DOI QR코드

DOI QR Code

Background Parenchymal Enhancement on Breast MRI in Breast Cancer Patients : Impact on Biopsy Rate and Cancer Yield

유방암 환자에서 시행한 유방 자기공명영상에서 배경 실질 조영 증강이 조직검사율과 악성률에 미치는 영향

  • Kim, Tae Yun (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Sung Hun (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Baik, Jee Eun (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Yun Joo (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kang, Bong Joo (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 김태윤 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 김성헌 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 백지은 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 김윤주 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 강봉주 (가톨릭대학교 의과대학 서울성모병원 영상의학과)
  • Received : 2013.07.09
  • Accepted : 2013.09.06
  • Published : 2013.09.30

Abstract

Purpose : To evaluate the potential effects of background parenchymal enhancement of MR imaging in diagnosed breast cancer patients on the rate of additional biopsy and resultant cancer yield. Materials and Methods: 322 patients who were diagnosed with breast cancer and had undergone breast MR imaging were included in this study. Two radiologists reviewed the MRI for degree of background parenchymal enhancement and additional suspicious lesions described as BI-RADS category 4 or 5 on radiologic reports. Biopsy was done for these lesions, pathology reports were reviewed to calculate the cancer yield. Results: Background parenchymal enhancement of MR imaging in a total of 322 patients were classified as minimal degree 47.5%, mild degree 28.9%, moderate degree 12.4% and marked degree 11.2%. Among these 332 patients, MR imaging of 70 patients showed additional suspicious malignant lesions described as BI-RADS category 4 or 5, and consequently, 66 patients underwent biopsy. Biopsy rates in those with minimal or mild background parenchymal enhancement and those with moderate and marked background parenchymal enhancement were 19.9% and 22.3% (p-value 0.77) respectively. Cancer yields in those with minimal or mild background parenchymal enhancement and those with moderate and marked background parenchymal enhancement were 6.5% and 5.2% (p value 0.88) respectively. Both these results did not show stastically significant difference between the two groups. Conclusion: The degree of background parenchymal enhancement in MR imaging of breast cancer patients did not significantly impact additional biopsy rates or cancer yields.

목적 : 유방암이 진단된 환자에서 시행한 자기공명영상에서 배경 실질 조영 정도에 따른 추가적인 조직 검사율 및 악성률의 차이를 알아 보고자 하였다. 대상 및 방법 : 유방암을 진단받고 유방 자기공명영상을 촬영한 322명의 환자를 대상으로, 2명의 영상의학과 의사가 이들의 유방 자기공명영상을 분석하여 배경 실질 조영 증강 정도를 평가하였으며, 판독지를 통해 추가적인 BI-RADS 범주 4 이상의 병변 유무를 확인하였다. 추가적인 BI-RADS 범주 4 이상의 병변에 대해서는 조직검사를 시행하였고, 악성률을 구하기 위해 조직검사 결과를 확인하였다. 결과 : 총 322명의 유방암 환자의 배경 실질 조영 증강 단계별 환자수는 최소 조영 증강 47.5%, 경한 조영 증강 28.9%, 중간 조영 증강 12.4% 그리고 현저한 조영 증강 11.2%였다. 이 중 70예에서 추가적으로 악성이 의심되는 조영 증강 병변이 발견되었고, 4예를 제외한 66예에서 조직 검사가 시행되었다. 배경 실질 조영 증강이 적은 경우 (최소/경한 조영 증강)와 많은 경우 (중간/현저한 조영 증강) 에 따른 조직 검사율은 각각 19.9%, 22.3%이었고, 악성률은 각각 6.5%, 5.2%이었으나, p-value가 각각 0.77, 0.88로 통계적으로 유의한 차이를 보이지 않았다. 결론 : 유방암이 진단된 환자에서 시행한 자기공명영상에서 배경 실질 조영 정도와 조직 검사율 및 악성률 사이에는 차이가 없었다.

Keywords

References

  1. Kuhl CK, Bieling HB, Gieseke J, et al. Healthy premenopausal breast parenchyma in dynamic contrast-enhanced MR imaging of the breast: normal contrast medium enhancement and cyclical-phase dependency. Radiology 1997;203:137-144 https://doi.org/10.1148/radiology.203.1.9122382
  2. Delille JP, Slanetz PJ, Yeh ED, Kopans DB, Halpern EF, Garrido L. Hormone replacement therapy in postmenopausal women: breast tissue perfusion determined with MR imaging-- initial observations. Radiology 2005;235:36-41 https://doi.org/10.1148/radiol.2351040012
  3. DeMartini WB, Liu F, Peacock S, Eby PR, Gutierrez RL, Lehman CD. Background parenchymal enhancement on breast MRI: impact on diagnostic performance. AJR Am J Roentgenol 2012;198:W373-380 https://doi.org/10.2214/AJR.10.6272
  4. Hambly NM, Liberman L, Dershaw DD, Brennan S, Morris EA. Background parenchymal enhancement on baseline screening breast MRI: impact on biopsy rate and short-interval follow-up. AJR Am J Roentgenol 2011;196:218-224 https://doi.org/10.2214/AJR.10.4550
  5. Morris EA. Diagnostic breast MR imaging: current status and future directions. Magn Reson Imaging Clin N Am 2010;18:57-74 https://doi.org/10.1016/j.mric.2009.09.005
  6. Uematsu T, Yuen S, Kasami M, Uchida Y. Comparison of magnetic resonance imaging, multidetector row computed tomography, ultrasonography, and mammography for tumor extension of breast cancer. Breast Cancer Res Treat 2008;112: 461-474 https://doi.org/10.1007/s10549-008-9890-y
  7. Uematsu T, Kasami M, Watanabe J. Background enhancement of mammary glandular tissue on breast dynamic MRI: imaging features and effect on assessment of breast cancer extent. Breast Cancer 2012;19:259-265 https://doi.org/10.1007/s12282-011-0279-0
  8. Kuhl C. The Current status of breast MR imaging Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology 2007;244:356-378 https://doi.org/10.1148/radiol.2442051620
  9. Uematsu T, Kasami M,Watanabe J. Does the degree of background enhancement in breast MRI affect the detection and staging of breast cancer? Eur Radiol 2011;21:2261-2267 https://doi.org/10.1007/s00330-011-2175-6