삼중음성 유방암과 Estrogen Receptor/Progesteron Receptor 양성 유방암의 영상의학적 소견 비교 = Comparison of Radiologic Features of Triple-Negative and Estrogen Receptor/Progesteron Receptor Positive Breast Cancer

다국어 초록 (Multilingual Abstract)

Purpose: To retrospectively investigate the imaging [mammographic, ultrasonographic (US), magnetic resonance (MR) imaging] features and standardized uptake values (SUV) in positron emission tomography (PET)/computed tomography (CT) of triple-negative breast cancers (TNBC) and to compare them with breast cancers that are either estrogen receptor (ER) positive or progesteron receptor (PR) positive.
Materials and Methods: 155 breast cancers cases were identified in 134 women (mean age, 51 years; range, 31-86 years). Surgically confirmed TNBC (n = 27) and ER-positive/PR-positive breast cancers (n = 81) were included among them. Cancers were investigated with mammography (n = 81), US (n = 106), MR imaging (n = 34) and PET-CT (n = 59). Mammographic findings are identified by detection of characteristic masses and microcalcifications. US findings included tumor size, margin, tumor shape, calcification and posterior shadowing. MR findings included tumor size, shape, margin, internal enhancement, intratumoral signal intensity and kinetics. Peak SUVs (p-SUV) of breast cancers were evaluated in PET/CT. These findings were compared with TNBC and ER/PR positive groups.
Results: Mammographic findings had no significant association with the TNBC. High pathological grade (p < 0.05), larger than 2 cm in size, well-marginal mass, and round or oval-shaped (p < 0.05) is US were significantly associated with TNBC. In MR imaging, round mass shape (p < 0.05), well-circumscribed mass margin (p < 0.05), rim enhancement (p < 0.05), were significantly associated with TNBC. The peak SUV of TNBC tend to be higher than that of ER-positive/PR-positive breast cancer (7.95 ± 5.50 vs. 4.91 ± 3.00, p < 0.05).
Conclusion: TNBC tend to have high pathological grade, are of a large, round and smooth mass with rim enhancement on MR and US. In addition to above features, PET-CT with SUV estimation can improve the accuracy of test through the evaluation of TNBC.

국문 초록 (Abstract)

목적: 삼중음성 유방암과 estrogen receptor (ER)/progesteron receptor (PR) 양성 유방암의 영상 소견을 비교하여 분석하고, positron emission tomography (PET)-CT에서 얻은 최대 standardized uptake values (SUV) 값을 평가하여, 삼중음성 유방암을 예측할 수 있는지 알아보고자 하였다.
대상과 방법: 조직학적으로 유방암이 확진된 134명의 환자(평균 나이 51세, 31~86세) 155예의 유방암을 대상으로 하였다. 이 중 삼중음성 유방암(27예)과 ER/PR 양성 유방암(81예)이 수술적으로 확진되었고, 유방 촬영술(81예), 초음파(106예), 자기공명영상(34예), PET-CT (59예)를 시행하였다. 각 종괴의 조직학적 등급을 평가하였고, 유방 촬영술 영상은 종괴와 석회화 여부, 초음파에서는 종괴 크기, 변연, 모양, 석회화와 후방 음향, 자기공명영상에서는 종괴 크기, 모양, 변연, 내부 조영증강, 종양 내 신호 강도와 역동적 조영증강으로 나누어 평가하였다. PET-CT에서는 최대 SUV값을 측정하였다. 삼중음성 유방암과 ER/PR 양성 유방암군으로 나누어 위의 소견들에 대하여 비교 평가하였다.
결과: 유방 촬영술 소견은 두 군 간에 유의한 차이가 없었다. 삼중음성 유방암일 경우 조직학적 등급이 높게 나타났고, 초음파 소견은 삼중음성 유방암에서 크기가 2 cm 이상이며, 변연이 잘 그려지고, 모양이 둥글거나 난원형을 보이는 것으로 나타났다(p ＜ 0.05). 자기공명영상에서는 삼중음성 유방암일 경우, 종괴 모양이 둥글고, 변연이 잘 그려지며, 테두리 조영증강을 보이는 특징이 있는 것으로 나타났다(p ＜ 0.05). PET-CT에서 최대 SUV값은 삼중음성 유방암에서 ER/PR 양성 유방암보다 유의하게 높았다(7.95 ± 5.50 vs. 4.91 ± 3.00, p ＜ 0.05).
결론: 삼중음성 유방암은 자기공명영상과 초음파에서 조직학적 등급이 높고, 크기가 크고, 모양이 둥글고, 변연이 잘 그려지며, 테두리 조영증강을 보인다. 추가적으로 최대 SUV를 평가하면, 삼중음성 유방암을 예측하는 데 도움이 될 것이다.

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