• 대한임상검사과학회지
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• 제47권4호
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• pp.292-297
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• 2015

우리나라의 경우 갑상선암, 간암, 폐암 관련 연구가 보고되었으나 다발성 골수종환자에 관한 microRNA 연구는 보고된 경우가 없어 알아보고자 하였다. 또한, 다발성 골수종 환자의 골수(bone marrow)에서 채취한 검체를 이용한 연구가 대부분 보고되고 있으며, 파라핀 포매 조직을 이용한 경우는 거의 없어 파라핀 포매 조직에서도 가능한지 알아보았다. 연구 대상은 2010년 1월부터 2012년 7월까지 충남대학교병원 진단검사의학과에 다발성 골수종 진단을 위해 골수검사를 의뢰한 8 검체를 대상으로 하였다. microRNA는 보고된 내용 중 관련성이 높다고 한 miR-15a와 miR-16, miR-21, miR-181a, miR-221를 시행하여 다음과 같은 결과를 얻었다. 각 검체별 fold change 값이 1.5 이상 또는 -1.5 이하로 유의성을 보인 경우는 miR-15a에서 3예(37.5%)로 나타났다. Microarray 검사법으로 보고한 기존 연구와 비교한 결과, miR-15a의 경우 일치하는 결과로 한국인의 다발성 골수종 환자에서 진단에 활용할 수 있음을 확인하였다. miR-221은 상반된 결과를 얻었다. 이와 같이 miR-15a의 경우, 서양인과 일치하는 결과를 얻었으며, miR-221은 서양인과 상반된 결과로 좀 더 연구가 필요하리라 생각된다. 파라핀 포매 조직에서도 microRNA를 검출 할 수 있음을 확인하였다. 하지만 검체수가 적어 좀 더 정확한 확인 검사와 많은 검체를 이용한 연구가 더욱 필요하다.

• 핵의학기술
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• 제18권2호
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• pp.57-61
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• 2014

국내 갑상선암 환자의 발병률이 증가함에 따라 방사성요오드 치료가 필요한 환자가 증가하고 있다. 방사성 요오드 치료에 이용되고 있는 캡슐용기들 중 1.1 GBq과 5.5 GBq의 국산제품에 설계도면을 바탕으로 차폐체를 구현한 후 366 keV 이상에 감마선들에 대하여 캡슐용기의 방사선 누설선량을 GEANT4 전사모사를 이용하여 평가하였다. 치료용 I-131 캡슐용기 누설선량을 측정하기 위해 각각의 용기에 대하여 용기 표면에서 10 cm 거리 및 100 cm 거리에서의 누설선량을 측정하였다. 용기표면에서 10 cm 거리와 100 cm 거리에서의 누설선량 측정은 방사형으로 발생되는 방사선을 위치별로 측정하기 위해 $10{\times}10{\times}10cm^3$ 부피의 정육면체 형태의 물 팬텀(phantom)을 상부, 상부측면, 측면, 하부측면, 하부 다섯 방향에 설치하여 누설선량을 계산하였다. 용기별로 5개 방향에서 용기표면으로 부터 10 cm, 100 cm 거리에서 전산모사를 수행한 결과 법적 허용기준인 10 cm 거리에서 2.0 mSv/h, 100 cm 거리에서 0.02 mSv/h 이하의 선량 규정과 비교하였을 때 법적기준치보다 현저히 낮은 누설선량이 방출되는 것을 확인하였다.

• 대한두경부종양학회지
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• 제8권2호
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• pp.72-81
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• 1992

