Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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MRI Findings Suggestive of Metastatic Axillary Lymph Nodes in Patients with Invasive Breast Cancer

유방암 환자에서 액와부 림프절 전이를 시사하는 자기공명영상 소견

  • Ka Eun Kim (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Shin Young Kim (Department of Radiology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Eun Young Ko (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 김가은 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 김신영 (순천향대학교 의과대학 부속 천안병원 영상의학과) ;
  • 고은영 (성균관대학교 의과대학 삼성서울병원 영상의학과)
  • Received : 2021.05.22
  • Accepted : 2021.08.10
  • Published : 2022.05.01
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Abstract

Purpose This study aimed to investigate the diagnostic performance of features suggestive of nodal metastasis on preoperative MRI in patients with invasive breast cancer. Materials and Methods We retrospectively reviewed the preoperative breast MRI of 192 consecutive patients with surgically proven invasive breast cancer. We analyzed MRI findings of axillary lymph nodes with regard to the size, long/short ratio, cortical thickness, shape and margin of the cortex, loss of hilum, asymmetry, signal intensity (SI) on T2-weighted images (T2WI), degree of enhancement in the early phase, and enhancement kinetics. Receiver operating characteristic (ROC) analysis, chi-square test, t test, and McNemar's test were used for statistical analysis. Results Increased shorter diameter, uneven cortical shape, increased cortical thickness, loss of hilum, asymmetry, irregular cortical margin, and low SI on T2WI were significantly suggestive of metastasis. ROC analysis revealed the cutoff value for the shorter diameter and cortical thickness as 8.05 mm and 2.75 mm, respectively. Increased cortical thickness (> 2.75 mm) and uneven cortical shape showed significantly higher sensitivity than other findings in McNemar's test. Irregular cortical margins showed the highest specificity (100%). Conclusion Cortical thickness > 2.75 mm and uneven cortical shape are more sensitive parameters than other findings, and an irregular cortical margin is the most specific parameter for predicting axillary metastasis in patients with invasive breast cancer.

목적 유방암 환자의 수술 전 자기공명영상에서 림프절 전이를 시사하는 소견들에 따른 진단 성적을 알아보고자 한다. 대상과 방법 수술 전 유방 자기공명영상을 촬영하고 유방암 수술을 시행한 192명의 환자를 후향적으로 분석하였다. 영상 소견에서 림프절의 크기와 장경/단경의 비율, 피질의 두께와 모양, 변연, 수질의 소실, 비대칭성, T2 강조영상에서의 신호강도, 이른 조영증강의 정도, 조영증강의 역학을 조사하였다. 수신자판단특성곡선 분석, 카이 분석과 t-검정, 맥니마 검정을 이용하여 통계분석을 시행하였다. 결과 단경의 증가, 피질의 불규칙한 모양과 피질 두께의 증가, 수질의 소실, 비대칭성, 피질의 불규칙한 변연 그리고 T2 강조영상에서의 낮은 신호강도는 전이를 시사하는 의미 있는 소견이었다. 이중 단경과 피질의 두께에 대해 수신자판단특성곡선 분석으로 각각 8.05 mm와 2.75 mm로 절단값을 얻었다. 2.75 mm 이상의 피질 두께, 피질의 불규칙한 모양은 맥니마 검정으로 다른 소견들과 비교할 때 민감도의 유의한 차이를 보였다. 피질의 불규칙한 변연(100%)은 가장 높은 특이도를 보였다. 결론 유방 자기공명영상의 전이 림프절 분석에서 2.75 mm 이상의 피질 두께와 피질의 불규칙한 모양은 다른 소견들보다 높은 민감도를 보이고 피질의 불규칙한 변연은 가장 높은 특이도를 보이는 소견이다.

Keywords

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