초음파 유도하 침 생검을 이용한 연부조직 종양의 진단에 있어 양전자방출 컴퓨터 단층촬영술의 유용성

전세빈(Se Bin Jun),김정일(Jeung Il Kim),이인숙(In Sook Lee),송유선(You Seon Song),최경운(Kyung Un Choi) 대한정형외과학회 2021 대한정형외과학회지 Vol.56 No.5

목적: 연부조직 종양의 진단을 위해서는 생검이 필요하지만, 육종 등 이질성을 가진 종양들의 특징상 정확한 부위의 채취가 어려워 수술적 개방 생검으로도 진단이 어려운 경우가 많다. 이 경우 초음파 유도하 침생검이 진단율을 올릴 수 있는 방법으로 사용되고 있다. 본 연구는 자기공명 관류영상(magnetic resonance perfusion)에서 발견된 연부조직 종양을 진단하는 데 있어 초음파 유도하 침 생검의 정확도를 평가하고, 양전자방출 컴퓨터 단층촬영술(positron emission tomography–computed tomography, PET–CT)의 유용성에 대해 알고자 하였다. 대상 및 방법: 2014년 1월부터 2018년 12월까지 자기공명 관류영상에서 발견된 연부조직의 종양에 대해 초음파 유도하 침 생검을 시행한 총 152예의 환자들 중 최종 진단을 얻어 초음파 유도하 침 생검의 결과와 비교할 수 있었던 86예에 대해 그 정확도를 후향적으로 평가하였다. 총 86예의 환자를 자기공명 관류영상만을 시행한 50예와 자기공명 관류영상과 PET–CT를 함께 시행한 36예로 나누어 그 정확도를 비교, 분석하여 PET–CT가 초음파 유도하 침 생검의 정확도를 향상시킬 수 있는지 알고자 하였다. 결과: 총 86예의 환자들 중 자기공명 관류영상만을 시행한 50예 중에서는 34예에서 최종 진단과 초음파 유도하 침 생검의 결과가 일치하였으며, 자기공명 관류영상과 PET–CT를 함께 시행한 36예 중에서는 32예에서 최종 진단과 초음파 유도하 침 생검의 결과가 일치하여 초음파 유도하 침 생검의 정확도에 있어 유의한 차이를 보였다. 이 중 연부 조직 육종만 따로 분류한다면 자기공명 관류영상만을 시행한 12예 중에서 6예에서 최종 진단과 초음파 유도하 침 생검의 결과가 일치하였고 자기공명 관류영상과 PET–CT를 함께 시행한 18예 중에서는 17예에서 최종 진단과 초음파 유도하 침 생검의 결과가 일치하여 마찬가지로 초음파 유도하 침 생검의 정확도에 있어 유의한 차이를 보였다. 결론: 연부조직 종양을 진단함에 있어 초음파 유도하 침 생검은 정확도가 높은 유용한 검사로 알려져 있지만 육종의 경우 이질성이 있어 자기공명 관류영상만으로는 정확한 생검 부위를 설정하는 데 어려움이 있다. PET–CT 영상은 이러한 연부조직 종양에서 침 생검 부위를 특정하고 정확도를 유의하게 향상시킬 수 있을 것으로 생각된다. Purpose: A biopsy is needed to diagnose soft tissue tumors. However, it is extremely difficult to pinpoint the site of a tumor due to the heterogeneity of sarcomas. Thus, even when an open biopsy is conducted, it is difficult to diagnose a soft tissue tumor. In such cases, an ultrasound (US)-guided biopsy is used to improve the diagnostic accuracy. This study evaluated the accuracy of US-guided biopsy for a diagnosis of soft tissue tumors found initially in a magnetic resonance (MR) perfusion and assessed the availability of positron emission tomography–computed tomography (PET–CT) for a diagnosis of soft tissue tumors. Materials and Methods: From January 2014 to December 2018, the US-guided biopsy was performed on 152 patients with a suspected soft tissue tumor found in an MR perfusion and 86 cases were definitively diagnosed with a soft tissue tumor. The accuracy of the US-guided biopsy was assessed retrospectively. Among the 86 cases, only MR perfusion was used before the biopsy in 50 cases, while both MR perfusion and PET–CT was conducted on 36 cases. The accuracy was analyzed to determine if the PET–CT could improve the precision of a biopsy. Results: From 86 cases, 34 out of 50 cases, in which only MR perfusion had been conducted, matched the result of the definitive diagnosis and the US-guided biopsy. 32 out of 36 cases, in which both PET–CT and MR perfusion were conducted, matched the definitive diagnosis and the US-guided biopsy. These results show significant differences in the accuracy of US-guided biopsy. In the case of soft tissue sarcomas, 6 out of 12 cases, in which only MR perfusion had been conducted, matched the result of the definitive diagnosis and the US-guided biopsy. 17 out of 18 cases, in which both PET–CT and MR perfusion were conducted, matched the definitive diagnosis. Moreover US-guided biopsy also showed significant differences in the accuracy of US-guided biopsy. Conclusion: In diagnosing soft tissue tumors, a US-guided biopsy is a well-known tool for its high accuracy. However, the heterogeneity of sarcoma makes it difficult to locate the exact site for a biopsy using only MR perfusion. Thus, the use of PET–CT will meaningfully improve the accuracy of a diagnosis by precisely targeting the site for the US-guided biopsy.