Thyroid cancer, the most common cancer of endocrine neoplasms, has tremendous variation in tumor biologic behavior. There is no consensus about treatment mode to prevent recurrences despite of recent advance in understanding characteristics of thyroid cancer. So, we have made a clinical analysis and follow-up study of recurred 27 cases among 189 cases treated under the diagnosis of thyroid carcinoma in the department of surgery, Chonnam University Hospital from February, 1982 to February, 1992 to clarify our experience about the characteristics of recurred thyroid cancer. The results were as follow: According to the pathological classification of recurred thyroid cancer, recurrence rate was 11.6% in papillary carcinoma, 15.6% in follicular carcinoma, 37.5% in medullary carcinoma, 66.7% in undifferentiated carcinoma, respectively, and the mean recurrence rate of thyroid cancer was 14.3%. The recurrence rate according to age was 28.6% in 8th decade and 17.9% in 4th decade. The recurrence rate according to sex was not singificant(15.6% in male: 14% in female). The mean period to relapse was 4 years 6 months in papillary carcinoma, 2 years 5 months in follicular carcinoma, 2 years 1 months in medullary carcinoma, 2 years 6 months in undifferentiated carcinoma. The recurrence rate according to previous operating methods, such as performing lymph node dissection or not, mode of thyridectomy, type of lymph node dissection was statisfically non-specific. Common recurrent sites of papillary and follicular carcinoma was cervical lymph node and remained thyroid tissue. Medullary and undifferentiated carcinoma was noted in multiregional or systemic involvement Reoperation was performed with complete resection of recurred or metastatic mass, such as radical neck dissection or mass extirpation from involved organs as possible. The postoperative complications were 2 cases of horseness, and 1 case with hematoma, transient hypocalcemia, wound infection, and pulmonary insufficency, respectively. 5-year survival rate was 85.5% in papillary carcinoma, 66.7% in follicular carcinoma. 50% in medullary carcinoma, and 50% in undifferentiated carcinoma. We concluded that recurrence in thyroid cancer give a reconsideration to previous conservative therapy and more extensive surgical procedures for thyroid cancer including lymphatic dissection are recommanded to prevent recurrences in selected cases if possible.

• 대한두경부종양학회지
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• 제12권2호
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• pp.153-160
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• 1996

Regardless of the prognostic factors in papillary thyroid cancer, such as sex, age, size of tumor, extent of disease, and distant metastasis, the prognosis of papillary thyroid cancer is sometimes difficult to predict from clinical and microscopic analysis alone and additional prognostic indicators are needed. Recent studies of thyroid cancer have indicated that DNA aneuploidy may be correlated to the biological behavior of malignancy and inversely correlated to the prognosis, but it still remains contraversal. We performed this study to assess DNA ploidy patterns in relation with the previously known prognostic factors in AMES scoring system and lateral neck node metastasis in papillary thyroid cancer. A series of 132 patients with papillary thyroid cancer and 80 patients with benign thyroid tumor(27 follicular adenomas and 53 adenomatous goiters) as a control group from October 1993 to Feburary 1995 were analyzed and their nuclear DNA content was measured with flow cytometry using fresh tissue specimens. DNA aneuploidy was found in 8(6.1%) in papillary cancer and 8(10%) in benign tumor. S-phase traction(SFP) and proliferative index(PI) were higher in thyroid cancers, being 2.18$\pm$4.24%, 6.34$\pm$4.94% in the papillary thyroid cancers and 1.97$\pm$2.93%, 4.44$\pm$3.80% in the benign tumors, respectively. However there was no significant difference of values between two groups(p>0.05). Among variable prognostic factors studied(age, sex, size of tun or, extent of disease, distant metastasis in AMES scoring system and lateral neck node metastasis), DNA aneuploidy was found to be common in distant metastasis(p<0.001) and in lateral neck node metastasis(p>0.035), but there was no significant difference between the high risk and low risk group according to the AMES scoring system(p<0.08). In our study, DNA aneuploidy was not valuable in determining the presence of malignancy and did not correlate to the AMES scoring system. However, follow-up study of more cases will be needed for accurate information about the DNA ploidy as a independent prognostic factor.

• 핵의학기술
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• 제16권2호
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• pp.99-105
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• 2012

