유두 종양의 자기공명 영상소견
MR findings of papillary neoplasms of the breast
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적 : 유방암을 진단 받은 환자의 자기공명영상에서 추가적으로 발견된 유두상 병변의 자기공명영상 소견과 수술적 절제 후상향화 비율을 알아보고자 한다. 대상 및 방법 : 본원에서 유방암 진단된 환자의 수술 전 자기공명영상 1729건에서 지표 종양 외에 악성 의심 조영증강을 보인 병변 중 초음파 유도하 핵생검에서 유두 종양으로 진단된 21명의 환자의 22개 병변을 대상으로 하였다. 이 중 수술적 절제를 시행한 병변은 핵생검 결과와 절제 생검 결과를 비교하였다. 또한 이 병변들의 자기공명영상 소견을 BI-RADS MRI lexicon에 따라 후향적으로 분석하여 특징을 알아보았다. 결과 : 자기공명영상에서는 종괴 8예, 비종괴 7예, 초점 7예로 관찰되었고 초점으로 나타난 병변은 병리 조직에서 모두(100%) 양성 병변으로 진단되었고, 역동적 조영증강 검사에서 고원형과 세척형 양상을 보였다. 양성 유두종 1예 (11.1%), 비정형요소를 가진 유두 종양 3예 (100%), 유두 종양 3예 (60%)가 수술적 절제 후 관상피내암, 침윤성 관상피암, 침윤성소엽암 등으로 상향화되었다. 결론 : 초음파 유도하 핵생검에서 유두상 병변으로 진단된 병변들의 자기공명영상 소견은 양성과 악성을 예측하기에 특징적인 차이점을 보이지 않아 영상소견만으로 양성과 악성을 구분할 수 없으며 다수에서 수술적 절제 후 조직학적 상향화를 보여(41.2%, 7/17) 반드시 수술적 절제를 통한 확진이 필요할 것이다.
Abstract
Purpose : To review MR imaging finding of papillary lesion identified as additional suspicious lesion on MR image in women with biopsy-proven breast cancer and to evaluate upgrading rates after subsequent surgical histopathological diagnosis. Materials and Methods: Among 1729 preoperative MR image of women with biopsy proven breast cancer, USguided CNB-proven 22 papillary lesions from 21 patients, which showed additional suspicious contrast enhancement other than index cancer on MR image, were subjected to the study. Some of these lesions underwent surgery, thus the comparisons between the histopathologic results were able to be compared to the results of USguided CNB. Also retrospective analysis was done for MR findings of these lesions by BI-RADS MRI lexicon. Results: On MR imaging, 8 mass lesions, 7 non-mass lesions, 7 focus lesions were detected. All of the focus lesion (100%, 7/7) was diagnosed as benign lesion and showed plateau and washout pattern in dynamic MR image. After excisional biopsy, one of 9 benign papilloma (11.1%), 3 of 3 papillary neoplasm with atypia component (100%), 3 of 5 papillary neoplasm (60%) were upgraded to malignancy such as ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC). Conclusion: The MR images of papillary lesions diagnosed by US-guided CNB exhibit no significant differences between malignancy and benign lesion. Also 41.2% of the lesion (7/17) was upgraded after subsequent surgery. Thus all of the papillary lesions require excisional biopsy for definite diagnosis and the MR imaging, it’s just not enough by itself.
