근육보다 낮은 저음영, 미세석회화, 불규칙한 경계를 가진 갑상선 결절, 세침검사

상기 환자

복부 초음파와 갑상선 초음파 시행시

갑상선 결절

초음파 특징 특이도 specificity

marked hypo-echogenicity(주변 근육보다 낮은 음영( 41-92%

micro-calcification (미세석회화, small, intranodular, punctate, hyperechoic spots with scanty or no posterior acoustic shadowing) 44-95%

irregular or micro-lobulated margin(불규칙한 경계), absence of halo 48-92%

chaotic arrangement or intranodular vascular images 80%

more tall than wide

세침검사 (FNA), 미세석회화가 딱딱하여 바늘이 통과하지 않음, 표면을 긁는다는 관점으로 검사함

; [ Cytologic Diagnosis ]

Thyroid, right lower, (7mm), aspiration cytology;

A few atypical follicular cells (Atypia of Undetermined significance) (Bethesda III)

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< limited by low cellularity >

[ Comments ]

참고)The Bethesda system for Thyroid Cytopathology (risk of malignancy and management)

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Diagnostic category Risk of malignancy (%) Usual management

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I. Insufficient for Diagnosis 1-4% Repeat FNA with ultrasound guidance

II. Benign <1% Clinical follow-up

III.Atypia of Undetermined significance 5-15% Repeat FNA

IV. Suspicious for Follicular Neoplasm 15-30% Surgical, as clinically indicated

V. Suspicious for Malignancy 60-75% Surgical, as clinically indicated

VI. Malignant 97-99% Surgical, as clinically indicated

3개월뒤 FNA재검 고려, 아래쪽에서 석회화를 피해 접근해야 세포를 많이 얻을 것으로 생각됨

동대문구 답십리 우리안애, 우리안愛 내과, 건강검진 클리닉 내과 전문의 전병연