Purpose : This study is designed to compare two parameters reflecting $^{18}F$-FDG uptake, SUV and radioactivity, for diagnosis of thyroid cancer in dual time $^{18}F$-FDG PET/CT imaging and to find which parameter is more useful to decide whether the tumor is malignant or not. Materials and Methods : We performed retrospective study for 40 patients. All patients are diagnosed as primary thyroid cancer and examined $^{18}F$-FDG PET/CT. First, we got the dispersion of scattering beam of neck and lung apex to set a background and compared each dispersion, mean value, standard deviation of maxSUV and radioactivity. Also, mean maxSUV, ${\Delta}maxSUV$, ${\Delta}maxBq$/ml(%) and radioactivity between groups according to lesion's size based on biopsy are compared with independent-sample t-test. Results : the values that were from maxSUV and radioactivity measurement technique were compensated and calculated to practical values for mean comparison and patients were divided to two groups based on tumor size, Group1 ($size{\leq}1$ cm, n=21), Group2 (size>1 cm, n=19) for accurate comparison. In Group1, maxSUV (semi-quantitative analysis) was increased from $5.64{\pm}5.85$ (1.89~17.84) at first image to $5.90{\pm}5.01$ (1.95~18.22) at second image and radioactivity (Bq/ml) (quantitative analysis) showed similar increase from $5.93{\pm}6.38$ (2.50~16.75) at first image to $6.01{\pm}5.25$ (2.66~16.58) at second image. In Group2, TFmaxSUV was $10.54{\pm}14.36$ (2.54~33.89) in true first image, TSmaxSUV was $9.85{\pm}12.88$ (2.62~26.20) in true second image separately. The maxSUV showed a significant difference in the mean comparison between the two groups (p=0.035) But, mean radioactivity (Bq/ml) was $5.93{\pm}6.38$ (4.81~40.99) in true first image, $6.01{\pm}5.25$ (4.51~36.93) in true second image and didn't show a significant difference statistically (p=0.126) Conclusion : In diagnosis of thyroid tumor, SUV and radioactivity depending on $^{18}F$-FDG uptake showed high similarity with coefficient of determination (R2=0.939) and malignant evaluation results using dual time also showed similar aspect. Radioactivity for evaluation of malignant tumor didn't show better specificity or sensitivity than maxSUV.

• 핵의학기술
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• 제15권1호
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• pp.75-80
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• 2011

유럽 및 미국에서는 다인용 치료병실을 사용하고 있는 실정이다. 이에 서울대학교병원에서 현재 1인용 치료병실로 사용하고 있는 병실을 2인용 치료병실로 운영할 때 안전성에 대해 알아보고자 한다. 서울대학교병원 기존 치료병실에 침대와 침대 사이 차폐벽을 설치하여 2인용 치료병실로 운영할 경우, 상대방 환자로부터 방출되는 감마선의 산란에 의한 외부피폭과 상대방 환자에 의해 발생되는 오염으로 인한 외부 및 내부피폭을 평가하였다. 2인용 치료병실의 안전성 평가를 위해 외부 및 내부피폭을 평가하였을 때 원자력법에서 고시하는 '진료환자의 격리 수량, 5 mSv'이하의 피폭을 받게 됨을 알 수 있었다. 그리고 환자들의 피폭관리방안을 수립하여 교육 및 관리함으로써 환자 상호 간의 불필요한 피폭을 방지할 수 있다는 것을 알 수 있었다. 갑상선암 환자의 증가에 따라 치료병실 이용하는 환자가 적체되고 있는 추세이다. 이에 국제적 추세에 발맞춰 현행 1인용 치료병실을 2인용 치료병실로 개선함으로써 비용절감 및 관리의 효율성을 증대할 수 있으며 환자의 소외감과 고립감을 해소하여 치료효과를 높일 수 있다.

• 핵의학기술
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• 제12권1호
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• pp.130-136
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• 2008