전완부 및 수부에 발생한 연부조직종양

권영호 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

목 적 : 전완부 및 수부에 발생한 연부조직 종양을 유형별로 분류하여 후향성 조사로 예후와 임상적 결과를 분석하고자 한다. 대상 및 방법 : 1990년 3월부터 2006년 2월까지 17년간 본원 정형외과에서 전완부 및 수부의 연부조직종양으로 확진되어 수술적 치료를 받은 91명, 91례를 대상으로 하였다. 이들 연부조직종양을 양성과 악성으로 구분하였고, 각각의 발생 빈도, 발생 부위, 치료방법, 결과 및 예후를 비교 분석하였다. 결 과 : 양성 종양과 악성 종양은 각각 74례, 17례였다. 양성 종양은 결절종이 29례로 가장 많았고, 다음으로 혈관종이 12례, 사구종이 11례였다. 악성 종양은 악성 흑색종이 8례로 가장 많았고, 두 번째로는 편평 상피암종이 5례였다. 그 외 포상 횡문근육종 1례, 상피양 육종 1례, 피부섬유육종 1례, 혈관육종 1례였다. 증상 발현까지의 시간은 평균 6.1 개월이었고 6개월 이하는 10례였다. 초진시 주증상으로 단순 종물 발현이 65례로 가장 많았고 16례에서 통증을 주 증상으로 하였다. 악성 종양은 광범위절제술 및 재건술 9례, 이단술 5례, 절단술 3례로 치료하였고 부가적인 항암 치료 및 방사선 치료를 받았다. 악성종양은 5년 생존율은 67%였고 종양학적 결과는 No evidenc of disease(NED) 10례, Died of disease(DOD) 5례, Alive with disease(AWD) 2례였다. 결 론 : 전완부 및 수부에 발생하는 악성 연부조직 종양은 발생 빈도가 낮아 정확한 진단 및 치료 방침을 결정하기 힘들지만 초기 임상 증상이 모호할 시 반드시 병리학적 검사를 실시하여햐 한다. 상지에 발생하는 양성 연부 조직 종양은 병소 내 절제술이나 경계부 절제술로 치료가 가능하였으나 악성 연부조직 종양은 근치적 절제술 및 재건술이 필요하며 절단이 필요한 경우도 있다. Purpose : To analyze the prognosis and clinical results through retrospective survey with classification of soft tissue tumors in the forearm. Materials and Methods : Patients undergoing surgical treatment with diagnosis of forearm and hand tumors from March 1990 to February 2006 were reviewed. The incidences of occurrence, the location of tumors, treatment methods, clinical results, and prognosis were compared and analyzed. Results : The subjects consisted of 74 cases of benign tumors and 17 cases of malignant tumors. Benign tumors were 74 cases consisted of 29 cases of ganglion that took the largest share and 12cases of hemangioma that took the second and 11 cases of glomus tumor . In case of malignant tumors, 8 cases of malignant melanoma took the largest share and 5 cases of squamous cell carcinoma took the second. In terms of main symptoms at first the examinations, manifestation of palpable mass were most frequent with 65 cases. In case of malignant tumors, 9 cases received wide excision and reconstructions, 5 cases received disarticulation, and 3 cases received amputations; they also received chemotherapies and radiotherapies additionally. The 5-year survival proportion of malignant tumor patients was 67%, and no evidence of disease was 10 cases, and died of disease was 5 cases, and alive with disease was 2 cases. Conclusion : Malignant tumor in forearm was uncommon case so it was difficult to make guide line for diagnosis and treatment. The benign tumors occurred in the forearm may be treated with intra-lesion excision or marginal excision and malignant tumors require wide resection or amputation also consider.

