• 대한영상의학회지
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• 제84권5호
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• pp.999-1008
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• 2023

발생률이 높고, 예후는 좋지만 재발을 잘하는 경향이 있는 갑상선암에서도 전통적인 치료법은 수술이다. 하지만, 2000년대 초반부터, 간암, 폐암, 신장암에서와 마찬가지로 고주파 절제술이 원발 갑상선암 및 재발 갑상선암에 적용되기 시작했다. 원발암에서는 1 cm 이하 크기의 미세유두암 저위험군에서 수술 불가능한 경우에 대한 많은 연구가 이뤄져 왔고, 1 cm보다 더 크고 4 cm 이하의 다양한 군에 대해서도 일부 연구가 시행되었으며, 전반적으로 모두 양호한 결과를 보고하였다. 재발암에 대해서도 주로는 국소 경부 재발암에 고주파 절제술이 시행되었으며, 일부 폐, 뼈 등의 원격 전이에 대해서도 시도되었고, 전반적으로 양호한 결과가 보고되었다. 최근 들어, 한국, 미국, 유럽 등 각지에서 갑상선암의 고주파 절제술에 대해 옹호하는 움직임이 있다. 하지만, 미국 국립 종합 암 네트워크(National Comprehensive Cancer Network) 등의 중립적인 임상지침에는 고주파 절제술이 아직 인정되지는 않은 상태이다. 지금까지의 노력들과 미래의 연구를 바탕으로 향후 가까운 미래에 갑상선암의 치료에 있어 고주파 절제술이 적절한 자리매김을 할 것으로 전망한다.

• 대한두경부종양학회지
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• 제24권1호
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• pp.47-52
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• 2008

Purpose：The incidence of papillary thyroid microcarcinoma(PTMC) has increased due to the widespread use of high resolution ultrasonography and fine-needle aspiration biopsy. However, the clinical and biologic behaviors of PTMC is debatable. The aim of this study was to describe clinicopathologic features of PTMC and to suggest whether tumor size(5mm) might prove the useful parameter for determining the surgical strategy in PTMC. Material and Methods：From Jan. 2000 to Dec. 2005, 1355 of 2678 patients with papillary thyroid carcinoma were identified as having PTMC, based on tumor size${\leq}$10mm(50.6%). Among patients with PTMC, we further separated tumors<5mm(minute group：group M) from those 5 to 10mm(tiny group：group T). We compared the clinicopathological characteristics and the TNM stagings between two groups. Results：There were 114(8.4%) men and 1241(91.6%) women with a median age of 47 years(range；13-79). During a mean follow-up of 47.3(range；22-93), 13 patients(1.0%) developed locoregional recurrences and 3 patients(0.2%) showed distant metastases at initial presentation. Statistical analysis revealed that the presence of extracapsular invasion(p<0.0001), invasion to adjacent structure(p<0.0001), multifocality(p<0.0001), central lymph node metastasis(p<0.0001), and lateral lymph node metastasis(p<0.0001) were all significantly higher in tiny group(tumor${\geq}$5mm). Furthermore, minute group demonstrated a significantly lower tumor stage(AJCC TNM classification) compared with tiny group(p<0.0001). Conclusion：Patients with PTMC have a favorable treatment outcomes, although the distinction needs to be made with reference to the clinicopathologic behaviors. It would be reasonable to consider that tumor size(5mm) would be useful parameter for the treatment strategy of PTMC.

• 대한두경부종양학회지
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• 제14권2호
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• pp.228-235
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• 1998

Objectives: Papillary microcarcinoma of the thyroid was evaluated as to the effectiveness of diagnostic modalities, lymphatic spread pattern, and therapeutic decision according to tumor size. Material and Methods: We retrospectively analyzed a clinicopathologic findings of 72 papillary microcarcinoma patients who were treated at the over 11 years between 1985 and 1995. The authors divided papillary microcarcinoma of the thyroid into two subgroups according to tumor size: $0{\leqq}5mm$ and $5<0{\leqq}10mm$. An analysis including age and gender distribution, diagnostic tools(thyroid sonogram, thyroid scan, thyroid function test, fine needle aspiration cytology, frozen section), pathological examination of lymphnode, and surgical procedures was carried out in each subgroups. Results: The carcinoma of smaller than 5mm were found in 32 patients, and of 6 -10mm were in 40 patients. The average age of patients was 45years and all of them were female. Cold nodules on thyroid scan were noticed in 53 patientss and normal findings were in 15 patients. Suspicious malignant lesions(fine calcification, solid mass, irregular margin) on thyroid sonography were detected in 23 patients and the sonography was more useful in detecting $0{\leqq}5mm$ small sized lesions than other diagnostic methods. FNAC were performed in 17 patients, and 7 patients were diagnosed as having thyroid papillary cancer. But diagnotic rate in $0{\leqq}5mm$ small sized lesions was very low(one of eights).Frozen section were performed in all patients, among these 15 patients were diagnosed as being benign diseases and false negative rates were higher in $0{\leqq}5mm$ small sized lesions than in $5<0{\leqq}10mm$ sized lesions(p-value<0.006). Only thyroidectomies were performed in 24 patients and thyroidectomy with node dissections in 48 patients. The lymphnode metastatic rates were much higher in multifocal lesions(61.5%) than in single lesion. The incidence of cervical lymphnode metastasis was 19.4% in $0{\leqq}5mm$ sized lesions and 47.9% in $5<0{\leqq}10mm$ sized lesions. Postoperative management were performed with TSH suppression therapy(T4, synthroid) in all patients and RI therapy in 29 patients. Conclusion: On the basis of our study, improved preoperative diagnostic tools for papillary microcarcinoma of the thyroid was helpful in the choice of surgical treatment. As a result of techninological progress(ultrasonography, FNAC), the pencentage of the discovery of papillary microcarcinoma has been increased. The thyroid ultrasonography was useful in detecting small sized lesions($0{\leqq}5mm$), but FNAC may not be beneficial in detecting small sized lesions($0{\leqq}5mm$). In the surgical procedure, thyroid lobectomy alone should be avoided because of the high rate of bilaterality and multifocality.