• 대한영상의학회지
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• 제84권5호
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• pp.1009-1016
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• 2023

고주파 절제술(radiofrequency ablation)은 미세 침습 치료술의 한 방법으로 양성 갑상선 결절과 갑상선 재발암 환자에서 수술적 치료를 대신하여 이용되고 있다. 국내에서는 2002년 세계 최초로 갑상선 결절에 대한 고주파 절제술을 시작하여, 2008년에는 대규모 연구 결과를 발표하였다. 2009년 대한갑상선영상의학회(Korean Society of Thyroid Radiology)는 고주파 절제술에 대한 첫 권고안을 만들었으며, 2012년과 2018년에 이를 개정하였다. 대한갑상선영상의학회의 지침서는 갑상선 결절의 고주파 절제술에 대한 세계 최초의 지침서로 국내 및 국외에서 갑상선 고주파 절제술을 시행하는 시술자들을 위한 지침이 되었다. 이 지침서들은 한국 및 전 세계 여러 나라에서 고주파 절제술의 확립 및 확산에 크게 기여하였다. 또한 대한 갑상선영상의학회는 2015년부터 참가자 수준에 맞춘 고주파 절제술의 심화 실습 과정을 진행하고 있다. 본 종설에서는 대한갑상선영상의학회에서 실시한 고주파 절제술 교육의 역사를 소개하고, 고주파 절제술의 학습 곡선 및 현재 한국에서의 교육 프로그램을 기술한 후 앞으로 나아갈 방향을 제시해보고자 한다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권23호
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• pp.10307-10311
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• 2015

Background: The Bethesda System for Reporting Thyroid Cytopathology is one of the main classification systems for thyroid nodules. It expects that 7% of all fine needle aspiration biopsies will be reported as atypia or follicular lesions of undetermined significance, and 5-15% of these undetermined nodules are malignant. Our study is a retrospective analysis of variables that may be associated with outcome in patients with indeterminate thyroid nodules. Materials and Methods: Patients who underwent thyroidectomy in our institution between 2010 and 2014 were retrieved from the institutional records database. Patient demographics and medical histories were recorded. All ultrasonography reports were examined for nodule features and biochemical blood levels, hormone levels and complete blood counts were recorded. Results: A total of 103 patient cytopathology reports were regarded as belonging to the undetermined category. Some 35% of patients had malignant nodules. Median preoperative red cell distribution width (RDW) level was 13.6 inthe benign group, while it was 14.3 in patients with malignancy, demonstrating a significant correlation (p=0.003). Only calcification presence was significantly different between benign and malignant groups on ultrasonography (p=0.034). Conclusions: Ultrasonography is one of the primary tools for this matter. RDW levels may become another promising tool to predict malignancy.

• 대한두경부종양학회지
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• 제10권2호
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• pp.112-121
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• 1994

During the 7 years period from March 1987 to Febrary 1994, 344 patients with thyroid nodules, were admitted and operated at Department of Surgery, Collage of Medicine, Hallym university. We obtained following results: 1) The thyroid nodules were prevalent in female with ratio 1:17.1, both benign and malignant nodules were prevalent in the forth decade(37.8%:25.8%). 2) The duration of illness within 6 months was most common: 47.1% and within 1 years was 66.6%. 3) The most prominent symptoms & sign were palpable mass in anterior neck(96.8%). 4) The right-sided thyroid nodules were most common. 5) Thyroid scaning and thyroid function test were found to be not much value in differentiating malignancy. 6) Accuracy of the fine needle aspiration cytology was 75.5%. 7) There were 251 cases(73.0%) of benign and 93 cases(27.0%) of malignant nodules: most frequent benign nodule was adenomatous goiter(67.7%) and the most frequent malignant nodule was papillary adenocarcinoma (86.0%). 8) The most commonly performed surgical procedure was unilateral lobectomy with isthmectomy in both benign(41.0%) and malignant(33.3%). 9) Postoperative complications are as follows: transient hypothyroidism 22cases, transient hoaseness 16 cases, hypothyroidism 6 cases, wound infection 4 cases, hematoma 3 cases, permanent hoaseness 2 cases.