연부조직 종양에 관한 통계학적 고찰

홍광의(Kwang Iee Hong),김종민(Jong Min Kim),이종주(Chong Ju Lee),서연림(Yeon Lim Suh) 대한피부과학회 1990 대한피부과학회지 Vol.28 No.1

By Enzinger and Weiss classification, 664 cases of soft tissue tumors, which were confirmed histologically at the department of pathology of Hangang Sacred Heart Hospital from Janusry 1979 to December 1988, were analyzed statistically. The results were as follows : 1. Of the 664 cases, 261 cases (39.3%) were consulted at the Department of General Surgery, 124 cases (18.7%) were consulted at the Department of Orthopedic Surgery, 115 cases (17.3%)were consulted at the Department of Dermatology. 2, Of the 664 cases, 631 cases (95%) were benign and 33 cases (5%) were malignant. 3. The most common benign tumor was lipoma, which was followed by hemangioma and lymphangioma. Among malignant tumors liposarcoma was the most common one, followed by malignant fibrous histiocytoma. 4. The distribution of age of benign tumor was relatively even from childhood to old age but that of malignant tumor showed highest prevalence in 7th decade. 5. The distribution of sex of benign tumor showed male to female ratio of 1: 1.1 but that of malignant tumor showed male to female ratio of 1.5: l. 6. The predilection sites of benign tumors were head, neck and trunk, but those of malignant tumors were lower extremities and trunk. 7. Kinds of soft tissue tumors consulted at the Department of Dermatology were hemangioma, neurofibroma, lipoma, dermatofibroma, ymphangioma, leiomyoma, juvenile xanthogranuloma, xanthoma, keloid and neurilemmoma. (Kor J Dermatol 28(1): 44 53, 1090)

연부조직에 발생한 단소성 섬유 종양의 임상 결과

공창배(Chang-Bae Kong),최성우(Sung Woo Choi),조상현(Sang-Hyun Cho),송원석(Won-Seok Song),조완형(Wan-Hyeong Cho),고재수(Jae-Soo Koh),전대근(Dae-Geun Jeon) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.6

목적: 연부조직에 발생한 단소성 섬유종은 드문 종양으로, 저자들은 원자력병원에서 경험한 연부조직 단소성 섬유종 환자들의 종양학적 결과에 대해 알아보고자 하였다. 대상 및 방법: 2009년 1월부터 2014년 12월까지 단소성 섬유종으로 진단된 이후 치료 받은 6명의 환자를 대상으로 하였다. 이들의 임상 기록, 자기공명영상, 병리 소견을 후향적으로 분석하였다. 결과: 남자가 4예, 여자가 2예였으며, 평균 연령은 45세(32-56세)였다. 한 명의 환자에서 광범위 절제술, 다섯 명의 환자에서 변연부 절제술을 시행하였다. 수술 후 4예에서 현미경적으로 절제연에 종양세포가 있음이 확인되었으나 추가적인 수술 및 방사선 치료, 항암 치료는 시행하지 않았다. 절제술 후 조직학적 진단은 단소성 섬유종이 4예, 악성 단소성 섬유종이 2예였다. 추시 기간은 평균 25.8개월(6-66개월)이었으며 국소 재발이나 원격 전이가 발생한 환자는 없었다. 결론: 단소성 섬유종은 재발과 전이가 잘 되지 않는 중등도 종양으로 신경, 혈관, 뼈와 같은 주요 해부학적 구조물에 종양이 근접한 경우 이를 보존하는 수술법도 하나의 방법이 될 수 있다고 생각된다. 하지만 절제연 양성의 결과가 나왔을 경우 환자에게 국소 재발의 위험성이 높음을 주지시키고 면밀히 관찰해야 한다. Purpose: Solitary fibrous tumors (SFT) represent a rare entity of soft tissue tumors which are exclusively located in the thoracic cavity as pleural fibrous tumors. Extrathoracic SFT in the soft tissues are very rare. We analyzed the oncologic outcome of the soft tissue SFT. Materials and Methods: Between January 2009 and December 2014, we treated 6 soft tissue SFT cases. Patients’ clinical data, magnetic resonance imagings and pathologic findings were reviewed. Results: The patients included two women and four men. The average age of the patients was 45 years (range, 32–56 years). The mean tumor size is 7.2 ㎝ (range, 3.5–13.0 ㎝). One patient received wide excision of the tumor and remaining 5 patients marginal excision. After the excision, pathologic report confirmed that 4 patients showed margin positive. However, no patient received further surgery or adjuvant treatments. After the immunohistochemistry, 2 out of 6 patients identified as malignant soft tissue SFT. The mean follow-up period was 25.8 months (range, 6–66 months). Although 4 patients revealed margin positivity, no subsequent local recurrence or distant metastasis was observed. Conclusion: Since the SFT are categorized as intermediated biological potential with a low risk of metastasis and recurrence, marginal excision can be a one of the surgical options for these tumors which are located adjacent to vital structures. However, close observation is needed because local recurrence can be significantly higher the patients with positive resection margins.

