of the SNs, 16 (30.8%) of the MNs and 10 (52.6%) of the LrNs, so the margin became clearer as its size increased but was lobulated. A halo sign was observed in only 10 (12.0%) out of 83 nodules. Microcalcification was observed in 28 (33.7%) out of 83 nodules, but only in 1 (8.3%) out of 12 SNs. RLNM was frequently observer in the MNs (11.5%) and LrNs (15.8%). In color Doppler US, a low and high blood flow were observed in 50% and 16.7% of the SNs, 35.3% and 44.1% of the MNs and 40% and 60% of the LrNs, respectively. Therefore, the blood flow per unit area increased as the size increased. The sensitivity of US was 85.5% in all nodules. CONCLUSION : The echogenicity of PTC increased significantly as the size increased. Although there was no statistical significance, there were differences in the shape of the margin, the degree of vascularity and the frequency of the RLNM according to the size. US is a very sensitive study in diagnosing PTC and its sensitivity will be improved by considering the different ultrasonographic findings depending on the size.

목적 : 갑상선 유두상 암종의 초음파 검사에서 결절의 크기에 따라 상이한 소견이 있는지를 알아 보고자 하였다. 대상 및 방법 : 최근 3년간 조직학적으로 갑상선 유두상 암종으로 확진된 83명의 환자를 대상으로 하였다. 모든 결절을 소결절(≤ 1 cm), 중결절(> 1 cm, ≤ 2 cm), 대결절(> 2 cm)로 분류하여 회색조 초음파상 에코발생도(echogenicity), 변연부의 모양, 달무리 징후(halo sign) 유무, 석회화 유무 및 특징, 국소 림프절로의 전이 유무 그리고 색도플러상 혈류량의 정도를 비교 분석하였으며 초음파 진단의 민감도를 알아보았다. 결과 : 12예의 소결절중 11예(91.7%), 52예의 중결절중 45예(86.5%), 19예의 대결절중 12예 (63.2%)가 저에코로 관찰되어 크기가 증가할수록 에코발생도가 증가하였다 (p < 0.05). 불분명하거나 불규칙한 변연은 소결절의 8예(66.7%), 중결절의 31예(59.6%), 대결절의 7예(36.8%)에서 보였고, 분엽상 변연은 소결절의 1예(8.3%), 중결절의 16예(30.8%), 대결절의 10예(52.6%)에서 관찰되어 크기가 증가할 수록 변연은 분명하지만 분엽상을 보인 빈도가 높았다. 달무리 징후는 전체 83예중 10예(12.0%)에서만 관찰되었다. 미세석회화는 83예중 28예(33.7%)에서 관찰되었고 소결절에서는 1예(8.3%)만 관찰되었다. 국소 림프절로의 전이는 중결절(11.5%)과 대결절(15.8%)에서 흔하였다. 색도플러 초음파상 소결절에서는 저혈류와 고혈류가 각각 50%(3/6)와 16.7%(1/6), 중결절에서는 35.3%(12/34)와 44.1%(15/34)였고 대결절에서는 40%(6/15)와 60%(9/15)를 보여 크기 증가에 따라 단위면적당 혈류량이 증가하였다. 전체 초음파 진단의 민감도는 85.5%였다. 결론 : 갑상선 유두상 암종은 크기가 증가할수록 에코발생도가 의미 있게 증가하였다. 그리고 통계학적 유의성은 없었지만 크기 증가에 따라 변연부 모양, 혈류량의 정도, 그리고 국소 림프절 전이의 빈도에서도 차이가 있었다. 갑상선 유두상 암종의 진단에 있어서 초음파는 매우 민감도가 높은 검사이며 크기에 따른 초음파 소견의 차이를 함께 고려한다면 민감도를 더욱 향상시킬 수 있을 것이다.

Keywords

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