본문 바로가기
KERD
논문KCI 등재

유방 절제 생검 후 유방암이 진단된 환자에서 수술 전 자기공명영상의 유용성

Usefulness of Preoperative Breast MRI in Breast Cancer Diagnosed After Excisional Biopsy

최재정|강봉주|김성헌|정나영|차은숙|위정현
대한자기공명의과학회 (Korean Society Of Magnetic Resonance In Medicine)|2008.12|Investigative Magnetic Resonance Imaging|제12권 제2호|pp. 161-169

2

조회

0

다운로드

0

인용

0

참고문헌

키워드

BiopsyBreast neoplasmMagnetic resonance (MR)
주제분류방사선과학

초록

목적 : 유방 절제 생검 후 유방암이 진단된 환자에서 잔류종양과 추가 병변을 진단하는데 있어 자기공명영상의 유용성을 알아보고자 하였다. 대상 및 방법 : 2005년 3월부터 2007년 8월까지 유방 절제 생검으로 유방암이 진단되고 수술 전 자기공명영상을 시행한 16명의 환자를 대상으로 하였다. 생검 후 생긴 공동 주위로 두껍고 규칙한 조영증강 테두리를 보이거나 공동에 연하여 조영증강되는 종괴가 있는 경우를 잔류종양이 있다고 보았다. 또한 공동과 분리된 다초점성, 다발성, 혹은 반대측 유방 병변 등의 추가 병변을 확인하였다. 수술 후 조직학적 소견을 비교하여 자기공명영상의 정확성을 평가하였고 자기공명영상소견에 따라 향후 치료에 변화가 있었는지를 알아보았다. 결과 : 공동주위 조영증강 소견으로 잔류종양을 평가하는 자기공명영상의 민감도와 특이도는 각각 85.7%(6/7)와 55.6%(5/9)이었다. 자기공명영상으로 6명의 환자에서 다초점성(multifocal), 다발성(multicentric), 혹은 반대측 유방에 추가 병변을 발견하였다. 자기공명영상의 결과에 따라 7명의 환자에서 치료 범위가 변화되었다. 결론 : 절제 생검 후 자기공명영상에서 보인 소견 중 공동주위 조영증강 소견만으로 잔류종양 유무를 감별하기 어렵다. 그러나 유방 자기공명영상은 다초점성 및 다발성 혹은 반대측 병변을 포함한 추가병변을 발견하는 데 도움을 주어 수술적 치료에도 유용한 정보를 제공한다.

Abstract

Purpose : The aim of this study was to evaluate the usefulness of MRI performed after excisional biopsy to diagnose residual cancer and additional lesions. Materials and Methods : A total of 16 patients who had breast cancer diagnosed by excisional biopsy underwent preoperative breast MRI between March 2005 and August 2007 were included. MRI findings were considered positive for residual cancer if focal, thick, or irregular rim enhancement or adjacent enhancing lesion was identified around the postoperative biopsy cavity. And additional lesions separated from biopsy cavity including multifocal, multicentric, or contralateral lesion were evaluated. We evaluated the diagnostic accuracy of MRI, comparing MRI with histopathologic finding, and the impact of MRI on surgical planning. Results : The sensitivity and specificity of MRI for detecting residual disease considering rim enhancement were 85.7%(6/7) and 55.6%(5/9). Additional lesions including multifocal, multicentric, or contralateral lesion were found in 6 patients. In 7 patients, results of MRI findings changed surgical treatment planning. Conclusion : The pattern of rim enhancement on MRI after excisional biopsy is not differential point to evaluate remnant lesion. But MRI has an important role to help the detection of multifocal or multicentric, or contralateral breast malignancies, resulting in beneficial change in surgical treatment planning.

참고문헌 (28)

