대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제78권4호
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  • Pages.225-234
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  • 2018
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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CT 스캔에서 지방침윤만 보이는 원인 불명의 비후된 복막에 대한 초음파 유도하의 복막조직 생검의 진단적 유용성

The Diagnostic Usefulness of Ultrasound-Guided Peritoneal Biopsy for the Solitary Peritoneal Thickening of an Unknown Cause Visualized as Only Infiltrated Fat Tissue on a CT Scan

  • 추윤주 (경북대학교병원 영상의학과) ;
  • 염헌규 (경북대학교병원 영상의학과) ;
  • 이상엽 (경북대학교병원 영상의학과) ;
  • 김갑철 (칠곡 경북대학교병원 영상의학과) ;
  • 조승현 (칠곡 경북대학교병원 영상의학과) ;
  • 이종민 (경북대학교병원 영상의학과) ;
  • 김태헌 (경북대학교병원 영상의학과) ;
  • 송정흡 (경북대학교병원 공공보건의료사업실)
  • Chu, Yun Ju (Department of Radiology, Kyungpook National University Hospital) ;
  • Ryeom, Hunkyu (Department of Radiology, Kyungpook National University Hospital) ;
  • Lee, Sang Yub (Department of Radiology, Kyungpook National University Hospital) ;
  • Kim, Gab Chul (Department of Radiology, Kyungpook National University Chilgok Hospital) ;
  • Cho, Seung Hyun (Department of Radiology, Kyungpook National University Chilgok Hospital) ;
  • Lee, Jongmin (Department of Radiology, Kyungpook National University Hospital) ;
  • Kim, Tae Hun (Department of Radiology, Kyungpook National University Hospital) ;
  • Song, Jung Hup (Public Health Medical Service, Kyungpook National University Hospital)
  • 투고 : 2017.05.28
  • 심사 : 2017.11.14
  • 발행 : 2018.04.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: CT 스캔에서, 복막에 지방 침윤만 보이는 원인 불명의 비후된 복막에 대한 초음파 유도하의 복막조직 생검의 진단적 유용성에 대해 알아보고자 하였다. 대상과 방법: CT 스캔에서 분명한 종괴 형성 없이 복막에 단지 지방 침윤만 보이는 원인 불명의 비후된 복막이 있으면서 초음파 유도하 복막조직 생검을 받은 36명의 환자(남성 16명, 여성 20명, 평균 연령 51.7세)를 대상으로 후향적으로 연구를 하였다. 병리조직학적으로 특이진단이 가능했던 비율을 알아 보았으며, 악성 질환의 진단에 있어서의 정확도를 조사하였다. 결과: 병리조직 검사가 가능한 조직 채취는 모든 환자에서 가능하였다. 특이적 병리조직 진단은 36명 중 31명(86.1%)에서 가능하였다; 31명 중 15명(48.4%)은 복막암종증, 31명 중 15명(48.4%)은 결핵성 복막염, 31명 중 1명(3.2%)은 지방층염이었다. 36명 중 5명(13.9%)에서는 비특이적 병리조직 진단만 가능하였다; 5명 중 4명(80%)은 만성 염증, 5명 중 1명(20%)은 중피세포 증식증이었다. 악성질환 진단에 있어서 민감도 83.3%, 특이도 100%, 양성예측치 100%, 음성예측치 85.7%, 그리고 정확도 86.1%를 보였다. 결론: 초음파 유도하의 복막조직 생검은 복막에 지방 침윤으로만 보이는 원인 불명의 경한 복막 비후에 대해서도 비교적 정확한 진단 방법으로 생각되어 복강경 또는 수술적 조직생검에 앞서 우선적으로 시도될 수 있을 것으로 생각된다.

Purpose: To assess the usefulness of an ultrasound (US)-guided peritoneal biopsy for the solitary peritoneal thickening visualized as only infiltrated fat on a computed tomography (CT) scan. Materials and Methods: This retrospective study included 36 patients (16 males, 20 females; mean age, 51.7 years) who underwent a US-guided biopsy for the solitary peritoneal thickening of unknown cause visualized as only infiltrated fat without an apparent mass formation on a CT scan. The rate of the specific histopathological diagnosis and accuracy for the diagnosis of malignant disease was assessed. Results: The procedure was technically successful with the acquisition of an adequate amount of the specimen for microscopic examination from all patients. A specific histopathological diagnosis was made in 31/36 patients (86.1%): peritoneal carcinomatosis in 15/31 (48.4%), tuberculous peritonitis in 15/31 (48.4%) and panniculitis in 1/31 (3.2%). A non-specific histopathological diagnosis was made in 5/36 (13.9%): chronic inflammation in 4/5 (80%) and mesothelial hyperplasia in 1/5 (20%). The procedure showed sensitivity of 83.3%, with a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 85.7%, and an accuracy rate of 86.1% for the diagnosis of malignant diseases. Conclusion: The US-guided peritoneal biopsy is a fairly accurate diagnostic procedure for the peritoneal thickening visualized as only infiltrated fat on a CT scan, and it can be used before performing laparoscopic or an open biopsy.

키워드

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피인용 문헌

  1. Reappraisal of the Role of Ascitic Fluid Adenosine Deaminase for the Diagnosis of Peritoneal Tuberculosis in Cirrhosis vol.78, pp.3, 2018, https://doi.org/10.4166/kjg.2021.068