우선 1cm 이상의 모든 병변에 대해 biopsy 하는 것은 가이드라인에 맞지 않는다!
K-TIRADS에 의한 조직검사 추천! K-TIRADS
category
US feature
malignancy risk ( % )
calculated sensitivity for malignancy ( % )
FNA ( cm )
5 . high – suspicion
Solid hypoechoic nodule with any of 3 suspicious features ( * )
60
79.3
1cm이상(선택적 0.5이상)
4 . intermediatesuspicion
1 ) solid hypoechoic nodule without any of 3 suspicious US features ( * ) or2 ) partially cystic or isohyperechoic nodule with of 3 suspicios US feature ( * )
15-50
25.4
1cm 이상
3 . low – suspicion
partially cystic or isohyperechoic nodulewithout any of 3 suspicious US features ( * )
3-15
7.8
1.5cm 이상
2 . benign
1 ) spongiform 2 ) partially cystic nodule with comet tailartifcat
<3<1
00
2cm이상 NA
1 . nonodule
–
–
–
NA
(참고:korean jounal of radiology / 대한내분비학회)
2. benign : -pure cyst-partially cystic nodule with comet tail artifact -> 크기에 관계없이 조직검사를 추천하지 않는다.
3 . Low suspicion : – partially cystic or iso – hyperechoic nodule ( No 3 suspicion features ) — > 1 . 5cm 이상 조직검사 – spongiform — > 2cm 이상 조직검사
4 . Intermediate suspicion : – Solid hypoechoic nodule ( No 3 suspicion features ) — > 1cm 이상 조직검사 – partially cystic or iso – hyperechoic nodule with any of 3 suspicion features — > 1cm 이상 조직검사
5 . High suspicion – Solid hypoechoic nodule with any of 3 suspicion feature — > 1cm 이상 조직검사 – ( * 3 suspicion US features ? / 1 ) microcalcification , 2 ) nonparallel orientation ( taller than wide ) , 3 ) Spiculated / microlobulated margin )
간략하게 정리하면
cyst – 조직검사를 하지 않은 partial cyst-1.5cm 조직검사 is oechoic – 2cm 이상 조직검사(suspicion feature가 있으면 1cm) hypoechoic – 1cm 이상 조직검사 Suspicious US features – (이전 suspicious malignancy : 1cm)