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Table 1.
갑상선결절 및 암 진료 권고안의 권고수준
Table 2.
K-TIRADS에 기초한 갑상선결절의 암 위험도 및 세침흡인검사 기준 a
| 카테고리 | 초음파 유형 | 암 위험도(%) | 계산된 암 위험도(%) | 세침흡인검사 c |
|---|---|---|---|---|
| 5 높은의심 | 암 의심 초음파 소견 b이 있는 저에코 고형결절 | ＞60 | 79 (61–85) | ＞1 cm (선택적으로 ＞0.5 cm d) |
| 4 중간의심 | 1) 암 의심 초음파 소견이 없는 저에코 고형결절 혹은 | 15–50 | 25 (15–34) | ≥1 cm |
| 2) 암 의심 초음파 소견이 있는 부분 낭성 혹은 등고에코 결절 | ||||
| 3 낮은의심 | 암 의심 초음파 소견이 없는 부분 낭성 혹은 등/고에코결절 | 3–15 | 8 (6–10) | ≥1.5 cm |
| 2 양성 | 1) 해면모양 | ＜3 | 0 | ≥2 cm |
| 2) comet tail artifact 보이는 부분 낭성 결절 혹은 순수 낭종 | ＜1 | 0 | ||
| 1 무결절 | – | – |
Table 3.
갑상선 세침흡인세포검사의 Bethesda system: 진단 범주와 악성도
Table 4.
Imaging-based risk stratification of the cervical lymph nodes for nodal metastasis48)
| Category | US | CT |
|---|---|---|
| Suspicious a | Cystic change | Cystic change |
| Calcification (micro/macro) | Calcification (micro/macro) | |
| Hyperechogenicity (focal or diffuse) | Heterogeneous enhancement | |
| Abnormal vascularity (peripheral or diffuse) | Strong enhancement (focal or diffuse) | |
| Indeterminate b | Loss of central hilar echo and absence of central hilar vascularity | Loss of central hilar fat and absence of central hilar vessel enhancement |
| Benign c | Central hilar echo | Central hilar fat |
| Central hilar vascularity | Central hilar vessel enhancement |
Table 5.
후두신경 기능 이상과 관련된 요소들
| 인자 | 증상과 징후 |
|---|---|
| 문진 | 음성 이상, 연하곤란, 기도 관련 증상, 객혈, 통증, 빠른 진행, 경부 또는 상흉부 수술 병력 |
| 이학적 검사 | 후두나 기관에 고정된 광범위하고 단단한 종물 |
| 영상학적 검사 | 후방 갑상선 외 침범 또는 기관식도 침범이 있는 경우, |
| 반회후두신경 또는 미주신경의 주행을 따라 광범위한 경부 림프절종이 있는 경우 |
Table 6.
갑상선암의 AJCC 지침(7판)에 따른 TNM 정의
Table 7.
갑상선유두암 또는 갑상선여포암의 병기
Table 8.
재발 위험도에 따른 환자의 분류
| 저위험군 | ▪유두암(아래 항목을 모두 충족하는 경우) |
| 1) 국소 및 원격전이가 없고 | |
| 2) 수술로 육안적 병소가 모두 제거되었으며 | |
| 3) 주위조직으로의 침윤이 없고 | |
| 4) 나쁜 예후를 갖는 조직형(키큰세포 변이종, 원주형세포 변이종, hobnail 변이종)이 아니며 | |
| 5) 방사성요오드 잔여갑상선제거술 이후에 시행한 첫 번째 치료 후 전신스캔에서 갑상선 부위(thyroid bed) 외에는 섭취가 없는 경우 | |
| 6) 혈관 침범이 없는 경우 | |
| 7) 림프절전이가 없거나 미세 림프절전이(＜0.2 cm) 가 5개 이하인 경우∗ | |
| ▪갑상선 내에 국한된 피막에 둘러싸인 여포 변이종 유두암∗ | |
| ▪갑상선 내에 국한된 여포암의 경우 혈관 침범이 없거나 경미한(4부위 이하) 경우∗ | |
| ▪갑상선 내에 국한된 미세유두암(다발성이거나 BRAF V600E 돌연변이 양성 포함됨) ∗ | |
| 중간위험군 | 1) 수술 후 병리조직검사에서 갑상선 주위 연조직으로 현미경적 침윤 소견 |
| 2) 첫번째 방사성요오드 잔여갑상선제거술 후 전신스캔에서 갑상선 부위 이외의 경부 섭취가 있는 경우 | |
| 3) 원발 종양이 나쁜 예후를 갖는 조직형이거나, 혈관 침범 소견이 있는 경우 | |
| 4) 임상적으로 림프절전이가 있거나(clinical N1) 3 cm 미만 크기의 림프절전이(pathologic N1)가 5개를 초과하거나∗, | |
| 5) 갑상선 외 침범이 있고 BRAF V600E 돌연변이 양성인 다발성 미세유두암∗ | |
| 고위험군 | 1) 종양이 육안적으로 주위 조직을 침범하였거나, |
| 2) 종양을 완전히 제거하지 못하였거나, | |
| 3) 원격전이가 있거나 | |
| 4) 수술 후 혈중 갑상선글로불린 농도가 높아서 전이가 의심되거나 | |
| 5) 경부 림프절전이의 최대 직경이 3 cm 이상인 경우∗ | |
| 6) 광범위한 혈관 침범(4 부위 초과)이 있는 여포암∗ |
∗ 의 항목을 제외한 모든 항목들은 권고수준 1에 해당하며, ∗은 권고수준 3임
Table 9.
Clinical implications of response to therapy reclassification in patients with differentiated thyroid cancer treated with total thyroidectomy and radioiodine remnant ablation
Table 10.
키나아제 억제제 치료 연관 부작용에 대한 선별 권고
Table 11.
키나아제 억제제 치료를 시작하기 전에 확인할 사항
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