• 대한방사선기술학회지:방사선기술과학
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• 제35권3호
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• pp.227-235
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• 2012

유방영상은 유방 전체의 재현 가능한 영상을 만들며, 만져지지 않는 조기 유방암의 가장 중요한 소견인 미세석회화와 종괴를 발견할 수 있어 유방 질환의 일차적인 선별검사로 이용되고 있다. 유방 병변의 미세석회화는 조기 유방암의 진단에 있어서 중요한 병변으로 보고되고 있지만 유방초음파 검사에서 검출이 어렵다. 본 연구에서는 유방초음파 영상에서 미세석회화 검출을 위해 6가지의 질감분석 파라미터를 이용하였으며, 정상 초음파영상과 미세석회화가 보이는 초음파 영상 간의 병변인식률을 알아보았다. 실험결과로는 유방촬영영상과 유방 초음파영상에서 병변을 구별하는 컴퓨터자동진단 인식률은 70~98%로 상당히 높은 결과를 나타내었다. ROC 분석에서도 평균대조도와 엔트로피 파라미터의 특이도는 다소 낮게 나타났으나, 나머지 4개 파라미터의 민감도와 특이도는 90% 이상을 나타내어 초음파영상에서 미세석회화 검출의 가능성을 보였다. 향후 6가지 질감분석 알고리즘들 외에 추가적인 파라미터 알고리즘의 연구가 계속 진행되어 컴퓨터자동진단의 실용화기반을 마련한다면 전문의 진단의 예비단계로서 더욱 중요한 의미를 가질 것이며, 유방암의 조기진단에 매우 유용할 것으로 사료된다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권14호
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• pp.5539-5544
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• 2014

Background: To evaluate the location of tumor relapse and imaging modality for detection according to the breast cancer subtype: luminal A, luminal B, HER2 positive luminal B, nonluminal HER2 positive, and triple negative. Materials and Methods: A total of 1244 patients with breast cancer with known estrogen receptor (ER), progesterone receptor (PR), Ki-67 and human epidermal growth factor receptor 2 (HER2), who underwent breast surgery from 2009 to 2012 were analyzed. Patients were classified into the following categories: luminal A (n=458), luminal B (n=241), HER2 positive luminal B (n=227), nonluminal HER2 positive (n=145) and triple negative (n=173). A total of 105 cases of relapse were detected in 102 patients: locoregional recurrence (n=46), recurrence in the contralateral breast (n=28) and distant metastasis (n=31). Comparison of proportions was used to determine the difference between subtypes. Results: Relapse rates by subtypes are as follows: luminal A 23 of 458 (5.02%), luminal B 19 of 241(7.88%), HER2 positive luminal B 15 of 227 (6.61%), nonluminal HER2 postive 19 of 145 (13.10%) and triple negative 29 of 173(16.76%). Luminal A tumors had the lowest rate of recurrence and had significantly lower recurrence rate in comparison with nonluminal HER2 postive (p=0.0017) and triple negative subtypes (p<0.0001). Compared with all other subtypes except nonluminal HER2 positive, triple negative tumors had the highest rate of tumor recurrence (p<0.01). Triple negatives were most likely to develop contralateral recurrence against all subtypes (p<0.05). Detection rate of locoregional and contralateral tumor recurrence were 28.3% on mammography (n=17/60). Conclusions: Luminal A tumors are associated with a low risk of recurrence while triple negative lesions have a high risk. In case of triple negative tumors, the contralateral breast has much more recurrence as compared with all other subtype. In terms of detection rates, breast USG was the best modality for detecting tumor recurrence, compared with other modalities (p<0.05). Subtyping of breast tumors using a molecular gene expression panel can identify patients who have increased risk of recurrence and allow prediction of locations of tumor recurrence for each subtype.

