Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer

Ka Hee Yi; Young Joo Park; Sung-Soo Koong; Jung-Han Kim; Dong Gyu Na; Jin-Sook Ryu; So Yeon Park; In Ae Park; Chung-Hwan Baek; Young Kee Shong; Young Don Lee; Jaetae Lee; Jeong Hyun Lee; Jae Hoon Chung; Chan Kwon Jung; Seung-Ho Choi; Bo Youn Cho

doi:10.3803/EnM.2010.25.4.270

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Yi, Park, Koong, Kim, Na, Ryu, Park, Park, Baek, Shong, Lee, Lee, Lee, Chung, Jung, Choi, and Cho: Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer

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Endocrinol Metab 2010;25(4):270-297.

Published online: 12 December 2010

DOI: https://doi.org/10.3803/EnM.2010.25.4.270

Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer

Ka Hee Yi, Young Joo Park, Sung-Soo Koong, Jung-Han Kim, Dong Gyu Na, Jin-Sook Ryu, So Yeon Park, In Ae Park, Chung-Hwan Baek, Young Kee Shong, Young Don Lee, Jaetae Lee, Jeong Hyun Lee, Jae Hoon Chung, Chan Kwon Jung, Seung-Ho Choi, Bo Youn Cho

^¹Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul

^²Departments of Internal Medicine, Seoul National University College of Medicine, Seoul

^⁷Departments of Pathology, Seoul National University College of Medicine, Seoul

^³Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju

^⁴Departments of Surgery, Sungkyunkwan University School of Medicine, Seoul

^⁸Departments of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul

^¹³Departments of Medicine, Sungkyunkwan University School of Medicine, Seoul

^⁵Departments of Human Medical Imaging and Intervention Center, Seoul

^⁶Departments of Nuclear Medicine, Endocrinology, University of Ulsan College of Medicine, Seoul

^⁹Departments of Metabolosm, University of Ulsan College of Medicine, Seoul

^¹²Departments of Radiology, University of Ulsan College of Medicine, Seoul

^¹⁵Departments of Otolaryngology, University of Ulsan College of Medicine, Seoul

^¹⁰Department of Surgury, School of Medicine, Gachon University, Incheon

^¹¹Department of Nuclear Medicine, Kyungpook National University School of Medicine, Daegu

^¹⁴Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea

Corresponding author: Bo Youn Cho Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehang-no, Jongno-gu, Seoul 110-744, Korea Tel: +82-2-2072-2242, Fax: +82-2-762-9662, E-mail: bycho@plaza.snu.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Fig. 1.

하나 혹은 그 이상의 갑상선결절을 가진 환자의 평가 알고리듬

Table 1.

갑상선결절 및 암 진료권고안의 권고수준

권고수준	정 의
1	강력히 권고함: 권고한 행위를 하였을 때 중요한 건강상의
	이득 또는 손실이 있다는 충분하고도 객관적인 근거가 있는
	경우
2	권고함: 권고한 행위를 하였을 때 중요한 건강상의 이득
	또는 손실이 있다는 근거가 있지만, 근거가 확실하지 않아
	일상적으로 행하라고 권고하기 어렵거나 근거가 간접적인
	경우
3	권고함: 전문가의 의견(expert opinion)에 따라 권고하는
	사항
4	권고 보류: 권고한 행위를 하였을 때 중요한 건강상의 이득
	또는 손실이 있다는 근거가 없거나 이견이 많아서, 해당
	행위를 하는 것에 대해 찬성도 반대도 하지 않음

Table 2.

갑상선 미세침흡인세포검사의 Bethesda system 진단 양식

1	Nondiagnostic or unsatisfactory
	Cyst fluid only
	Vertually acellular specimen, no follicular cells present
	Other (obscuring blood, clotting artifact, poor fixation, poor cell preservation etc.)
2	Benign
	Consistent with a benign follicular nodule (includes adenomatoid nodules, colloid nodule, etc.)
	Consistent with lymphocytic (Hashimoto) thyroiditis in the proper clinical context
	Consistent with granulomatous (subacute) thyroiditis
	Other
3	Atypia of undetermined significance or follicular lesion of undetermined significance
4	Follicular neoplasm or suspicious for a follicular neoplasm
	Specify if Hürthle cell (oncocytic) type
5	Suspicious for malignancy
	Suspicious for papillary carcinoma
	Suspicious for medullary carcinoma
	Suspicious for metastatic carcinoma
	Suspicious for lymphoma
	Other
6	Malignant
	Papillary thyroid carcinoma
	Poorly differentiated carcinoma
	Medullary thyroid carcinoma
	Undifferentiated (anaplastic) carcinoma
	Squamous cell carcinoma
	Carcinoma with mixed features (specify)
	Metastatic carcinoma
	Non-Hodgkin lymphoma
	Other

Table 3.

갑상선암의 AJCC 지침(7판)에 따른 TNM 정의

	원발종양 (T)
T1	원발종양 크기가 2 cm 이하이며 갑상선외 침입이 없음
T1a	1 cm 이하
T1b	1 cm 보다 크거나 2 cm 이하
T2	원발종양 크기가 2 cm보다 크거나 4 cm 이하
T3	원발종양 크기가 4 cm보다 크거나 현미경적 갑상선외 침입(주변
	근육 및 연부조직)이 있는 경우
T4a	원발종양의 크기에 상관없이 피하 연부 조직, 후두, 기관, 식도
	또는 반회후두신경 침범 시
T4b	Prevertebral fascia를 침범하거나 경동맥/종격동 혈관을
	둘러싸고 있는 경우
TX	원발 종양의 크기를 모르지만 갑상선외 침범이 없을 때
	국소 림프절(N)
N0	림프절전이가 없는 경우
N1a	Level VI 림프절전이(기관전, 기관주위, 전후두/Delphian 림프절)
N1b	일측성, 양측성, 반대편 경부 림프절(level I, II, III, IV, V), 후인두
	혹은 상종격동 림프절(level VII) 전이
NX	수술 당시 림프절전이를 평가하지 않은 경우
	원격전이(M)
M0	원격전이가 없는 경우
M1	원격전이가 있는 경우
MX	원격전이 여부를 알 수 없는 경우

Table 4.

갑상선유두암 또는 갑상선여포암의 병기

	45세 미만
Stage I	Any T	Any N	M0
Stage II	Any T	Any N	M1
	45세 이상
Stage I	T1	N0	M0
Stage II	T2	N0	M0
Stage III	T3	N0	M0
	T1-T3	N1a	M0
Stage IVA	T4a	N0, N1a	M0
	T1-T4a	N1b	M0
Stage IVB	T4b	Any N	M0
Stage IVC	Any T	Any N	M1

Table 5.

갑상선수질암의 병기(모든 연령에 해당)

Stage I	T1	N0	M0
Stage II	T2, T3	N0	M0
Stage III	T1-T3	N1a	M0
Stage IVA	T4a	N0, N1a	M0
	T1-T4a	N1b	M0
Stage IVB	T4b	Any N	M0
Stage IVC	Any T	Any N	M1

Table 6.

갑상선역형성암의 병기

Stage IVA	T4a	Any N	M0
Stage IVB	T4b	Any N	M0
Stage IVC	Any T	Any N	M1

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