Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Fine Needle Aspiration Cytology vs. Core Needle Biopsy for Thyroid Nodules: A Prospective, Experimental Study Using Surgical Specimen

갑상선 결절에 대한 세침 흡인 세포 검사와 중심부 바늘 생검의 비교: 수술 검체를 기반으로 한 전향적, 실험적 비교 연구

  • Hyuk Kwon (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine) ;
  • Jandee Lee (Department of Surgery, Severance Hospital, Yonsei University, College of Medicine) ;
  • Soon Won Hong (Department of Pathology, Yongin Severance Hospital, Yonsei University, College of Medicine) ;
  • Hyeong Ju Kwon (Department of Pathology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Jin Young Kwak (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine) ;
  • Jung Hyun Yoon (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine)
  • 권혁 (연세대학교 의과대학 세브란스병원 영상의학과) ;
  • 이잔디 (연세대학교 의과대학 세브란스병원 외과) ;
  • 홍순원 (연세대학교 의과대학 용인세브란스병원 병리과) ;
  • 권형주 (연세대학교 원주의과대학 원주세브란스기독병원 병리과) ;
  • 곽진영 (연세대학교 의과대학 세브란스병원 영상의학과) ;
  • 윤정현 (연세대학교 의과대학 세브란스병원 영상의학과)
  • Received : 2021.07.06
  • Accepted : 2021.09.11
  • Published : 2022.05.01
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Abstract

Purpose To evaluate and compare the diagnostic outcomes of ultrasonography (US)-guided fine needle aspiration (FNA) and core needle biopsy (CNB) performed on the same thyroid nodule using a surgical specimen for direct comparison. Materials and Methods We included 89 thyroid nodules from 88 patients from February 2015 to January 2016. The inclusion criterion was thyroid nodules measuring ≥ 20 mm (mean size: 40.0 ± 15.3 mm). Immediately after surgical resection, FNA and subsequent CNB were performed on the surgical specimen under US guidance. FNA and CNB cytopathologic results on the specimen were compared with the surgical diagnosis. Results Among the 89 nodules, 30 were malignant and 59 were benign. Significantly higher inconclusive rates were seen in FNA for malignant than benign nodules (80.0% vs. 39.0%, p < 0.001). For CNB, conclusive and inconclusive rates did not differ between benign and malignant nodules (p = 0.796). Higher inconclusive rates were seen for FNA among cancers regardless of US features, and in the subgroup of size ≥ 40 mm (62.5% vs. 22.9%, p = 0.028). Eleven cancers were diagnosed with CNB (36.7%, 11/30), while none was diagnosed using FNA. Conclusion In this experimental study using surgical specimens, CNB showed a potential to provide improved diagnostic sensitivity for thyroid cancer, especially when a conclusive diagnosis is limited with FNA.

목적 수술 검체를 사용하여 동일한 갑상선 결절에 시행한 세침 흡인 세포검사와 중심부 바늘 생검의 진단 결과를 비교 평가하고자 하였다. 대상과 방법 2015년 2월부터 2016년 1월까지 88명의 20 mm 이상 크기의 89개의 갑상선 결절이 연구에 포함되었다(평균 크기: 40.0 ± 15.3 mm). 갑상선이 적출된 후 검체에 초음파 보조하에 세침 흡인 검사와 중심부 바늘 생검을 차례대로 시행하였다. 세포 병리 검사 결과는 수술 병리 진단 결과와 비교하였다. 결과 89개의 결절 중 30개는 악성, 59개는 양성이었다. 악성 결절에서 양성 결절보다 유의하게 비진단적 세침 흡인 검사 결과율이 높았다(80.0% vs. 39.0%, p < 0.001). 중심부 바늘 생검의 경우 양성과 악성 결절 사이에 결과의 유의한 차이가 없었다(p = 0.796). 크기가 40 mm 이상인 결절과(62.5% vs. 22.9%, p = 0.028) 초음파 소견과는 상관없이, 악성 결절에서 비진단적 세침 흡인 검사 결과율이 높았다. 30개의 갑상선암 중 11개(36.7%)가 중심부 바늘 생검으로 진단되었으나, 세침 흡인 검사에서는 진단된 검체가 없었다. 결론 수술 검체를 이용한 본 실험 연구에서, 중심부 바늘 생검은 갑상선암에 대한 진단적 민감도를 높일 수 있는 가능성이 있는 것으로 생각된다.

Keywords

References

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