대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제83권3호
  • /
  • Pages.645-657
  • /
  • 2022
  • /
  • 1738-2637(pISSN)
  • /
  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

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

Fine Needle Aspiration Cytology vs. Core Needle Biopsy for Thyroid Nodules: A Prospective, Experimental Study Using Surgical Specimen

  • 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)
  • 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)
  • 투고 : 2021.07.06
  • 심사 : 2021.09.11
  • 발행 : 2022.05.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

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.

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.

키워드

참고문헌

  1. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1-133  https://doi.org/10.1089/thy.2015.0020
  2. Na DG, Kim JH, Sung JY, Baek JH, Jung KC, Lee H, et al. Core-needle biopsy is more useful than repeat fine-needle aspiration in thyroid nodules read as nondiagnostic or atypia of undetermined significance by the Bethesda system for reporting thyroid cytopathology. Thyroid 2012;22:468-475  https://doi.org/10.1089/thy.2011.0185
  3. Sung JY, Na DG, Kim KS, Yoo H, Lee H, Kim JH, et al. Diagnostic accuracy of fine-needle aspiration versus core-needle biopsy for the diagnosis of thyroid malignancy in a clinical cohort. Eur Radiol 2012;22:1564-1572  https://doi.org/10.1007/s00330-012-2405-6
  4. Hong MJ, Na DG, Kim SJ, Kim DS. Role of core needle biopsy as a first-line diagnostic tool for thyroid nodules: a retrospective cohort study. Ultrasonography 2018;37:244-253  https://doi.org/10.14366/usg.17041
  5. Anderson TJ, Atalay MK, Grand DJ, Baird GL, Cronan JJ, Beland MD. Management of nodules with initially nondiagnostic results of thyroid fine-needle aspiration: can we avoid repeat biopsy? Radiology 2014;272:777-784  https://doi.org/10.1148/radiol.14132134
  6. Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer 2007;111:508-516  https://doi.org/10.1002/cncr.23116
  7. Ho AS, Sarti EE, Jain KS, Wang H, Nixon IJ, Shaha AR, et al. Malignancy rate in thyroid nodules classified as Bethesda category III (AUS/FLUS). Thyroid 2014;24:832-839  https://doi.org/10.1089/thy.2013.0317
  8. Onder S, Firat P, Ates D. The Bethesda system for reporting thyroid cytopathology: an institutional experience of the outcome of indeterminate categories. Cytopathology 2014;25:177-184  https://doi.org/10.1111/cyt.12091
  9. Nayar R, Ivanovic M. The indeterminate thyroid fine-needle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer 2009;117:195-202  https://doi.org/10.1002/cncy.20029
  10. Yeon JS, Baek JH, Lim HK, Ha EJ, Kim JK, Song DE, et al. Thyroid nodules with initially nondiagnostic cytologic results: the role of core-needle biopsy. Radiology 2013;268:274-280  https://doi.org/10.1148/radiol.13122247
  11. Park KT, Ahn SH, Mo JH, Park YJ, Park DJ, Choi SI, et al. Role of core needle biopsy and ultrasonographic finding in management of indeterminate thyroid nodules. Head Neck 2011;33:160-165  https://doi.org/10.1002/hed.21414
  12. Renshaw AA, Pinnar N. Comparison of thyroid fine-needle aspiration and core needle biopsy. Am J Clin Pathol 2007;128:370-374  https://doi.org/10.1309/07TL3V58337TXHMC
  13. Chen BT, Jain AB, Dagis A, Chu P, Vora L, Maghami E, et al. Comparison of the efficacy and safety of ultrasound-guided core needle biopsy versus fine-needle aspiration for evaluating thyroid nodules. Endocr Pract 2015;21:128-135  https://doi.org/10.4158/EP14303.OR
  14. Pyo JS, Sohn JH, Kang G. Core needle biopsy is a more conclusive follow-up method than repeat fine needle aspiration for thyroid nodules with initially inconclusive results: a systematic review and meta-analysis. J Pathol Transl Med 2016;50:217-224  https://doi.org/10.4132/jptm.2016.02.15
  15. Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 2011;260:892-899  https://doi.org/10.1148/radiol.11110206
  16. Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, 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
  17. Lee YH, Baek JH, Jung SL, Kwak JY, Kim JH, Shin JH; Korean Society of Thyroid Radiology (KSThR); Korean Society of Radiology. Ultrasound-guided fine needle aspiration of thyroid nodules: a consensus statement by the Korean Society of Thyroid Radiology. Korean J Radiol 2015;16:391-401  https://doi.org/10.3348/kjr.2015.16.2.391
