The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Prevalence of Thyroid Cancer in Thyroid Nodules with Dense Calcification

거대석회화를 동반한 갑상선 결절에서 갑상선암의 빈도

  • Yoon, Jee-Hee (Department of Internal Medicine Chonnam National University Medical School) ;
  • Kim, Hee-Kyung (Department of Internal Medicine Chonnam National University Medical School) ;
  • Kim, Soo-Jeong (Department of Internal Medicine Chonnam National University Medical School) ;
  • Cho, Jin-Seong (Department of Surgery, Chonnam National University Medical School) ;
  • Kang, Ho-Cheol (Department of Internal Medicine Chonnam National University Medical School)
  • 윤지희 (전남대학교 의과대학 내과학교실) ;
  • 김희경 (전남대학교 의과대학 내과학교실) ;
  • 김수정 (전남대학교 의과대학 내과학교실) ;
  • 조진성 (전남대학교 의과대학 외과학교실) ;
  • 강호철 (전남대학교 의과대학 내과학교실)
  • Published : 2012.09.01
⟨ Previous Next ⟩

Abstract

Background/Aims: High-resolution ultrasonography has made it possible to predict thyroid cancers without invasive procedures. Densely calcified nodules are difficult to image on ultrasound, and considering them to be high risk features for thyroid cancers has been controversial. The aim of this study was to evaluate the prevalence of malignancy in patients with densely calcified nodules using an analysis of clinical parameters related to the development of thyroid cancer. Methods: We retrospectively reviewed the thyroid sonographic findings and clinical characteristics of patients with thyroid nodules who attended Chonnam National University Hwasun Hospital during a 5-year period (2,387 cases). Dense calcifications included coarse dense calcification and peripheral calcification (163 cases). Nodules with microcalcification (< 2 mm) were excluded from this analysis (154 cases). Ultrasonography-guided fine needle aspiration (FNA) was performed for all nodules with dense calcification. Results: Among the densely calcified nodules, 37 (22.7%) were malignant. The prevalence of malignancy in patients with densely calcified thyroid nodules was higher than that in patients without calcification (p < 0.01). The incidence of malignancy was greater in coarse calcified thyroid nodules than in nodules with peripheral (egg-shell) calcification, but this difference was not statistically significant (30.1% vs. 16.2%, p = 0.101). Conclusions: Nodules with dense calcification carry a higher risk for malignancy than non-calcified nodules. Further, it is more difficult to obtain an adequate or diagnostic sample for nodules with dense calcification. Therefore, careful evaluation is necessary to diagnose malignancy in densely calcified nodules.

목적: 갑상선 결절은 흔하게 발견되며 약 5%에서 갑상선암으로 진단되므로 악성 결절과 양성 결절을 구분하는 것이 중요하다. 최근 고해상도 갑상선 초음파의 발달로 악성을 시사하는 초음파 소견을 예측하고자 다양한 연구가 진행되었고, 미세석회화와 악성화의 연관성이 확립된 반면, 거대석회화와 갑상선암의 연관성에 대한 논란이 있어 다수를 대상으로 후향적 연구를 시행하였다. 방법: 5년 동안 갑상선 결절로 인하여 화순전남대병원을 방문하여 갑상선 초음파를 시행하였던 환자들 중에서 갑상선적출술을 받았거나, 갑상선암의 위험인자로 잘 알려진 미세석회화를 동반하는 경우를 제외하고, 거대석회화 유 무에 따라 두 군으로 구분하여 갑상선 초음파, 미세침흡인세포검사 결과 및 수술을 통한 병리 결과를 확인하였다. 결과: 거대석회화를 동반하는 군에서 악성의 빈도는 22.7% (37/163)로 석회화가 불분명하거나 없는 군의 악성 결절의 빈도가 13.4% (271/2,021)인 것과 비교하여 통계학적으로 유의하게 높았고(p < 0.01), 비정형 및 악성의심 결절의 빈도도 유의하게 높았다(p < 0.01). 거친석회화 군에서 변연부석회화군에 비해 통계학적 의의는 없었지만 악성의 빈도가 높았다(30.1% vs. 16.2%). 결론: 거대석회화를 동반한 갑상선 결절은 악성의 빈도가 높으며, 부적절한 검체를 얻을 확률이 높으므로 주의 깊은 미세침흡인세포검사 및 추적검사가 필요하다.