골 및 연부 조직 종양에서의 미세 침 흡입 세포 검사

이수용,전대근,이종석,김석준,조경자,오형호,박민효,박현수,장진대,Lee, Soo-Yong,Jeon, Dae-Geun,Lee, Jong-Seok,Kim, Sug-Jun,Cho, Kyung-Ja,Oh, Hyung-Ho,Park, Min-Hyo,Park, Hyun-Soo,Jang, Jin-Dae 대한근골격종양학회 1996 대한골관절종양학회지 Vol.2 No.1

From January 1994 to August 1995 we performed 270 cases of fine needle aspiration cytology for bone and soft tissue lesions. Among them 137 cases were diagnosed histologically. Sixty-seven cases were benign and 70 cases were malignant. We analysed these on the aspect of sensitivity, specifity, positive predictive value, negative predictive value of the cytologic examination. Malignant cases consisted of bone tumor 29 cases; soft tissue tumor 25 cases; and metastatic tumor 16 cases. The sensitivity and specifity of the aspiration cytology for malignant tumor were 67.8% and 97%, respectively. The positive and negative predictive value of aspiration cytology were 97.4% and 72.7%, respectively. Among them 40 cases were primary bony lesions; 14 benign lesions, 26 malignamt bone tumors. Sensitivity of aspiration cytology for these primary bony lesion was 90%(18/20) and its specifity was 100%(13/13). Three cases showed atypical cells in cytology but with biopsy we could find them as one benign and two malignancies. Two cases of manignancy showed negative result in cytology; one was parosteal sarcoma of proximal femur and the other was osteosarcoma of proximal tibia which was biopsied already at other hospital. Although the overall sensitivity and specifity for malignant bone and soft tissue tumors were relatively low and not so predictable, the fine needle aspiration cytology for primary bony lesion was useful in the differential diagnosis of benign or malignancy.

Preliminary Experience Using Dynamic MRI at 3.0 Tesla for Evaluation of Soft Tissue Tumors

박용구,지원희,김선기,이소연,정준용 대한영상의학회 2013 Korean Journal of Radiology Vol.14 No.1

Objective: We aimed to evaluate the use of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) at 3.0 T for differentiating the benign from malignant soft tissue tumors. Also we aimed to assess whether the shorter length of DCEMRI protocols are adequate, and to evaluate the effect of temporal resolution. Materials and Methods: Dynamic contrast-enhanced magnetic resonance imaging, at 3.0 T with a 1 second temporal resolution in 13 patients with pathologically confirmed soft tissue tumors, was analyzed. Visual assessment of time-signal curves, subtraction images, maximal relative enhancement at the first (maximal peak enhancement [Emax]/1) and second (Emax/2) minutes, Emax, steepest slope calculated by using various time intervals (5, 30, 60 seconds), and the start of dynamic enhancement were analyzed. Results: The 13 tumors were comprised of seven benign and six malignant soft tissue neoplasms. Washout on time-signal curves was seen on three (50%) malignant tumors and one (14%) benign one. The most discriminating DCE-MRI parameter was the steepest slope calculated, by using at 5-second intervals, followed by Emax/1 and Emax/2. All of the steepest slope values occurred within 2 minutes of the dynamic study. Start of dynamic enhancement did not show a significant difference, but no malignant tumor rendered a value greater than 14 seconds. Conclusion: The steepest slope and early relative enhancement have the potential for differentiating benign from malignant soft tissue tumors. Short-length rather than long-length DCE-MRI protocol may be adequate for our purpose. The steepest slope parameters require a short temporal resolution, while maximal peak enhancement parameter may be more optimal for a longer temporal resolution.

