갑상샘 결절에 대한 진단적 접근 = Diagnostic Approaches to Patients with Thyroid Nodules

다국어 초록 (Multilingual Abstract)

Thyroid nodules are epidemic with the rising use of high-resolution thyroid ultrasonography for

health screening. The primary aim in investigating a thyroid nodule is to exclude the

possibility of malignancy, which occurs in about 5% of nodules. Initial history taking and physical

examination should focus on the clinical risk factors associated with thyroid cancer.

Measurement of thyroid stimulating hormone (TSH) is the only biochemical test routinely needed

to exclude autonomously functioning nodules. Thyroid ultrasonography-guided fine needle

aspiration biopsy (US-FNA) is the most accurate standard diagnostic test for most thyroid

nodules. Ultrasonographic features of nodules associated with increased risk of thyroid cancers

include hypoechogenicity, microcalcification, irregular spiculated margin, taller-than-wide,

Doppler signal in the nodules, and suspicious cervical lymphadenopathies. These findings are

helpful in risk stratification of the nodules and in deciding which nodule should be sampled in

multinodular goiters. The success of the procedure heavily depends on the experience and

expertise of the clinicians. Knowledge on basic US-FNA techniques and some tricks is very

important to improve overall diagnostic yields. Practically critical issues related to US-FNA are

emphasized based on several guidelines and author's experiences.

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