대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제82권5호
  • /
  • Pages.1231-1245
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  • 2021
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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유방의 소엽상피내암과 침윤성 소엽암의 영상의학적 소견 비교

Comparison of the Imaging Features of Lobular Carcinoma In Situ and Invasive Lobular Carcinoma of the Breast

  • 윤가영 (울산대학교 의과대학 강릉아산병원 영상의학과) ;
  • 차주희 (울산대학교 의과대학 서울아산병원 영상의학과) ;
  • 김학희 (울산대학교 의과대학 서울아산병원 영상의학과) ;
  • 방민서 (울산대학교 의과대학 울산대학교병원 영상의학과) ;
  • 이희진 (울산대학교 의과대학 서울아산병원 병리과) ;
  • 공경엽 (울산대학교 의과대학 서울아산병원 병리과)
  • Ga Young Yoon (Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Joo Hee Cha (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hak Hee Kim (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Min Seo Bang (Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Hee Jin Lee (Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Gyungyub Gong (Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2020.08.11
  • 심사 : 2021.01.14
  • 발행 : 2021.09.01
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초록

목적 크기가 작은 소엽상피내암(lobular carcinoma in situ;이하 LCIS)과 침윤성 소엽암(invasive lobular carcinoma; 이하 ILC)의 영상의학적 소견을 비교하여 감별에 도움을 줄 수 있는지 알아보았다. 대상과 방법 2012년 1월부터 2016년 12월까지 2 cm 이하의 LCIS 여성 환자 52명(중앙값 45세, 범위 32-67세)과 ILC 여성 환자 180명(중앙값 49세, 범위 36-75세)을 대상으로 하였다. 모든 환자는 유방촬영술과 초음파 검사를 받았고, LCIS 환자 20명과 ILC 환자 150명은 MRI 검사를 받았다. 두 집단의 임상적, 영상의학적 소견들을 비교했고, 병변 크기에 따라 소그룹으로 나눠 추가 분석하였다. 결과 LCIS 환자는 다변량 분석에서 나이가 적을수록(odds ratio [이하 OR] = 1.100), 종괴 크기가 작을수록(OR = 1.103), 종괴가 둥글거나 타원형일 때(OR = 4.098), 종괴가 피부선과 평행할 때(OR = 5.464), 지방과 동등한 에코일 때(OR = 3.360), 오즈비(OR)가 유의하게 높았다. 그룹 간 감별에서 receiver operating characteristic curve 아래 면적값은 0.904 (95% 신뢰구간, 0.857-0.951)였다. 소그룹 분석에서 크기가 더 작은 LCIS (≤ 1 cm)는 ILC보다 양성에 가깝게 보였다. 결론 크기가 작은 LCIS는 ILC보다 양성에 가까운 소견들을 보였다. 몇 가지 영상의학적 소견은 LCIS를 예측과 관련된 독립인자로 생각된다.

Purpose To investigate the usefulness of imaging features for differentiating between small lobular carcinoma in situ (LCIS) and invasive lobular carcinoma (ILC). Materials and Methods It included 52 female with LCISs (median 45 years, range 32-67 years) and 180 female with ILCs (median 49 years, range 36-75 years), with the longest diameter of ≤ 2 cm, who were evaluated between January 2012 and December 2016. All the female underwent mammography and ultrasonography. Twenty female with LCIS and 150 female with ILC underwent MRI. The clinical and imaging features were compared, and multivariate analysis was performed to identify the independent predictors of LCIS. Female with LCIS were also sub-grouped by lesion size and compared with the female with ILC. Results Multivariate analysis showed that younger age (odds ratio [OR] = 1.100), smaller lesion size (OR = 1.103), oval or round shape (OR = 4.098), parallel orientation (OR = 5.464), and isoechotexture (OR = 3.360) were significant independent factors predictive of LCIS. The area under the receiver operating characteristic curve for distinguishing LCIS from ILC was 0.904 (95% confidence interval, 0.857-0.951). Subgroup analysis showed that benign features were more prevalent in female with smaller LCISs (≤ 1 cm) than in those with ILC. Conclusion Small LCISs tend to demonstrate more benign features than small ILCs. Several imaging features are independently predictive of LCIS.

