Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
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Magnetic Resonance Imaging Factors Predicting Re-excision in Breast Cancer Patients Having Undergone Conserving Therapy

유방보존술을 시행받는 유방암환자에서 재절제 예측의 자기공명영상소견

  • Jang, Mijung (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Kim, Sun Mi (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Yun, Bo La (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Kim, Sung-Won (Department of Surgery, Seoul National University Bundang Hospital) ;
  • Kang, Eun Young (Department of Surgery, Seoul National University Bundang Hospital) ;
  • Park, So Yeon (Department of Pathology, Seoul National University Bundang Hospital) ;
  • Kim, Jee Hyun (Department of Oncology, Seoul National University Bundang Hospital) ;
  • Kim, Yeongmi (Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University) ;
  • Ahn, Hye Shin (Department of Radiology, Chung-Ang University Hospital)
  • 장미정 (분당서울대학교병원 영상의학과) ;
  • 김선미 (분당서울대학교병원 영상의학과) ;
  • 윤보라 (분당서울대학교병원 영상의학과) ;
  • 김성원 (분당서울대학교병원 외과) ;
  • 강은영 (분당서울대학교병원 외과) ;
  • 박소연 (분당서울대학교병원 병리과) ;
  • 김지현 (분당서울대학교병원 종양학과) ;
  • 김영미 (성균관대학교 삼성창원병원 영상의학과) ;
  • 안혜신 (중앙대학교병원 영상의학과)
  • Received : 2014.04.03
  • Accepted : 2014.05.13
  • Published : 2014.06.30
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Abstract

Purpose : The aim of this study was to determine the magnetic resonance imaging (MRI) features associated with re-excision due to the presence of a positive margin after breast conserving therapy (BCT) in breast cancer patients. Materials and Methods: We reviewed the records of 286 consecutive breast cancer patients who received BCT between January 2006 and December 2007. Among 246 patients who had undergone BCT, 38 (15.4%) underwent immediate further surgery due to positive margin status. We analyzed the MRI findings using ${\chi}^2$ test, Fisher's exact test and t tests. Multivariate logistic regression was conducted for prediction of re-excision. Results: Tumor size (p < 0.001), lesion multiplicity (p = 0.003), and non-mass-like enhancement (NMLE) type on MRI (p < 0.001) were associated with margin involvement in BCT. On preoperative MRI, larger size (${\geq}5cm$) (odds ratio = 2.96), NMLE (odds ratio = 3.81), and multifocal lesions (odds ratio = 2.54) were positively associated with re-excision. In cases involving NMLE, segmental distribution was associated with a greater likelihood of immediate re-excision. Conclusion: Larger size, multiplicity, and NMLE on MRI are significantly associated with re-excision after BCT in breast cancer patients. For NMLE lesions, the segmental distribution pattern was predictive of re-excision.

목적: 유방암 환자의 수술 전 자기공명영상 소견에서 유방 부분절제술 후 변연 침범에 의한 재수술과 관련된 실패와 관련된 영상 소견을 알아보고자 하였다. 대상과 방법: 2006년 1월부터 2007년 12월까지 유방 보존술을 시행받은 286명의 유방암 환자를 대상으로 하였다. 이들 중 38(15.4%)명은 수술 직후 보존술 부위 경계에 유방암 양성 소견이 있어 추가 수술을 시행 받았다. 수술전 시행한 자기공명영상 소견을 보존술 후 변연 침범에 따른 실패에 따른 재수술 여부와 비교하여 평가하였다. 재수술을 예측할 수 있는 인자를 보기 위해 다중 회귀 분석을 시행하였다. 결과: 수술 전 자기공명영상에서 유방암의 크기가 5 cm이상일 때 (p < 0.001) (odds ratio = 2.96), 비종괴성 조영증강소견으로 나타날때(p < 0.001) (odds ratio = 3.81), 그리고 다발성 병변일때(p = 0.003) (odds ratio = 2.54) 재수술의 빈도가 높았다. 비종괴성 조영증강소견의 경우에는 분절성 분포를 보일때 다른 분포와 비교하여 유방 보존술이 실패할 가능성이 높았다. 결론: 수술전 자기공명영상에서 유방암 크기가 클때, 다발성 병변일 때 그리고 비종괴성 조영증강소견으로 보일때 유방 보존술 후 이차수술의 확률이 실패 확률이 높은 것으로 나타났다. 분절성 분포를 가지는 비종괴성 조영증강소견의 경우 유방 보존술 후 이차수술의 가능성이 실패할 가능성이 높을 것으로 예측할 수 있었다.

Keywords

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