유방암에서 신보강화학요법 후 잔류암에 대한 유방촬영술, 유방초음파, 유방자기공명영상의 정확성의 비교 = Comparison of the Accuracy of Mammography, Ultrasonography and MRI for Evaluating Residual Tumor after Neoadjuvant Chemotherapy for Breast Cancer

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of our study was to determine the relative accuracy of mammography, ultrasonography and MRI for evaluating residual tumor after neoadjuvant chemotherapy for breast cancer, as compared with the pathological results.
Materials and Methods: From December 2004 through August 2005, 13 patients who had mammography, ultrasonography and MRI performed for evaluating tumor response were enrolled in our study from a total of 47 patients who received neoadjuvant chemotherapy for breast cancer. The therapy response was defined by ultrasonography that was able to compare the images taken before and after therapy, and each imaging was retrospectively analyzed by two board-certified radiologists who specialized in breast imaging. The presence or absence of residual tumor was investigated and the tumor measurement according to the imaging was divided into underestimating, being equal to or overestimating the size of the residual tumor, compared with that of the pathological results. The relative accuracy of these modalities was then assessed.
Results: Eight of 13 patients showed a partial response and 5 patients showed stable lesion. Agreement rates about the residual tumor, as measured by mammography, ultrasonography and MRI and then compared with the pathological results, were 39%, 54% and 77%, respectively. Of the three methods, MRI agreed with the pathological results significantly more often, but it may overestimate (8%) or underestimate (15%) (p = 0.102). When there was disagreement with the pathological results, mammography exhibited a tendency to underestimate (38%) and ultrasonography exhibited a tendency to overestimate (31%).
Conclusion: MRI had a higher relative accuracy than did mammography and ultrasonography for evaluating the residual tumor in patients receiving neoadjuvant chemotherapy for breast cancer. However, MRI may overestimate (8%) or underestimate (15%) the residual tumor.

국문 초록 (Abstract)

목적: 신보강화학요법을 받은 유방암 환자의 잔류암 진단에 있어 유방촬영술, 유방초음파, 유방자기공명영상의 상대적 정확성을 병리 결과와 비교하여 알아보고자 하였다.
대상과 방법: 2004년 12월부터 2005년 8월까지 신보강화학요법을 받은 총 47명의 유방암 환자 중 치료 반응을 보기 위해 유방촬영술, 유방초음파, 유방자기공명영상을 모두 시행한 13명을 대상으로 하였다. 치료 반응은 치료 전후의 영상 비교가 가능했던 초음파검사 소견으로 판정하였고, 각각의 영상은 후향적으로 두 명의 유방 영상전문의에 의해 분석되었다. 영상에서 잔류암의 존재 여부 및 측정된 잔류암의 크기를 병리결과와 비교하여 과소측정, 일치, 과대측정으로 나누었고 각각의 검사 방법들의 상대적 정확성을 알아보았다.
결과: 총 13명 중 8명은 부분 반응을 보였고, 5명은 안정 병변을 보였다. 잔류암을 진단하는 데 있어 유방촬영술, 유방초음파, 유방자기공명영상 소견을 병리 결과와 비교했을 때 일치율은 각각 39%, 54%, 77%였다. 유방자기공명영상의 경우 다른 두 검사에 비해 통계적으로 유의하게 일치율이 높았지만 과대측정(8%)되거나 과소측정(15%)될 수 있었다 (p=0.102). 일치하지 않는 경우, 유방촬영술은 과소측정되는 경향이 있었고(38%), 초음파는 과대측정되는 경향이 있었다(31%).
결론: 신보강화학요법을 받은 유방암 환자에서 잔류암을 진단하는 데 있어 자기공명영상은 과대측정(8%)되거나 과소측정(15%)될 수 있으나 유방촬영술과 초음파에 비해 상대적 정확도가 높았다.

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