• Korean Journal of Radiology
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• 제21권5호
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• pp.605-613
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• 2020

Objective: To determine the malignancy risk of isolated macrocalcifications (a calcified nodule with complete posterior acoustic shadowing) detected on ultrasonography (US) and to evaluate the postoperative American Thyroid Association (ATA) risk stratification of malignant tumors manifesting as isolated macrocalcifications. Materials and Methods: A total of 3852 thyroid nodules (≥ 1 cm) of 3061 consecutive patients who had undergone biopsy between January 2011 and June 2018 were included in this study. We assessed the prevalence, malignancy rate, and size distribution of isolated macrocalcifications and evaluated the histopathologic features and postoperative ATA risk stratification of malignant tumors manifesting as isolated macrocalcifications. Results: Isolated macrocalcifications were found in 38 (1.2%) of the 3061 patients. Final diagnosis was established in 30 (78.9%) nodules; seven malignant tumors were diagnosed as papillary thyroid carcinomas (PTCs). The malignancy rate of the isolated macrocalcifications was 23.3% in the 30 nodules with final diagnoses and 18.4% in all nodules. Among the six surgically-treated malignant tumors, five (83.3%) had an extrathyroidal extension (ETE) (minor ETE 1, gross ETE 4), and two (33.3%) had macroscopic lymph node metastasis. Four (66.7%) malignant tumors were categorized as high-risk tumors, one as an intermediate-risk tumor, and one as a low-risk tumor using the ATA risk stratification. Histopathologically, out of the six malignant tumors, ossifications were noted in four (66.7%) and predominant calcifications in two (33.3%). Conclusion: The US pattern of isolated macrocalcifications (≥ 1 cm) showed an intermediate malignancy risk (at least 18.4%). All malignant tumors were PTCs, and most showed an aggressive behavior and a high or intermediate postoperative ATA risk.

• 대한두경부종양학회지
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• 제15권2호
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• pp.189-193
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• 1999

Objectives: Fine needle aspiration cytology(FNAC) is a well established preoperative diagnostic procedure in the thyroid nodules. However, diagnostic accuracy of FNAC varies according to the size and the structural characteristics of thyroid nodule. We performed the ultrasound guided FNAC(US-guided FNAC) for impalpable thyroid nodule, and estimated the sampling accuracy rate through a comparison study between the cytologic diagnosis and the final histologic diagnosis of the postoperative specimens in order to determine clinical efficacy of the US-guided FNAC. Materials and Methods: We evaluated 117 patients underwent US-guided FNAC from January 1997 to December 1998. These patients had 129 thyroid nodules to need cytologic examination. Whereas the nodules were so no graphically classified into cystic, solid, and mixed type according to echo pattern, the aspirated thyroid specimens were classified into benign, malignant, suspicious, and insufficient. Results: Positive sampling for diagnositc examination was achieved in 75 nodules(58.1%), and US-guided FNAC in our study showed the accuracy rate of 95.2%, false positivity rate of 0%, and false negativity rate of 5.5%. Conclusions: US-guided FNAC is a powerful techniques for evaluating cytologic characterics and allowing a reliable diagnositc result in the impalpable thyroid nodule. However, the experienced technique is recommanded in order to obtain the sufficient samples for reliable results.

• Investigative Magnetic Resonance Imaging
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• 제19권4호
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• pp.224-230
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• 2015

Purpose: To determine whether we should recommend ultrasonography (US) for an incidental thyroid nodule identified by additional cervicothoracic sagittal T2-weighted image (C-T sag T2WI) of lumbar spine magnetic resonance imaging (MRI). Materials and Methods: A retrospective study of 61 patients who underwent both lumbar spine MRI and thyroid US between December 2011 and April 2015 was conducted. For all US-found thyroid nodules > 1 cm, investigators evaluated whether there was any correlation between thyroid nodule detectability by C-T sag T2WI and US features such as echogenicity, composition, or suspicion of malignancy. Results: Solid hypoechoic (2/4; 50%) or mixed echoic nodules (4/8; 50%) appeared to be found relatively more easily by C-T sag T2WI than more benign-looking solid isoechoic (1/4; 25%) or spongiform nodules (0/6; 0%). Among six nodules with ultrasonographic suspicion for malignancy, only one nodule was detected by C-T sag T2WI. Conclusion: If an incidental thyroid nodule is seen by C-T sag T2WI, it would be better to recommend thyroid US for identifying malignancy.

• 대한영상의학회지
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• 제84권1호
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• pp.92-109
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• 2023

갑상선 결절 환자에서 초음파 검사는 일차적 영상 진단법으로 정립되어 있으며 치료 결정을 위한 핵심적인 진단 역할을 갖는다. Korean Thyroid Imaging Reporting and Data System(이하 K-TIRADS)는 초음파 유형에 기초한 암 위험도 분류체계로서 실시간 초음파 검사를 시행하면서 쉽게 결절 진단이 가능하다는 장점을 갖고 있다. 개정된 2021 K-TIRADS는 결절의 초음파 분류 기준을 보다 명확히 하였고, 고위험 갑상선암의 의심 소견이 없는 환자에서 병리진단검사를 결정하는 결절 크기 기준을 개정하여 불필요한 병리진단검사를 최소화하고 적절한 갑상선암 진단 예민도가 유지되도록 개정하였다. 갑상선영상의학진료는 갑상선 결절 환자의 진단 및 비수술적 치료를 수행하는 중요한 임상적 역할을 가지고 있으며, 적절한 환자 진료를 위해서는 표준적 진료 지침에 근거하여 진료가 수행되어야 한다.