목적: 방사성옥소 치료를 받는 많은 환자들이 장기간의 전처치와 격리 입원 동안에 신체적 불편함을 호소하므로 이를 줄여주기 위하여 첫째, 방사성옥소 치료 전 환자들이 저옥소식을 잘 지킬 수 있도록 도움을 주며 둘째, 4일간의 격리입원기간 동안 심리적 어려움과 신체 적불편함을 줄여줌으로써 환자의 만족도를 향상시키는 효과를 기대하고자 본 연구를 하였다. 대상 및 방법: 1. 연구자들의 브레인스토밍을 통해 환자들의 불편함을 파악하였다. 2. 방사성옥소 치료를 위해 입원한 환자 36명에게 입원 기간 동안 느낀 점을 기록하게 하고 이를 조사하였다. 3. 환자 퇴원시에 치료과정에 대한 만족도 설문을 문제점 개선 전 33명, 개선 후 22명에게 조사하였다. 결과: 문제점과 개선안을 도출하였으며 가능한 범위 내에서 개선활동을 실시하였다. 그리고 만족도 설문을 조사하였으며 개선 전 후를 비교하였다. 문제점으로 1) 저옥소식: 맛이 없다, 반찬 가려 먹기가 어렵다. 2) 치료병실 생활: 속이 메스꺼워 음식 섭취가 곤란하다, 병실이 춥다. 3) 호르몬제 투여중지: 전신이 나른하다, 몸이 붓는다가 도출되었으며 이를 해결하기 위한 개선 활동은 1) 입원 전 예약 시에 음식조절(저옥소식)에 대한 설명을 자세히 하였다. 2) 타부서와의 협의-협조사항(치료병실의 청결유지와 쾌적한 병실을 만들기 위해 16층 병동과 협의, 저옥소식 영양상담을 치료 과정중에 넣기 위해 영양과와 협의, 온열매트리스 설치와 보온이불 구입을 위해 시설팀과 협의 등)을 해결하려 노력했다. 3) 전반적인 개선활동(방사성옥소를 차질없이 구입, 치료병실의 치료 전 후 방사능오염 방지, 환자의 심리적 불안감 해소 등)을 하였다. 환자의 만족도 설문에 대한 개선 활동 전 후 비교 결과에서 '치료과정 전체에 대해 힘들었다'는 개선 전 후에 각각 80.6%, 81.8%로 큰 차이가 없었다. 또한 문제점으로 도출된 '저옥소식이 힘들었다'는 개선 전 후에 각각 24.1%, 27.8%로 역시 큰 차이가 없었다. 그러나 '병실생활이 힘들었다'는 개선 전 후에 각각 48.3%, 72.2%로 큰 차이를 보였다. 그리고 '호르몬 투여중지로 인해 힘들었다'는 개선 전 후에 각각 27.6%, 0%로 큰 차이를 보였다. 고찰 및 결론: 환자들의 불편함을 줄여주기 위하여 연구자들의 개선활동이 있었고 그 중에서 입원병실의 생활환경이 특히 향상되었다. 그러나 결과에서 '병실생활이 힘들었다'에 대한 답의 비율은 오히려 더 높아졌다. 이는 '호르몬 투여 중지로 힘들었다'로 답하는 환자의 비율이 상대적으로 줄었기 때문에 높아진 것으로 생각되었다. 방사성옥소 치료로 인해 생길 수밖에 없는 신체적 반응 때문에 대부분의 환자들은 항상 힘들었다고 할 것이다. 만족도 개선 활동으로 환자의 힘든 치료과정을 완전히 해소시켜 줄 수는 없었으나 환자입장에서 생각할 수 있게 된 계기가 되었으며 좀 더 향상된 치료환경을 제공하는 기회가 되었다.

• 대한두경부종양학회지
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• 제15권1호
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• pp.46-51
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• 1999

Background: Total thyroidectomy and postoperative radiodiodine ablation therapy in differentiated thyroid carcinomas enhance the reliability of serum thyroglobulin(Tg) levels and radioiodine scan in detecting recurrence or distant metastasis. There have been, however, some limitations in using these methods under certain conditions. Recently, several reports have indicated that thyroid peroxidase(TPO) could be used as an alternative tumor marker. We aimed to estimate the significance of serum TPO levels in differentiated thyroid carcinoma. Materials and Methods: Forty-eight patients who had undergone total thyroidectomy due to papillary thyroid carcinomas and who had been followed-up for at least 3 years were classified into two groups: 27 patients without any evidence of recurrence in group 1; and 20 patients with recurrence or distant metastasis in group 2. All patients were examined by radioiodine scans. Serum Tg, TSH, antithyroglobulin antibody, and TPO were measured and the relationships were statistically analyzed. The sensitivity and specificity of $^{131}I$ scan, serum Tg, and serum TPO were evaluated. Results: Serum Tg levels were $3.81{\pm}5.16ng/mL$ in group 1 and $147.02{\pm}193.75ng/mL$ in group 2. Only 2 patients in group 1 showed Tg levels exceeding 10ng/mL. In contrast, 4 patients in group 2 were under 10ng/mL. Serum antithyroglobulin antibody and TSH levels showed no statistical difference between the two groups. In group 1, 16 patients showed negative serum TPO results, and 4 patients in group 2 showed negative results. There was no correlation among serum Tg levels, antithyroglobulin antibody titers, and serum TPO levels in each group. In group 2, 4 patients with negative serum Tg levels showed positive TPO results and positive whole body scans. Two cases with false negative $^{131}I$ scans showed positive serum TPO and Tg results. In 4 cases showing false negative serum TPO levels, serum Tg levels and $^{131}I$ scans were positive. Conclusion: Serum Tg levels, radioiodine scans, and serum TPO levels can be clinically used as complementary methods in the diagnosis of recurrent or metastatic thyroid carcinomas. Serum TPO levels may be helpful when other methods fail to detect recurrences or distant metastasis in highly suspected patients.