키워드

참고문헌

  1. Foote FW, Stewart FW. Lobular carcinoma in situ: a rare form of mammary cancer. Am J Pathol 1941;17:491-496
  2. Giuliano AE, Connolly JL, Edge SB, Mittendorf EA, Rugo HS, Solin LJ, et al. Breast cancer-major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin 2017;67:290-303
  3. Mann RM, Loo CE, Wobbes T, Bult P, Barentsz JO, Gilhuijs KG, et al. The impact of preoperative breast MRI on the re-excision rate in invasive lobular carcinoma of the breast. Breast Cancer Res Treat 2010;119:415-422
  4. Hwang ES, Nyante SJ, Yi Chen Y, Moore D, DeVries S, Korkola JE, et al. Clonality of lobular carcinoma in situ and synchronous invasive lobular carcinoma. Cancer 2004;100:2562-2572
  5. Sakr RA, Schizas M, Carniello JV, Ng CK, Piscuoglio S, Giri D, et al. Targeted capture massively parallel sequencing analysis of LCIS and invasive lobular cancer: repertoire of somatic genetic alterations and clonal relationships. Mol Oncol 2016;10:360-370
  6. Lopez-Garcia MA, Geyer FC, Lacroix-Triki M, Marchio C, Reis-Filho JS. Breast cancer precursors revisited: molecular features and progression pathways. Histopathology 2010;57:171-192
  7. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: breast cancer. version 1. Available at. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Published 2019. Accessed Jun 26, 2019
  8. Nagi CS, O'Donnell JE, Tismenetsky M, Bleiweiss IJ, Jaffer SM. Lobular neoplasia on core needle biopsy does not require excision. Cancer 2008;112:2152-2158
  9. Hwang H, Barke LD, Mendelson EB, Susnik B. Atypical lobular hyperplasia and classic lobular carcinoma in situ in core biopsy specimens: routine excision is not necessary. Mod Pathol 2008;21:1208-1216
  10. Karabakhtsian RG, Johnson R, Sumkin J, Dabbs DJ. The clinical significance of lobular neoplasia on breast core biopsy. Am J Surg Pathol 2007;31:717-723
  11. O'Neil M, Madan R, Tawfik OW, Thomas PA, Fan F. Lobular carcinoma in situ/atypical lobular hyperplasia on breast needle biopsies: does it warrant surgical excisional biopsy? A study of 27 cases. Ann Diagn Pathol 2010;14:251-255
  12. Hussain M, Cunnick GH. Management of lobular carcinoma in-situ and atypical lobular hyperplasia of the breast--a review. Eur J Surg Oncol 2011;37:279-289
  13. Scoggins M, Krishnamurthy S, Santiago L, Yang W. Lobular carcinoma in situ of the breast: clinical, radiological, and pathological correlation. Acad Radiol 2013;20:463-470
  14. Choi BB, Kim SH, Park CS, Cha ES, Lee AW. Radiologic findings of lobular carcinoma in situ: mammography and ultrasonography. J Clin Ultrasound 2011;39:59-63
  15. Maxwell AJ, Clements K, Dodwell DJ, Evans AJ, Francis A, Hussain M, et al. The radiological features, diagnosis and management of screen-detected lobular neoplasia of the breast: findings from the Sloane Project. Breast 2016;27:109-115
  16. Amos B, Chetlen A, Williams N. Atypical lobular hyperplasia and lobular carcinoma in situ at core needle biopsy of the breast: an incidental finding or are there characteristic imaging findings? Breast Dis 2016;36:5-14
  17. Abdel-Fatah TM, Powe DG, Hodi Z, Lee AH, Reis-Filho JS, Ellis IO. High frequency of coexistence of columnar cell lesions, lobular neoplasia, and low grade ductal carcinoma in situ with invasive tubular carcinoma and invasive lobular carcinoma. Am J Surg Pathol 2007;31:417-426
  18. Abdel-Fatah TM, Powe DG, Hodi Z, Reis-Filho JS, Lee AH, Ellis IO. Morphologic and molecular evolutionary pathways of low nuclear grade invasive breast cancers and their putative precursor lesions: further evidence to support the concept of low nuclear grade breast neoplasia family. Am J Surg Pathol 2008;32:513-523
  19. D'Orsi CJ, Sickles EA, Mendelson EB, Morris EA, American College of Radiology. ACR BI-RADS(R) atlas: breast imaging reporting and data system. 5th ed. Reston, VA: American College of Radiology 2013
  20. Choe J, Chikarmane SA, Giess CS. Nonmass findings at breast US: definition, classifications, and differential diagnosis. Radiographics 2020;40:326-335
  21. Uematsu T, Kasami M, Yuen S. Triple-negative breast cancer: correlation between MR imaging and pathologic findings. Radiology 2009;250:638-647
  22. Baltzer PA, Yang F, Dietzel M, Herzog A, Simon A, Vag T, et al. Sensitivity and specificity of unilateral edema on T2w-TSE sequences in MR-mammography considering 974 histologically verified lesions. Breast J 2010;16:233-239
  23. Crisi GM, Mandavilli S, Cronin E, Ricci A Jr. Invasive mammary carcinoma after immediate and short-term follow-up for lobular neoplasia on core biopsy. Am J Surg Pathol 2003;27:325-333
  24. Dabbs DJ, Oesterreich S. Lobular neoplasia and invasive lobular carcinoma. In: Dabbs DJ, ed. Breast pathology. 2nd ed. Philadelphia, PA: Elsevier 2017:436-470