• Korean Journal of Radiology
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• 제20권6호
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• pp.947-955
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• 2019

Degenerating nodules (DNs), which primarily manifest as benign thyroid nodules, are one of the main causes of discordance in ultrasonography (US) and cytological assessments. Intranodular hemorrhage is one of the mechanisms contributing to discordant nodules, and an impaired blood supply may explain further DN shrinkage and infarction. The surgical specimens can be divided into acute and chronic stages based on the histological changes, which usually mimic the US features of malignant tumors. Serial US follow-up should be recommended instead of other unnecessary procedures. However, repeated fine-needle aspiration, diagnostic surgery, or core-needle biopsy may still be necessary for indeterminable or highly suspicious DNs.

• Asian Pacific Journal of Cancer Prevention
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• 제17권1호
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• pp.377-380
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• 2016

Background: Epidemiological data on thyroid cancer and associated risk factors are scarce in our setting. The present study was therefore designed to gather data which could be helpful in providing insights to thyroid physicians and surgeons for better management of affected patients. Purpose: To determine the frequency of carcinoma thyroid among patients presenting with goiter and its association with TSH, Tg/ATg and other demographic factors. Materials and Methods: A total of 73 adult patients of either gender with solitary solid cold nodules and/or multi-ndoular goiter (MNG) with predominant solid cold nodules were enrolled. All surgically resected samples were sent for histopathology. The frequency of thyroid cancer and its subtypes was noted and tested for association with gender, age (< or ${\geq}40years$), recent increase in swelling size, TSH, Tg and ATg. Results: Thyroid cancer was diagnosed in 26% (n=19) of the patients, 14 (73.7%) being diagnosed with papillary thyroid cancer and 5 (26.3%) with follicular thyroid cancer. No other subtypes were noted. Presence of thyroid cancer was significantly associated with recent increase in swelling size and higher TSH Values mean TSH values (P<0.05). No significant association was found with gender, age, Tg and ATg values (P>0.05). Conclusions: Overall percentage of thyroid cancer in our study sample was found to be 26%, with a predominance of papillary over follicular lesions. Rates were significantly higher in patients who had history of recent increase in swelling size and higher and higher pre-surgery TSH values.

• 대한방사선기술학회지:방사선기술과학
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• 제31권2호
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• pp.141-147
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• 2008

갑상선 질환은 임상에서 흔히 볼 수 있는 내분비계 질환이다. 기존의 FNA (미세침흡인검사)는 갑상선결절 진단에 매우 널리 이용되고 있으나 결절의 크기가 작고 불분명한 경우, 심부에 위치하여 촉진이 어렵거나, 복합 낭종인 경우에는 적절한 표본 획득의 어려움 등의 제한점을 가지고 있다. 이러한 제한점을 최소화하고 검사의 정확성을 높이기 위한 방법의 하나로써 최근에는 US-guided FNA (초음파유도 미세침흡인검사)가 활발히 시행되고 있다. 이에 이 연구에서는 한 대학병원에서 시행되고 있는 US-guided FNA의 결과를 분석하여 표본의 정확성을 파악함으로써 US-guided FNA의 진단적 유용성을 알아보고자 하였다. 갑상선 결절로 US-guided FNA를 시행 받은 364명의 연구대상자중 성별은 여성이 316명(86.8%)으로 월등히 많았으며 연령층은 40대의 비율(51.4%)이 가장 높은 것으로 나타났다. 결절의 위치는 오른쪽이 157명(43.1%), 왼쪽이 130명(35.7%), 협부 9명(2.5%)의 순이었다. 결절의 크기는 1cm 미만인 경우는 38.2%, 1cm 이상인 경우는 61.8%인 것으로 확인되었으며, 결절의 내부 에코 양상은 고형성인 경우가 255명(70.1%)으로 가장 많았으며 낭성은 39명(10.7%), 혼합형인 경우는 19.2%이었다. 병리검사 결과 양성 307명(84.3%), 악성은 20명(5.5%), 악성의심이 4명(1.1%)이었으며, 부적절한 검체는 33명(9.1%)이었다. US-guided FNA는 표본의 적절성과 진단적 정확성을 향상시킬 것으로 기대되며 향후 진단적 정확성과 관련하여 감수성과 특이성, 예측도 등의 지표에 대한 연구들이 보완되어야 할 것으로 사료된다.