Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
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Clinical Significance of Focal Breast Lesions Incidentally Identified by $^{18}F-FDG$ PET/CT

$^{18}F-FDG$ PET/CT에서 우연히 발견된 국소 유방 병변의 임상적 의의

  • Cho, Young-Seok (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Joon-Young (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Su-Jin (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hyun, Seung-Hyup (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Ji-Young (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Yong (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choe, Yearn-Seong (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Kyung-Han (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Byung-Tae (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 조영석 (성균관대학교 의과대학 삼성서울병원 핵의학과) ;
  • 최준영 (성균관대학교 의과대학 삼성서울병원 핵의학과) ;
  • 이수진 (성균관대학교 의과대학 삼성서울병원 핵의학과) ;
  • 현승협 (성균관대학교 의과대학 삼성서울병원 핵의학과) ;
  • 이지영 (성균관대학교 의과대학 삼성서울병원 핵의학과) ;
  • 최용 (성균관대학교 의과대학 삼성서울병원 핵의학과) ;
  • 최연성 (성균관대학교 의과대학 삼성서울병원 핵의학과) ;
  • 이경한 (성균관대학교 의과대학 삼성서울병원 핵의학과) ;
  • 김병태 (성균관대학교 의과대학 삼성서울병원 핵의학과)
  • Published : 2008.12.31
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Abstract

Purpose: We evaluated the incidence and malignant risk of focal breast lesions incidentally detected by $^{18}F-FDG$ PET/CT. Various PET/CT findings of the breast lesions were also analyzed to improve the differentiation between benign from malignant focal breast lesions. Materials & Methods: The subjects were 3,768 consecutive $^{18}F-FDG$ PET/CT exams performed in adult females without a history of breast cancer. A focal breast lesion was defined as a focal $^{18}F-FDG$ uptake or a focal nodular lesion on CT image irrespective of $^{18}F-FDG$ uptake in the breasts. The maximum SUV and CT pattern of focal breast lesions were evaluated, and were compared with final diagnosis. Results: The incidence of focal breast lesions on PET/CT in adult female subjects was 1.4% (58 lesions in 53 subjects). In finally confirmed 53 lesions of 48 subjects, 11 lesions of 8 subjects (20.8%) were proven to be malignant. When the PET/CT patterns suggesting benignancy (maximum attenuation value>75 HU or <30HU; standard deviation of mean attenuation > 20) were added as diagnostic criteria of PET/CT to differentiate benign from malignant breast lesions along with maximum SUV, the area under ROC curve of PET/CT was significantly increased compared with maximum SUV alone ($0.680{\pm}0.093$ vs. $0.786{\pm}0.076$, p<0.05). Conclusion: The malignant risk of focal breast lesions incidentally found on $^{18}F-FDG$ PET/CT is not low, deserving further diagnostic confirmation. Image interpretation considering both $^{18}F-FDG$ uptake and PET/CT pattern may be helpful to improve the differentiation from malignant and benign focal breast lesion.

목적 : $^{18}F-FDG$ PET/CT에서 우연히 발견되는 국소 유방 병변의 임상적인 중요성을 알아보기 위해 발병률과 악성 유무에 대해 살펴보았으며, PET/CT상 악성 병변을 시사하는 소견들을 알아보았다. 대상 및 방법: $^{18}F-FDG$ PET/CT를 시행 받은 3768명의 유방암의 병력이 없는 성인 여성을 대상으로 하여 후향적 평가를 실시하였다. 국소 유방 병변은 국소 $^{18}F-FDG$ 섭취증가 병변 또는 $^{18}F-FDG$ 섭취 양상과 관계없이 관찰되는 CT상의 결절성 병변으로 정의하였다. 이들 병변의 최대 SUV, 크기, CT상 결절성 변화 유무, 감쇠값 들을 분석하고, 이를 조직확인과 영상의학적 추가검사 그리고 임상적 추적관찰을 통해 얻은 최종 진단과 비교하였다. 결과: 53명에서 58개의 병면이 발견되어, 성인 여성의 $^{18}F-FDG$ PET/CT에서 국소 유방 병변의 발병률은 1.4%였다. 이중 추가적인 검사나 충분한 임상 추적 관찰이 시행되지 않아 분석에서 5명이 제외되었다. 나머지, 48명의 53개 병면에서 8명의 11개 병변(원발성 유방암 4, 전이성 유방암 7)이 악성으로 판명되어, 악성위험도는 20.8%였다. $^{18}F-FDG$ 섭취가 없는 CT상의 결절성 병변, CT상 결절이 보이지 않는 국소 $^{18}F-FDG$ 섭취증가 병변, 최대 감쇠값이 75 HU이상인 경우 또는 30 미만인 병변, 그리고 감쇠값의 표준 편차가 20 이상인 병변은 모두 양성으로 판명되었다. 최대 SUV만으로 악성 여부를 예측하는 경우 수신자판단특성 곡선의 곡선아래 면적은 0.580이었으나, 위에 언급한PET/CT소견을 보이는 유방병변들을 최대 SUV 관계없이 양성으로 판정하면, 곡선아래 면적이 0.768로 유의하게 증가하였다(p<0.05). 결론: 성인여성에서 $^{18}F-FDG$ PET/CT 시행시에 우연히 발견된 국소 유방 병변은 비교적 높은 악성 위험도를 갖고 있으므로 추가적인 진단적 검사가 요구된다. 특히, PET/CT의 CT 영상의 결절성병변 유무와 감쇠 양상을 고려하면, 악성 유방 병변에 대한 고위험 환자군을 선별하는 데 도움이 될 것으로 보인다.

Keywords

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