유방의 유두상 신생물 및 유방암과 관련된 유두상 병변의 영상분석: 유방촬영술, 초음파, 자기공명영상

Abstract

본 연구에서는 유방의 유두종과 유두종 관련 유방암의 유방촬영술, 초음파, 자기공명영상 및 임상적 특징 중 유방암과 관련된 특정 소견들을 알아보고자 한다. 대상군은 2003년 1월부터 2011년 8월 사이에 유방 유두종으로 치료를 받은 환자군으로 하였다. 각각의 증례들은 병리 결과에 따라 양성 유두종, 비정형 유두종, 유두종과 관련된 유방암, 악성 유두종으로 각각 나누었으며, 2명의 영상의학과 의사가 임상적 특징을 조사하고 유방촬영술, 유방초음파, 유방 자기공명영상 검사 사진을 2003년판 BI-RADS 용어에 따라 판독하였다. 각각의 결과에 대하여 유방암과의 연관성 여부를 단변량 분석 후 의미가 있는 특징에 대해서는 다변량 분석을 추가하였다. 그 후 의미있는 변수들에 대해서는 유방암 위험도의 오즈비를 구하였다. 총 179명의 환자에서 194개의 병변이 대상군에 포함되었으며, 117개의 양성 유두종, 24개의 비정형 유두종, 41개의 유두종 관련 유방암, 그리고 12개의 악성 유두종이 있었다. 130례의 유방촬영술, 181개의 유방초음파, 17명의 유방 자기공명영상검사가 검토되었다. 단변량 분석에서 임상적으로 악성 병변의 환자가 양성 병변의 환자에 비하여 통계적으로 유의하게 나이가 많았다 (p = 0.001). 또한 다수의 종괴 (p = 0.009) 과 변연부 위치(p = 0.003) 가 악성도와 관련이 있었다. 유방촬영술에서는 유방 악성 병변이 양성 병변에 비하여 더 잘 관찰되고 (p = 0.001) 밀도(p = 0.039) 또한 악성도와 관련이 있었다. 초음파 영상에서는 종괴형 병변(p = 0.018), 병변의 에코 패턴 (p = 0.006), 경계 (p = 0.001), 도플러 영상에서 혈류가 보이는 것(p = 0.005) 이 악성도와 관련이 있었다. 자기공명영상에서는 통계적으로 의미있는 소견이 없었다. 악성도에 대한 오즈비는 양측성일 때 8.9, 유방촬영술에서 고밀도일 때 4.1, 초음파 영상에서 혈류를 보일 때 3.3였다. 결론적으로 유방의 유두상 병변은 나이 든 환자에서 양측성이며, 변연부에 위치하고, 유방촬영술에서 고밀도의 잘 관찰되는 병변, 초음파 영상에서 혈류를 보일 때 악성도의 가능성이 높았다. |Purpose: To evaluate specific clinical, mammographic, ultrasound, and magnetic resonance imaging features of breast papillary lesions as indicators of malignancy.

Materials and methods: Subjects included all patients with papillary lesions of the breast, who were treated between January 2003 and August 2011. Cases were categorized as benign papilloma, atypical papilloma, benign papilloma with a malignancy, or papillary carcinoma. Two radiologists evaluated clinical features, and reviewed the results of mammographic, US, and MRI examinations. Univariate and multivariate analyses were used to determine which characteristics were significantly correlated with malignancy. Odds ratios for malignancy were calculated for significant features. Results: A total of 194 lesions in 179 patients were included and there were 117 benign papillomas, 24 atypical papillomas, 41 benign papillomas with malignancies, and 12 papillary carcinomas. One hundred thirty mammograms, 181 US exams, and 17 MRI scans were reviewed. For univariate analyses, patients with malignant lesions were significantly older than patients with benign lesions (p = 0.001). Multiplicity (p = 0.009) and peripheral location (p = 0.009) of lesions were significantly correlated with malignancy. In mammograms, the visibility (p = 0.001) and density (p = 0.039) were correlated with malignant lesions. In US exams, the type of lesion (p = 0.018), echo pattern (p = 0.006), boundary (p = 0.001), and vascularity (p = 0.005) on Doppler were significantly correlated with malignancy. There was no significant factor to differentiate benign lesions from malignancy on breast MR images. The calculated odds ratios for malignancy were 8.9 for bilaterality, 4.1 for high mammographic density, and 3.3 for vascularity in US.

Conclusion: Papillary lesions of the breast that are bilateral and peripherally located, exhibit high visibility and density in mammograms, and/or show high vascularity in US exams, have a relatively high probability of malignancy, particularly when they occur in older patients.; Purpose: To evaluate specific clinical, mammographic, ultrasound, and magnetic resonance imaging features of breast papillary lesions as indicators of malignancy.

Materials and methods: Subjects included all patients with papillary lesions of the breast, who were treated between January 2003 and August 2011. Cases were categorized as benign papilloma, atypical papilloma, benign papilloma with a malignancy, or papillary carcinoma. Two radiologists evaluated clinical features, and reviewed the results of mammographic, US, and MRI examinations. Univariate and multivariate analyses were used to determine which characteristics were significantly correlated with malignancy. Odds ratios for malignancy were calculated for significant features. Results: A total of 194 lesions in 179 patients were included and there were 117 benign papillomas, 24 atypical papillomas, 41 benign papillomas with malignancies, and 12 papillary carcinomas. One hundred thirty mammograms, 181 US exams, and 17 MRI scans were reviewed. For univariate analyses, patients with malignant lesions were significantly older than patients with benign lesions (p = 0.001). Multiplicity (p = 0.009) and peripheral location (p = 0.009) of lesions were significantly correlated with malignancy. In mammograms, the visibility (p = 0.001) and density (p = 0.039) were correlated with malignant lesions. In US exams, the type of lesion (p = 0.018), echo pattern (p = 0.006), boundary (p = 0.001), and vascularity (p = 0.005) on Doppler were significantly correlated with malignancy. There was no significant factor to differentiate benign lesions from malignancy on breast MR images. The calculated odds ratios for malignancy were 8.9 for bilaterality, 4.1 for high mammographic density, and 3.3 for vascularity in US.

Conclusion: Papillary lesions of the breast that are bilateral and peripherally located, exhibit high visibility and density in mammograms, and/or show high vascularity in US exams, have a relatively high probability of malignancy, particularly when they occur in older patients.