In predicting the outcome, prognosis, and recurrence of thyroid papillary cancer, not only the clinical factors should be considered but also lymphangiogenesis of thyroid nodules since it shows a strong clinical relevance in cervical LNM. D2-40 or VEGFR3 staining can be a predictor of LNM and cases with high D2-40 staining should be carefully followed for lymph node recurrence. No specific US feature was found to be related with cervical LNM.
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- 32 - -국문 요약-
임파선 전이 갑상선 유두암에 있어서 lymphangiogenesis와 초음파소견의 연관성
갑상선 유두암의 경부 림프절 전이에 대한 위험인자의 계층화는 수술 후 보조 옥소 치료 및 환자 예후에 대한 기준을 제공하는 데 있어서 중요하다. 이를 알아보기 위하여 림프관과 경부 림프절 전이와 연관된 종양의 영상학적 소견을 기반으로 하여 병리학적 요인을 분석하였다. 갑상선 절제술을 시행하여 갑상선 유두암으로 확인된 환자들 중 나이와 성별을 맞추어 126 명의 환자를 대상으로 경부 림프절 전이가 없는 군 (1 군) 과 경부 림프절 전이가 있는 군 (2 군) 로 구분하여 위험요인을 분석하였다. 두 군간의 갑상선초음파검사 결과를 비교하였으며, 병리학적 요인들로는 병리 보고서에 따라서 크기, 다중성, 그리고 갑상선외 침범 등을 분석하였다. 각 종양의 림프관 밀도는 VEGFR-3 와 D2-40 으로 염색하여 확인하였으며 경부 림프절 전이와 상관성을 알아보았다. 2 군에서 종양의 크기가 더 컸으며 다양성과 갑상선외 침범이 더 흔하게 관찰되었다 (P < 0.05). 1 군의 VEGFR-3 의 중간비율은 20 (0~30) 이었고 D2-40 의 값은 13 (7~23) 이었으며 2 군에서의 VEGFR-3 의 중간비율은 80 (70~90) 이었고 D2-40 의 값은 78 (54~114) 이었다. 종양내 D2-40 염색법으로 확인한 림프관 밀도는 1 군이 20.6%, 2 군이 79.4%였다. 종양내 D2-40 염색법으로 확인한 림프관 침범 정도는 경부 림프절 전이와 상관성이 높은 것으로 확인되었다 (OR, 1.230; CI, 1.01-1.499, P = 0.040). 갑상선초음파검사 결과 중 석회화는 2 군에서 더 많이 관찰되었지만 두 군간에 통계적 차이는 없었다 (P = 0.264). 림프관 밀도와 결절의 초음파 에코와의 상관성은 보이지 않았다. 결론적으로 종양내 림프관형성이 림프절 전이와 연관성이 높다고 할 수 있으며, 림프절 전이의 예측 가능한 인자로 사용될 수 있겠다.
핵심어: 림프관형성, 갑상선 유두암, 경부임파선 전이, 경부초음파검사