Study on the Usefulness about Molecular Breast Imaging In Dense Breast

치밀형 유방에서 Molecular Breast Imaging 검사의 유용성에 관한 고찰

  • Baek, Song Ee (Department of Nuclear Medicine, Severance Hospital, Yonsei University Health System) ;
  • Kang, Chun Goo (Department of Nuclear Medicine, Severance Hospital, Yonsei University Health System) ;
  • Lee, Han Wool (Department of Nuclear Medicine, Severance Hospital, Yonsei University Health System) ;
  • Park, Min Soo (Department of Nuclear Medicine, Severance Hospital, Yonsei University Health System) ;
  • Choi, Young Sook (Department of Nuclear Medicine, Severance Hospital, Yonsei University Health System) ;
  • Kim, Jae Sam (Department of Nuclear Medicine, Severance Hospital, Yonsei University Health System)
  • 백송이 (연세의료원 세브란스병원 핵의학과) ;
  • 강천구 (연세의료원 세브란스병원 핵의학과) ;
  • 이한울 (연세의료원 세브란스병원 핵의학과) ;
  • 박민수 (연세의료원 세브란스병원 핵의학과) ;
  • 최영숙 (연세의료원 세브란스병원 핵의학과) ;
  • 김재삼 (연세의료원 세브란스병원 핵의학과)
  • Received : 2016.03.18
  • Accepted : 2016.04.15
  • Published : 2016.05.21

Abstract

Purpose Mammography is the most widely used scan for the early diagnosis since it is possible to observe the anatomy of the breast. however, The sensitivity is markedly reduced in high-risk patients with dense breast. Molecular Breast Imaging (MBI) sacn is possible to get the high resolution functional imaging, and This new neclear medicine technique get the more improved diagnostic information through It is useful for confirmation of tumor's location in dense breast. The purpose of this study is to evaluate the usefulness of MBI for tumor diagnosis in patients with dense breast. Materials and Methods We investigated 10 patients female breast cancer with dense breast type who had visited the hospital from September 1st to Octorber 10th, 2015. The patients underwent both MBI and Mammography. MBI (Discovery 750B; General Electric Healthcare, USA) scan was 99mTc-MIBI injected with 20 mCi on the opposite side of the arm with the lesions, after 20 minutes, gained bilateral breast CC (CranioCaudal), MLO (Medio Lateral Oblique) View. Mammography was also conducted in the same posture. MBI and Mammography images were compared to evaluate the sensitivity and specificity of each case utilizing both image and two images in blind tests. Results The results of the blind test for breast cancer showed that the sensitivity of Mammography, MBI scan was 63%, 89%, respectively, and that their specificity was 38%, 87%, respectively. Using both the Mammography and MBI scan was Sensitivity 92%, specificity 90%. Conclusion This research has found that, The tumor of dense tissue that can not easily distinguishable in Mammography is possible to more accurate diagnosis since It is easy to visually evaluation. But MBI sacn has difficulty imaging microcalcificatons, If used in conjunction with mammography it is thought to give provide more diagnostic information.

[목 적] 유방촬영술은 유방의 해부학적 구조를 관찰할 수 있어 유방암의 조기 진단 및 발견에 가장 널리 이용하는 검사법이지만 치밀형 유방을 가진 고위험군 환자에서는 민감도가 현저히 감소한다. Molecular Breast Imaging (MBI) 검사는 고해상도로 유방의 기능적 영상 획득이 가능하고, 치밀 조직에서 종양의 위치 확인이 유용하여 더욱 향상된 진단적 정보를 얻을 수 있는 새로운 영상 기법이다. 이에 본 연구는 치밀형 유방을 가진 환자에게서 종양 진단을 위한 MBI의 유용성을 평가하고자 한다. [대상 및 방법] 2015년 9월 1일부터 10월 10일까지 본원에 내원한 여성 유방암 환자 중 치밀형 유방 환자 10명을 대상으로 연구하였으며, 대상 환자는 MBI와 유방촬영술을 모두 시행하였다. MBI (Discovery 750B; General Electric Healthcare, USA) 검사는 $^{99m}Tc-MIBI$ 20 mCi를 병변이 있는 반대 측 팔에 주사한 후 20분 뒤 양측 유방의 상하 방향, 내외 사 방향 영상을 얻었고, 유방촬영술 또한 동일한 자세로 시행하였다. MBI와 유방촬영 영상을 각각의 영상과, 두 영상을 모두 활용한 경우의 민감도와 특이도를 블라인드 테스트로 비교 평가하였다. [결 과] 유방촬영술에서는 민감도 63%, 특이도 38.6%였으며, MBI 검사에서는 민감도 88.5%, 특이도 87%였다. 유방촬영술과 MBI 검사를 모두 활용한 경우 민감도 93%, 특이도 91.7%로 나타났다. [결 론] 본 연구에서는 유방촬영술에서 쉽게 판별할 수 없었던 치밀 조직의 종양이 MBI 검사상 육안적 평가가 용이해져 보다 정확한 진단이 가능하였다. 그러나 MBI 검사는 미세석회화를 영상화 하는 데에 어려움이 있으므로 유방촬영술과 함께 진행된다면 더욱 많은 진단적 정보를 제공해 줄 것으로 생각된다.

Keywords

References

  1. Canadian Cancer Society, Statistics Canada and Provincial/ Territorial Cancer Registry. Canadian Cancer Statistics 2014.
  2. Jung KW, Won YJ, Kong HJ, Oh CM, Cho H, Lee DH, Lee KH. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2012. Cancer Res Treat 2015; 47(2):127-41. https://doi.org/10.4143/crt.2015.060
  3. Center for Cancer Control and Information Services, National Cancer Center, Monitoring of Cancer Incidence in Japan - Survival 2003-2005 report 2013.
  4. Korean Breast Cancer Society. Breast Cancer Facts & Figures 2015. Seoul : Korean Breast Cancer Society, 2015.
  5. Analysis of Cancers Missed at Screening Mammography. Bird RE, Wallace TW, Yankaskas BC. Radiology 1992; 613-617.
  6. 99mTc-MIBI Scintigraphy Compared to Mammography in the Diagnosis of Breast Cancer in Dense, Operative and Young Women Breast. Mulero F, et al. Rev Esp Med Nucl 2000;19: 344-349. https://doi.org/10.1016/S0212-6982(00)71888-X
  7. Chung SY, Han BK. Breast diagnostic imaging. Seoul: Ilchokak, 2006.
  8. Kerlikowske K, Grady D, Braclay J, Sickles EA, Ernster V. Likelihood ratios for modern screening mammography. Risk of Breast cancer based on age and mammographic interpretation. JAMA 1996;276:39-43. https://doi.org/10.1001/jama.1996.03540010041028
  9. Suk jinn am. Screening and diagnosis for breast cancer. J Korean Med Assoc 2009;52:946-951. https://doi.org/10.5124/jkma.2009.52.10.946
  10. Molecular breast imaging. O'Connor M, Rhodes D, Hruska C. Expert Rev Anticancer Ther. 2009 Aug;9(8): 1073-80. doi: 10.1586/era.09.75.