  1. Gajdos C, "Complete removal of nonpalpable breast malignancies with a stereotactic percutaneous vacuum-assisted biopsy instrument", J Am Coll Surg, 189, pp.237~240 (1999)
  2. Fourquet A, "Prognostic factors of breast recurrence in the conservative management of early breast cancer: a 25-year follow-up", Radiat Oncol Biol Phys1989, 17, pp.719~725 (1989)
  3. Anscher MS, "Local failure and margin status in early-stage breast carcinoma treated with conservation therapy and radiation therapy", Ann Surg, 218, pp.22~28 (1993)
  4. Pittinger TP, "Importance of margins status in outcome of breast-conserving surgery for carcinoma", Surgery, 116, pp.605~608 (1994)
  5. Cowen D, "Local and distant failures after limited surgery with positive margins and radiotherapy for node-negative breast cancer", Radiat Oncol Biol Phys, 47, pp.305~312 (2000)
  6. Jardines L, "Factors associated with a positive reexcision after excisional biopsy for invasive breast cancer", Surgery, 118, pp.803~809 (1995)
  7. Gwin JL, "Incidence of gross and microscopic carcinoma in specimens from patients with breast cancer after re-excision lumpectomy", Ann Surg, 218, pp.729~734 (1993)
  8. Solin U, "Results of re-excisional biopsy of the primary tumor in preparation for definitive irradiation of patients with early stage breast cancer", Radiat Oncol Biol Phys, 12, pp.721~725 (1985)
  9. Schnitt SJ, "Pathologic findings on re-excision of the primary site in breast cancer patients considered for treatment by primary radiation therapy", Cancer, 59, pp.675~681 (1987)
  10. McCormick B, "Limited resection for breast cancer: a study of inked specimen margins before radiotherapy", Radiat Oncol Biol Phys, 13, pp.1667~1671 (1987)
  11. CH Lee, "Detecting residual tumor after excisional biopsy of impalpable breast carcinoma: efficacy of comparing preoperative mammograms with radiographs of the biopsy specimen", AJR, 164, pp.81~86 (1995)
  12. American College of Radiology, "Breast imaging and reporting data system-magnetic resonance imaging, 1st edition. Reston" (2003), American College of Radiology
  13. Fischer U, "Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach", Radiology, 213, pp.881~888 (1999)
  14. Hata T, "Magnetic resonance imaging for preoperative evaluation of breast cancer: a comparative study with mammography and ultrasonography", Am Coll Surg, 198, pp.190~197 (2004)
  15. Gilles R, "Nonpalpable breast tumors: diagnosis with contrast enhanced subtraction dynamic MR imaging", Radiology, 191, pp.625~631 (1994)
  16. Bone B, "Sensitivity and specificity of MR mammography with histopathological correlation in 250 breasts", Acta Radiol, 37, pp.208~213 (1996)
  17. Helbich TH, "Differentiation of benign and malignant breast lesions: MR imaging versus Tc-99m sestamibi scintimammography", Radiology, 202, pp.421~429 (1997)
  18. Frei KA, Kinkel K, "MR imaging of the breast in patients with positive margins after lumpectomy: influence of the time interval between lumpectomy and MR imaging", AJR, 175, pp.1577~1584 (2000)
  19. Janie M. Lee, "MRI before reexcision surgery in patients with breast cancer", AJR, 182, pp.473~480 (2004)
  20. Schelfout K, "Contrast-enhanced MR imaging of breast lesions and effect on treatment", Eur J Surg Oncol, 30, pp.501~507 (2004)
  21. Tillman GF, "Effect of breast magnetic resonance imaging on the clinical management of women with early-stage breast carcinoma", Clin Oncol, 20, pp.3413~3423 (2002)
  22. 장윤우, 이민혁, 김동훈, "유방암 환자에서 수술 전 흉부 다검출 전산화단층촬영을 통한 유방암 평가: 유방자기공명영상과의 비교", 대한영상의학회지, 53(2), pp.137~143 (2005), 대한영상의학회
  23. Inoue M, "Dynamic multidetector CT of breast tumors: diagnostic features and comparison with conventional techniques", AJR, 181, pp.679~686 (2003)
  24. Sardanelli F, "Dynamic helical CT of breast tumor", Comput Assist Tomogr, 22, pp.398~407 (1998)
  25. LaTrenta LR, "Breast lesions detected with MR imaging: utility and histopathologic importance of identification with US", Radiology, 227, pp.856~861 (2003)
  26. Susan G. Orel, "MR imaging of the breast for the detection, diagnosis, and staging of breast cancer", Radiology, 220, pp.13~30 (2001)
  27. Elizabeth A. Morris, "Review of breast MRI: indications and limitations", Semin Roentgenol, 36, pp.226~237 (2001)
  28. Del Frate C, "Role of pre-surgical breast MRI in the management of invasive breast carcinoma", Breast, 16, pp.469~481 (2007)

이 간행물의 다른 논문 (15건)

자기공명영상과 PET/CT를 중심으로 한 전립선 암의 영상 진단변재영, 김민성, 이영준, 나성은, 유이령, 오순남, 장진희pp. 89-99개의 뇌 조직로부터 추출한 대사물질의 절대농도 측정 및 평가: 500 MHz 고자장 핵자기공명분광법을 이용한 예비연구결과우동철, 김휘율, 임향숙, 방은정, 최치봉, 이성호, 김상수, 최보영pp. 100-106낭성 종양의 체액에 대한 생체내, 생체외 3T 양성자 자기공명분광법과 양성자 핵자기공명기법의 비교: Preliminary Study이희중, 장용민, 김종열pp. 107-114Evaluation of Fibrosis in Liver Cirrhosis by Superparamagnetic Iron Oxide (SPIO)-Enhanced MR Imaging: Does the Radiological Non-Invasive Fibrosis Index Correlate with the Laboratory Non-Invasive Fibrosis Index?이창희, 김신기, 김경아, 최재웅, 이종미, 박철민pp. 115-122컴퓨터 시뮬레이션을 이용한 직각좌표 및 나선주사 방식의 병렬 자기공명 영상에서 움직임 효과 연구박호종, 안창범, 심동규, 박수경pp. 123-130
원문 보기