FDG - PET을 이용한 악성과 양성 연부조직 병변의 감별 : 반정량적 지표간의 비교

김병태(Byung Tae Kim),김상은(Sang Eun Kim),이경한(Kyung Han Lee),최준영(Joon Young Choi),최용(Yearn Seong Choe),최연성(Yong Choi),서재곤(Jai Gon Seo) 대한핵의학회 1997 핵의학 분자영상 Vol.31 No.1

N/A The purpose of this study is to evaluate the diagnostic accuracy of various quantitative indices for the differentiation of benign from malignant primary soft tissue tumors by FDG-PET. A series of 32 patients with a variety of histologically or clinically confirmed benign (20) or malignant (12) soft tissue lesions were evaluated with emission whole body (5min/bed position) PET after injection of [18F]FDG. Regional 20min transmission scan for the attenuation correction and calculation of SUV was performed in 16 patients (10 benign, 6malignant) followed by dynamic acquisition for 56min. Postinjection transmission scan for the attenuation correction and calculation of SUV was executed in the other 16 patients (10 benign, 6 malignant). The following indices were obtained : the peak and average SUV (pSUV, aSUV) of lesions, tumor-to-background ratio acquired at images of 51 min p.i. (TBR51), tumor-to-background ratio of areas under time-activity curves (TBRarea) and the ratio between the activities of tumor ROI at 51 min p.i. and at the time which background ROI reaches maximum activity on the time-activity curves (T51/Tmax). The pSUV, aSUV, TBR51, and TBRarea, in malignant lesions were significantly higher than those in benign lesions. We set the cut-off values of pSUV, aSUV, TBR51, TBRarea and T51/Tmax for the differentiation of benign and malignant lesions at 3.5, 2.8, 5.1, 4.3 and 1.55, respectively. The sensitivity, specificity and accuracy were 91.7%, 80.0%, 84.4% by pSUV and aSUV, 83.3%, 85.0%, 84.4% by TBR51, 83.3%, 100%, 93.8% by TBRarea and 66.7%, 70.0%, 68.8% by Tsl/Tmax. The time-activity curves did not give additional information compared to SUV or TBR. The one false negative was a case with low-grade fibrosarcoma and all four false positives were cases with inflammatory change on histology. The visual analysis of FDG-PET also detected the metastatic lesions in malignant cases with comparable accuracy. In conclusion, all pSUV, aSUV, TBR51, and TBRarea are useful metabolic semi-quantitative indices with good accuracy for the differentiation of benign from malignant soft-tissue lesions.

연부조직 병변의 세침흡인 세포학적 소견

옥순애,공경엽,최기영,허주령,유은실,이인철,Oak, Soon-Ae,Gong, Gyung-Yub,Choe, Ghee-Young,Hch, Jur-Yung,Yu, Eun-Sil,Lee, In-Chul 대한세포병리학회 1995 대한세포병리학회지 Vol.6 No.1

We reviewed 93 cases of fine needle aspiration of skin/subcutaneous and soft tissue lesions with histologic confirmation. On the basis of the most prominent cytologic features, morphologic classification of the aspirates was done. Skin and subcutaneous lesions included endometriosis, epidermal inclusion cyst, fat necrosis, pilomatrixoma and nodular fasciitis. Neoplastic lesions of soft tissue were categorized as ; round cell, spindle cell, polygonal cell, well-differentiated and myxoid tumor. This classification is convenient to recognize and categorize most soft tissue tumors.

Various Tumor-Mimicking Lesions in the Musculoskeletal System: Causes and Diagnostic Approach

김수연,박지선,류경남,진욱,박소영 대한영상의학회 2011 Korean Journal of Radiology Vol.12 No.2

Tumor-mimicking lesions in the musculoskeletal system can be defi ned as lesions mistaken as tumors due to the presence of palpation upon physical examination or a tumor-like appearance upon radiological examination. Moreover, tumormimicking lesions show diverse etiologies and anatomic locations. We illustrated the various tumor-mimicking lesions involving bone and soft tissue. In this review, the tumor-mimicking lesions were classifi ed into those based on clinical examination and those based on radiological examination in musculoskeletal radiology. Awareness of the various causes of tumor-mimicking lesions, correctly obtaining clinical information, and the proper selection of imaging modality are important for the differentiation of tumor-mimicking lesions from true neoplasms.

사지 연부조직 병소의 초음파 소견

전용석 최신의학사 1990 最新醫學 Vol.33 No.8