갑상선 미세유두암에 있어서 수술중의 중앙림프절의 동결절편 조직검사의 유용성

Abstract

Background Due to the recognized limitations of radiologic examinations— including thyroid ultrasonography (US) and neck computed tomography (CT)— it is not easy to identify central lymph node (CLN) metastasis before surgery for papillary thyroid microcarcinoma (PTMC). This study aims to evaluate the accuracy and usefulness of intraoperative frozen section examination (FSE), in order to determine the appropriate extent of thyroidectomy.

Methods 73 patients with unilateral PTMC who were prospectively enrolled also displayed no evidence of LN metastasis on preoperative ultrasonography. Each of the 73 patients underwent a hemi-thyroidectomy with an ipsilateral CLN dissection. Total thyroidectomy was considered if FSE was positive for metastasis.

Results When the positive FSE group was compared to the negative FSE group, the primary tumor size, age, male sex and multifocality were significantly associated with central lymph node metastasis on frozen section examination (p= 0.004, p = 0.023, p = 0.003 and p = 0.036, respectively). Additionally, tumor size (≥ 0.5cm), male sex, and multifocality were independent factors for predicting CLN metastasis on FSE. The sensitivity, specificity and overall accuracy of FSE for the determination of N status were 72.4%, 95.5%, and 86.3%, respectively.

Conclusion For detecting CLN metastasis and determining the appropriate extent of thyroidectomy, Intraoperative FSE of CLN is an accurate method. Male sex, tumor size (≥ 0.5) and multifocality should all be considered when performing intraoperative FSE of the CLN.