Investigative Magnetic Resonance Imaging

  • 제18권1호
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  • Pages.43-51
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  • 2014
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  • 2384-1095(pISSN)
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  • 2384-1109(eISSN)
대한자기공명의과학회 (Korean Society of Magnetic Resonance in Medicine)
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유두 종양의 자기공명 영상소견

MR Findings of Papillary Neoplasms of the Breast

  • 조예슬 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 김성헌 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 강봉주 (가톨릭대학교 의과대학 서울성모병원 영상의학과) ;
  • 최병길 (가톨릭대학교 의과대학 서울성모병원 영상의학과)
  • Jo, Yeseul (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) ;
  • Kang, Bong Joo (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Choi, Byung Gil (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 투고 : 2013.11.20
  • 심사 : 2014.02.25
  • 발행 : 2014.03.30
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초록

목적 : 유방암을 진단 받은 환자의 자기공명영상에서 추가적으로 발견된 유두상 병변의 자기공명영상 소견과 수술적 절제 후 상향화 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, 침윤성 소엽암 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.

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, US-guided 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 US-guided 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.

키워드

참고문헌

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