  18. Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol 2009;132:658-665  https://doi.org/10.1309/AJCPPHLWMI3JV4LA
  19. Jung CK, Min HS, Park HJ, Song DE, Kim JH, Park SY, et al. Pathology reporting of thyroid core needle biopsy: a proposal of the Korean Endocrine Pathology Thyroid Core Needle Biopsy Study Group. J Pathol Transl Med 2015;49:288-299  https://doi.org/10.4132/jptm.2015.06.04
  20. Hakala T, Kholova I, Sand J, Saaristo R, Kellokumpu-Lehtinen P. A core needle biopsy provides more malignancy-specific results than fine-needle aspiration biopsy in thyroid nodules suspicious for malignancy. J Clin Pathol 2013;66:1046-1050  https://doi.org/10.1136/jclinpath-2013-201559
  21. Choi YJ, Baek JH, Suh CH, Shim WH, Jeong B, Kim JK, et al. Core-needle biopsy versus repeat fine-needle aspiration for thyroid nodules initially read as atypia/follicular lesion of undetermined significance. Head Neck 2017;39:361-369  https://doi.org/10.1002/hed.24597
  22. Novoa E, Gurtler N, Arnoux A, Kraft M. Role of ultrasound-guided core-needle biopsy in the assessment of head and neck lesions: a meta-analysis and systematic review of the literature. Head Neck 2012;34:1497-1503  https://doi.org/10.1002/hed.21821
  23. Nam SJ, Kwak JY, Moon HJ, Yoon JH, Kim EK, Koo JS. Large (≥ 3 cm) thyroid nodules with benign cytology: can thyroid imaging reporting and data system (TIRADS) help predict false-negative cytology? PLoS One 2017;12:e0186242 
  24. Pinchot SN, Al-Wagih H, Schaefer S, Sippel R, Chen H. Accuracy of fine-needle aspiration biopsy for predicting neoplasm or carcinoma in thyroid nodules 4 cm or larger. Arch Surg 2009;144:649-655  https://doi.org/10.1001/archsurg.2009.116
  25. McCoy KL, Jabbour N, Ogilvie JB, Ohori NP, Carty SE, Yim JH. The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size. Surgery 2007;142:837-844  https://doi.org/10.1016/j.surg.2007.08.012
  26. Giles WH, Maclellan RA, Gawande AA, Ruan DT, Alexander EK, Moore FD Jr, et al. False negative cytology in large thyroid nodules. Ann Surg Oncol 2015;22:152-157  https://doi.org/10.1245/s10434-014-3952-7
  27. Lee HJ, Kim YJ, Han HY, Seo JY, Hwang CM, Kim K. Ultrasound-guided needle biopsy of large thyroid nodules: core needle biopsy yields more reliable results than fine needle aspiration. J Clin Ultrasound 2019;47:255-260  https://doi.org/10.1002/jcu.22721
  28. Yoon JH, Kim EK, Kwak JY, Moon HJ. Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules: review of current literature. J Pathol Transl Med 2015;49:230-235  https://doi.org/10.4132/jptm.2015.03.21
  29. Greaves TS, Olvera M, Florentine BD, Raza AS, Cobb CJ, Tsao-Wei DD, et al. Follicular lesions of thyroid: a 5-year fine-needle aspiration experience. Cancer 2000;90:335-341  https://doi.org/10.1002/1097-0142(20001225)90:6<335::AID-CNCR3>3.0.CO;2-L
  30. Kamran SC, Marqusee E, Kim MI, Frates MC, Ritner J, Peters H, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab 2013;98:564-570  https://doi.org/10.1210/jc.2012-2968
  31. Hakala T, Kellokumpu-Lehtinen P, Kholova I, Holli K, Huhtala H, Sand J. Rising incidence of small size papillary thyroid cancers with no change in disease-specific survival in Finnish thyroid cancer patients. Scand J Surg 2012;101:301-306  https://doi.org/10.1177/145749691210100415
  32. Elisei R, Molinaro E, Agate L, Bottici V, Masserini L, Ceccarelli C, et al. Are the clinical and pathological features of differentiated thyroid carcinoma really changed over the last 35 years? Study on 4187 patients from a single Italian institution to answer this question. J Clin Endocrinol Metab 2010;95:1516-1527  https://doi.org/10.1210/jc.2009-1536
  33. Colonna M, Guizard AV, Schvartz C, Velten M, Raverdy N, Molinie F, et al. A time trend analysis of papillary and follicular cancers as a function of tumour size: a study of data from six cancer registries in France (1983-2000). Eur J Cancer 2007;43:891-900  https://doi.org/10.1016/j.ejca.2006.11.024
  34. Yoon JH, Lee HS, Kim EK, Moon HJ, Park VY, Kwak JY. Cytopathologic criteria and size should be considered in comparison of fine-needle aspiration vs. core-needle biopsy for thyroid nodules: results based on large surgical series. Endocrine 2020;70:558-565 https://doi.org/10.1007/s12020-020-02416-z