• 대한핵의학회지
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• 제12권2호
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• pp.33-40
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• 1978

Clinical features of 147 patients with biopsy-proven thyroid carcinomas were investigated from January, 1972 to April, 1978 at the Seoul National University Hospital with the following results. 1) The incidence of thyroid carcinomas according to their histopathological classification revealed 76.2% of papillary carcinoma, 19.0% of follicular carcinoma, and 3 cases of occult sclerozing carcinoma, 1 case of giant cell carcinoma and 1 case of metastatic melanoma. 2) The ratio of male to femle patients was 1:8.3 and showed no difference between papillary and follicular carcinomas. 3) The age distribution showed the peak incidence in the fourth decade (29.3%) followed by the fifth and sixth decades. 4) The average duration of illness from the onset of symptoms was about 5 years while it was 4.4 years and 7.6 years in the papillary and follicular carcinomas respectively. 5) The diameter of the thyroid masses was smaller than 5 cm in 53.6% of the patients, from 5 cm to 10 cm in 40.0% and larger than 10 cm in 6.4%. 6) In 36.4% of the patients with thyroid carcinomas the thyroid masses were fixed to adjacent tissues. 7) Metastasis to the regional lymph nodes was noted in 40.0% of the total cases, and in 45.2% and 17.6% of the papillary and follicular carcinomas respectively, while the lung and bone metastases were found in 10.0% and 4.4% in each type respectively. 8) 88.9% of the patients showed cold areas in the thyroid scans using $^{131}I$. 9) Typical psammoma bodies were observed in 21.3% of the cases in the microscopic examination of the pathological specimens. 10) The initial diagnosis of thyroid malignancy could be made before histological confirmation in 64.5% of the patients. 11) The clinical staging slightly modified from Schulz method revealed 43.6% of the patients in stage I, 26.4% in stage II, 20.9% in stags III and 9.1 % in stage IV. 12) The association with Hashimoto's thyroiditis was noted in 4 cases, with nodular goiter in 3 cases, and with follicular adenoma in 1 case.

• 대한핵의학회지
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• 제20권1호
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• pp.59-65
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• 1986

Clinical features of 406 patients with histologically verified thyroid carcinomas were investigated from May, 1978 to April, 1985 at the Seoul National University Hospital with the following results. 1) The incidence of thyroid cancer according to their histological classification was 79.8% of papillary carcinoma, 14.5% of follicular carcinoma, 1.5% of medullary carcinoma, 2.2% of anaplastic carcinoma, 2 cases of squamous carcinoma and 3 cases of lymphoma. 2) The age distribution showed the peak incidence in the fourth decade (25.1%), followed by the fifth and the third decade. 3) The ratio of male to female patients was 1 : 6.1. The ratio is 1 : 5.9 in papillary carcinoma and 1 : 8.8 in follicular carcinoma. 4) The mean age was 40.2 year in papillary carcinoma, 37.4 year in follicular carcinoma. 36.5 year in medullary carcinoma, 60.3 year in anaplastic carcinoma, 62.0 year in squamous carcinoma, 59.7 year in lymphoma. 5) The diameter of the thyroid masses was smaller than 1.5cm in 19.9% of the patients, from 1.5cm to 5cm in 50.5%, from 5cm to 10cm in 25.4% and larger than 10cm in 25.4%. 6) Metastasis to the regional lymph nodes at diagnosis was noted in 44.2% of total patients, and distant metastasis was 5%, and local infiltration was 44.2%. 7) The clinical staging was revealed 42.1% of the patients in stage I, 9.1% in stage II, 35.7% in stage III, 5.2% in stage IV, and 7.9% in undetermined stage.