참고문헌 (31)
- Georgian-Smith D, "Variations in physician recommendations for surgery after diagnosis of a high-risk lesion on breast core needle biopsy", AJR Am J Roentgenol, 198, pp.256~263 (2012)
- Masood S, "Borderline breast lesions: diagnostic challenges and clinical implications", Adv Anat Pathol, 18, pp.190~198 (2011)
- Brookes MJ, "Radiological appearances of papillary breast lesions", Clin Radiol, 63, pp.1265~1273 (2008)
- Eiada R, "Papillary lesions of the breast: MRI, ultrasound, and mammographic appearances", AJR Am J Roentgenol, 198, pp.264~271 (2012)
- Kil WH, "Is surgical excision necessary in benign papillary lesions initially diagnosed at core biopsy?", Breast, 17, pp.258~262 (2008)
- Muttarak M, "Spectrum of papillary lesions of the breast: clinical, imaging, and pathologic correlation", AJR Am J Roentgenol, 191, pp.700~707 (2008)
- Tominaga J, "Magnetic resonance imaging of intraductal papillomas of the breast", J Comput Assist Tomogr, 35, pp.153~157 (2011)
- Chang JM, "Risk of carcinoma after subsequent excision of benign papilloma initially diagnosed with an ultrasound (US)-guided 14-gauge core needle biopsy: a prospective observational study", Eur Radiol, 20, pp.1093~1100 (2010)
- Ballesio L, "Role of breast magnetic resonance imaging (MRI) in patients with unilateral nipple discharge: preliminary study", Radiol Med, 113, pp.249~264 (2008)
- Bhattarai N, "Intraductal papilloma: features on MR ductography using a microscopic coil", AJR Am J Roentgenol, 186, pp.44~47 (2006)
- Daniel BL, "Magnetic resonance imaging of intraductal papilloma of the breast", Magn Reson Imaging, 21, pp.887~892 (2003)
- Francis A, "Breast papilloma:mammogram, ultrasound and MRI appearances", Breast, 11, pp.394~397 (2002)
- Kurz KD, "MRI features of intraductal papilloma of the breast: sheep in wolf’s clothing?", Acta Radiol, 52, pp.264~272 (2011)
- Rovno HD, "Solitary intraductal papilloma: findings at MR imaging and MR galactography", AJR Am J Roentgenol, 172, pp.151~155 (1999)
- Zhu Y, "Solitary intraductal papillomas of the breast: MRI features and differentiation from small invasive ductal carcinomas", AJR Am J Roentgenol, 199, pp.936~942 (2012)
- Radiology ACo, "Illustrated breast imaging reporting and data system (BI-RADS)" (1998), Va. American College of Radiology
- Park VY, "Second-look US: how to find breast lesions with a suspicious MR imaging appearance", Radiographics, 33, pp.1361~1375 (2013)
- Brennan SB, "Papilloma diagnosed at MRI-guided vacuum-assisted breast biopsy: is surgical excision still warranted?", AJR Am J Roentgenol, 199, pp.W512~W519 (2012)
- Baltzer PA, "False-positive findings at contrast-enhanced breast MRI: a BI-RADS descriptor study", AJR Am J Roentgenol, 194, pp.1658~1663 (2010)
- Liberman L, "Does size matter? Positive predictive value of MRI-detected breast lesions as a function of lesion size", AJR Am J Roentgenol, 186, pp.426~430 (2006)
- Tozaki M, "Positive and negative predictive values of BI-RADS-MRI descriptors for focal breast masses", Magn Reson Med Sc, 5, pp.7~15 (2006)
- Liberman L, "Percutaneous largecore biopsy of papillary breast lesions", AJR Am J Roentgenol, 172, pp.331~337 (1999)
- Rosen EL, "Imaging-guided core needle biopsy of papillary lesions of the breast", AJR Am J Roentgenol, 179, pp.1185~1192 (2002)
- Mercado CL, "Papillary lesions of the breast at percutaneous core-needle biopsy", Radiology, 238, pp.801~808 (2006)
- Jacobs TW, "Nonmalignant lesions in breast core needle biopsies: to excise or not to excise?", Am J Surg Pathol, 26, pp.1095~1110 (2002)
- Puglisi F, "Role of mammography, ultrasound and large core biopsy in the diagnostic evaluation of papillary breast lesions", Oncology, 65, pp.311~315 (2003)
- Drew PJ, "Dynamic contrast enhanced magnetic resonance imaging of the breast is superior to triple assessment for the pre-operative detection of multifocal breast cancer", Ann Surg Oncol, 6, pp.599~603 (1999)
- Liberman L, "MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer", AJR Am J Roentgenol, 180, pp.901~910 (2003)
- Liberman L, "MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer", AJR Am J Roentgenol, 180, pp.333~341 (2003)
- Fischer U, "Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach", Radiology, 213, pp.881~888 (1999)
- Abe H, "MR-directed (“Second-Look”) ultrasound examination for breast lesions detected initially on MRI: MR and sonographic findings", AJR Am J Roentgenol, 194, pp.370~377 (2010)