Keywords

References

  1. Hegedus L. Clinical practice: the thyroid nodule. N Engl J Med 2004;351:1764-1771. https://doi.org/10.1056/NEJMcp031436
  2. Peccin S, de Castsro JA, Furlanetto TW, Furtado AP, Brasil BA, Czepielewski MA. Ultrasonography: is it useful in the diagnosis of cancer in thyroid nodules? J Endocrinol Invest 2002;25:39-43.
  3. Kang HC. Ultrasonographic, cytologic and genetic diagnosis of thyroid cancer. Korean J Med 2009;77:543-551.
  4. Kim EK, Park CS, Chung WY, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 2002;178:687-691. https://doi.org/10.2214/ajr.178.3.1780687
  5. Wang N, Xu Y, Ge C, Guo R, Guo K. Association of sonographically detected calcification with thyroid carcinoma. Head Neck 2006;28:1077-1083. https://doi.org/10.1002/hed.20481
  6. Seiberling KA, Dutra JC, Grant T, Bajramovic S. Role of intrathyroidal calcifications detected on ultrasound as a marker of malignancy. Laryngoscope 2004;114:1753-1757. https://doi.org/10.1097/00005537-200410000-00014
  7. Kakkos SK, Scopa CD, Chalmoukis AK, et al. Relative risk of cancer in sonographically detected thyroid nodules with calcifications. J Clin Ultrasound 2000;28:347-352. https://doi.org/10.1002/1097-0096(200009)28:7<347::AID-JCU5>3.0.CO;2-O
  8. Takashima S, Fukuda H, Nomura N, Kishimoto H, Kim T, Kobayashi T. Thyroid nodules: re-evaluation with ultrasound. J Clin Ultrasound 1995;23:179-184. https://doi.org/10.1002/jcu.1870230306
  9. Moon WJ, Jung SL, Lee JH, et al. Benign and malignant thyroid nodules: US differentiation: multicenter retrospective study. Radiology 2008;247:762-770. https://doi.org/10.1148/radiol.2473070944
  10. Yaturu S, Rainer L. Thyroid nodule with eggshell calcification and oncocytic thyroid cancer. Med Sci Monit 2010;16: CS25-CS28.
  11. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid 2009;19:1159-1165. https://doi.org/10.1089/thy.2009.0274
  12. Cappelli C, Castellano M, Pirola I, et al. The predictive value of ultrasound findings in the management of thyroid nodules. QJM 2007;100:29-35.
  13. Tessler FN, Tublin ME. Thyroid sonography: current applications and future directions. AJR Am J Roentgenol 1999;173:437-443. https://doi.org/10.2214/ajr.173.2.10430150
  14. Katz JF, Kane RA, Reyes J, Clarke MP, Hill TC. Thyroid nodules: sonographic-pathologic correlation. Radiology 1984;151:741-745.
  15. Ginat DT, Butani D, Giampoli EJ, Patel N, Dogra V. Pearls and pitfalls of thyroid nodule sonography and fine-needle aspiration. Ultrasound Q 2010;26:171-178. https://doi.org/10.1097/RUQ.0b013e3181efa710
  16. Tae HJ, Lim DJ, Baek KH, et al. Diagnostic value of ultrasonography to distinguish between benign and malignant lesions in the management of thyroid nodules. Thyroid 2007;17:461-466. https://doi.org/10.1089/thy.2006.0337
  17. Liu HF, Tang WS, Yang ZY. Thyroid nodules with calcification and thyroid carcinoma. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2003;25:626-629.
  18. Yoon DY, Lee JW, Chang SK, et al. Peripheral calcification in thyroid nodules: ultrasonographic features and prediction of malignancy. J Ultrasound Med 2007;26:1349-1355.
  19. Park M, Shin JH, Han BK, et al. Sonography of thyroid nodules with peripheral calcifications. J Clin Ultrasound 2009;37:324-328. https://doi.org/10.1002/jcu.20584
  20. Taki S, Terahata S, Yamashita R, et al. Thyroid calcifications: sonographic patterns and incidence of cancer. Clin Imaging 2004;28:368-371. https://doi.org/10.1016/S0899-7071(03)00190-6
  21. Lu Z, Mu Y, Zhu H, et al. Clinical value of using ultrasound to assess calcification patterns in thyroid nodules. World J Surg 2011;35:122-127. https://doi.org/10.1007/s00268-010-0827-3
  22. Amrikachi M, Ramzy I, Rubenfeld S, Wheeler TM. Accuracy of fine-needle aspiration of thyroid. Arch Pathol Lab Med 2001;125:484-488.
  23. Gharib H. Changing concepts in the diagnosis and management of thyroid nodules. Endocrinol Metab Clin North Am 1997;26:777-800. https://doi.org/10.1016/S0889-8529(05)70282-6
  24. Bose S, Walts AE. Thyroid fine needle aspirate: a post-Bethesda update. Adv Anat Pathol 2012;19:160-169. https://doi.org/10.1097/PAP.0b013e3182534610