Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Atypical Ductal Hyperplasia (ADH): Can the Sonoelastography Predict the Upgrade of ADH to Malignancy?

유방의 비정형 관상증식증: 탄성초음파검사를 이용하여 악성으로의 등급상향을 예측할 수 있는가?

  • An, Yeong-Yi (Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea) ;
  • Kim, Sung-Hun (Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea) ;
  • Kang, Bong-Joo (Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea) ;
  • Lee, Ah-Won (Department of Pathology, Seoul St. Mary’s Hospital, The Catholic University of Korea) ;
  • Song, Byung-Joo (Department of Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea)
  • 안영이 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 김성헌 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 강봉주 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 이아원 (가톨릭대학교 의과대학 서울성모병원 병리과) ;
  • 송병주 (가톨릭대학교 의과대학 서울성모병원 외과)
  • Published : 2011.04.01
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Abstract

Purpose: To evaluate whether the sonoelastographic features of atypical ductal hyperplasia (ADH) can be used to predict an upgrade to malignancy. Materials and Methods: Conventional US and sonoelastographic images were available in 17 women with 18 ADH lesions diagnosed by sonographically guided core needle biopsy. Conventional US findings were analyzed according to the Breast Imaging Reporting and Data System classification. Elastographic images were classified into 5 elasticity scores according to the ITOH classification. In addition, the strain ratio between the mass and surrounding fat tissue as well as the mammographic features were reviewed. All lesions underwent subsequent surgical excision and a correlation was found for sonoelastographic and conventional US findings with pathologic results. Results: Of the 18 ADH lesions that underwent surgical excision, four were found to be malignant (underestimation rate of 22.2%). Moreover, there was no significant difference in elasticity score (p=0.054) and strain ratio (p=0.375) between atypical ductal hyperplasia and lesions upgraded to malignancy on elastography. A mass with microcalcifications on mammography had a significantly higher association with malignancy and microcalcifications, as opposed to the absence of a mass, which was in all cases, benign (p=0.036). Conclusion: Sonoelastography may not be a helpful indicator for the differentiation of atypical ductal hyperplasia from malignant lesions. However, a correlation with mammographic features provides insight for predicting malignancy.

목적: 탄성초음파 영상을 사용하여 비정형 관상증식증의 악성종양으로의 등급상향의 위험도를예측할 수 있는지 알아보고자 하였다. 대상과 방법: 고식적 초음파와 탄성초음파를 모두 시행하였으며 추후 수술적 제거를 한 총 17명의 환자, 18예를 대상으로 고식적 초음파와 탄성초음파 소견을 후향적으로 분석하였다. 고식적 초음파 소견은 BI-RADS 범주에 따라 분석하였으며, 탄성초음파에서는 Itoh의 분류에 따른 탄성점수와 변형률을 분석하였다. 이중 유방촬영술을 시행하였던 16예의 유방촬영술 소견을 후향적으로 분석하였다. 결과: 수술적 절제를 통해 총 4예에서 악성으로 등급상향 되었으며, 저평가율은 22.2%였다. 악성으로 등급상향 된 군과 그렇지 않은 군 간의 초음파 BI-RADS 범주와 탄성초음파에서의 탄성점수(p=0.054)와 변형률(p=0.375)은 통계학적으로 유의한 차이는 없었다. 유방촬영술에서 종괴와 미세석회화가 함께 있는 경우 악성으로 등급상향 되었으며, 미세석회화만 있는 경우는 양성이었고 모두 통계적으로 의의가 있었다(p=0.036). 결론: 탄성초음파 자체로는 비정형 관상증식증의 악성으로의 등급상향 위험도를 예측할 수 없지만, 유방촬영술 결과를 함께 해석한다면 도움이 될 수 있다.

Keywords

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