Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Atypical Ductal Hyperplasia: Risk Factors for Predicting Pathologic Upgrade on Excisional Biopsy

침생검 조직검사에서 진단된 비정형 관상피증식증: 수술적 절제 생검에서 악성으로 진단될 가능성을 예측할 수 있는 위험인자들

  • Ko Woon Park (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Boo-Kyung Han (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sun Jung Rhee (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Soo Youn Cho (Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Eun Young Ko (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Eun Sook Ko (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ji Soo Choi (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 박고운 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 한부경 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 이선정 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 조수연 (성균관대학교 의과대학 삼성서울병원 병리과) ;
  • 고은영 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 고은숙 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 최지수 (성균관대학교 의과대학 삼성서울병원 영상의학과)
  • Received : 2021.06.12
  • Accepted : 2021.08.16
  • Published : 2022.05.01
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Abstract

Purpose To determine the incidence of atypical ductal hyperplasia (ADH) in needle biopsy and the upgrade rate to carcinoma, and to evaluate difference in findings between the upgrade and non-upgrade groups. Materials and Methods Among 9660 needle biopsies performed over 48 months, we reviewed the radiologic and histopathologic findings of ADH and compared the differences in imaging findings (mammography and breast US) and biopsy methods between the upgrade and non-upgrade groups. Results The incidence of ADH was 1.7% (169/9660). Of 112 resected cases and 30 cases followed-up for over 2 years, 35 were upgraded to carcinoma (24.6%, 35/142). The upgrade rates were significantly different according to biopsy methods: US-guided core needle biopsy (USCNB) (40.7%, 22/54) vs. stereotactic-vacuum-assisted biopsy (S-VAB) (16.0%, 12/75) vs. USguided VAB (US-VAB) (7.7%, 1/13) (p = 0.002). Multivariable analysis showed that only US-CNB (odds ratio = 5.19, 95% confidence interval: 2.16-13.95, p < 0.001) was an independent predictor for pathologic upgrade. There was no upgrade when a sonographic mass was biopsied by US-VAB (n = 7) Conclusion The incidence of ADH was relatively low (1.7%) and the upgrade rate was 24.6%. Surgical excision should be considered because of the considerable upgrade rate, except in the case of US-VAB.

목적 조직생검으로 진단된 비정형 관상피증식증이 수술 후 악성으로 진단되는 과소평가율과 이를 예측할 수 있는 영상 소견이나 진단 방법에 따른 위험인자를 조사하고자 한다. 대상과 방법 2년 이상의 기간 동안 시행된 9660예의 침생검을 후향적으로 분석하여 영상 소견과 조직검사 방법에 따라 과소평가 군과 비 과소평가 군의 차이점을 비교하였다. 결과 9660예의 침생검 중 169 (1.7%)예가 비정형 관상피증식증으로 진단되었다. 절제 생검을 한 112예와 2년 이상 추적검사를 한 30예를 합친 142예 중 35예에서 과소평가되었다 (24.6%, 35/142). 과소평가율의 차이는 조직생검 방법에 따라 의미 있었다; 초음파 유도 핵생검(40.7%, 22/54), 입체정위 진공 보조흡입생검(16.0%, 12/75), 초음파 유도 진공 보조흡입생검 (7.7%, 1/13) (p = 0.002). 다변량 분석에서는 초음파 유도 핵생검(교차비 5.19, 95% 신뢰구간 2.16-13.95, p < 0.001)이 독립적인 위험 인자였다. 종괴로 보이는 병변이 초음파 유도 진공 보조흡입생검으로 진단된 경우는 과소평가가 보고되지 않았다( n = 7). 결론 비정형 관상피증식증이 1.7%로 진단되었고 과소평가율은 24.6%였다. 종괴로 보이는 병변이 초음파 유도 진공 보조흡입생검으로 제거된 경우를 제외하고는 상당한 과소평가율을 보이고 있으므로 수술적 절제를 고려해야 한다.

Keywords

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