• Korean Journal of Radiology
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• 제21권4호
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• pp.431-441
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• 2020

Objective: To compare the diagnostic performance and interobserver variability of strain ratio obtained from one or two regions of interest (ROI) on breast elastography. Materials and Methods: From April to May 2016, 140 breast masses in 140 patients who underwent conventional ultrasonography (US) with strain elastography followed by US-guided biopsy were evaluated. Three experienced breast radiologists reviewed recorded US and elastography images, measured strain ratios, and categorized them according to the American College of Radiology breast imaging reporting and data system lexicon. Strain ratio was obtained using the 1-ROI method (one ROI drawn on the target mass), and the 2-ROI method (one ROI in the target mass and another in reference fat tissue). The diagnostic performance of the three radiologists among datasets and optimal cut-off values for strain ratios were evaluated. Interobserver variability of strain ratio for each ROI method was assessed using intraclass correlation coefficient values, Bland-Altman plots, and coefficients of variation. Results: Compared to US alone, US combined with the strain ratio measured using either ROI method significantly improved specificity, positive predictive value, accuracy, and area under the receiver operating characteristic curve (AUC) (all p values < 0.05). Strain ratio obtained using the 1-ROI method showed higher interobserver agreement between the three radiologists without a significant difference in AUC for differentiating breast cancer when the optimal strain ratio cut-off value was used, compared with the 2-ROI method (AUC: 0.788 vs. 0.783, 0.693 vs. 0.715, and 0.691 vs. 0.686, respectively, all p values > 0.05). Conclusion: Strain ratios obtained using the 1-ROI method showed higher interobserver agreement without a significant difference in AUC, compared to those obtained using the 2-ROI method. Considering that the 1-ROI method can reduce performers' efforts, it could have an important role in improving the diagnostic performance of breast US by enabling consistent management of breast lesions.

• Childhood Kidney Diseases
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• 제23권2호
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• pp.124-127
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• 2019

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital anomaly of the genitourinary tract comprising uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Patients with HWW syndrome usually present symptoms such as dysmenorrhea, abdominal pain, pelvic mass, and purulent vaginal discharge. If not treated at an appropriate time, complications such as infertility, endometriosis, pyosalpinx, and subsequent pelvic adhesions may occur. Here, we report a case of HWW syndrome in a 7-year-old-girl who was also diagnosed as having central precocious puberty. She was brought to the pediatric department with chief complaints of lump in her breast and vaginal discharge. When she was around 2 months old, she was confirmed to have a single kidney on ultrasonography. We checked her past medical history and diagnosed her as having HWW syndrome based on the results of imaging studies, including abdominal ultrasonography and pelvic magnetic resonance imaging. She underwent treatment with gonadotropin-releasing hormone analogue for 2 years. During 24 months of follow-up, she showed no serious problems or complications. If renal anomalies are identified immediately after birth or in infancy, further screening tests should be conducted prior to menstruation for determining congenital abnormalities of the reproductive tract and vice versa.

• Archives of Plastic Surgery
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• 제48권3호
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• pp.246-253
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• 2021

In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient's pathology, the treatment plan should be carefully decided and individualized. At the authors' institution, the treatment plan is made individually based on each patient's symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient's pathophysiology, optimal outcomes can be achieved. Depending on each patient's pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.

• 대한영상의학회지
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• 제81권1호
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• pp.207-212
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• 2020

선근상피종은 관상피세포와 근상피세포의 이상성 증식을 특징으로 하는 유방의 매우 드문 질환이다. 대부분의 선근상피종은 양성이나 관상피세포 또는 근상피세포에서, 혹은 둘 모두에서 악성 변형을 보일 수 있다. 본 증례 보고는 선근피상종 내부에 발생한 근상피암으로 절제술 시행 1달 후에 빠르게 발생한 국소 재발에 관한 것이다. 초음파 검사와 자기공명검사에서 수술 후 생긴 혈종의 표재성 부분에 여러 개의 작은 재발 병소들이 관찰되었다. 본 증례 보고는 악성 선근상피종에서 수술 절제 면이 정상 조직과 가깝거나 높은 유사분열활성을 보이는 경우는 국소 재발의 가능성을 고려하여 수술 직후 유방영상검사 시행을 제안하고자 한다.

• Journal of Medicine and Life Science
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• 제20권2호
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• pp.73-82
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• 2023

Multiple studies have reported on unilateral axillary adenopathy following coronavirus disease 2019 (COVID-19) vaccination, which is currently recognized as a common finding. Here, we present a series of eight adult patients with reactive axillary lymphadenopathy following COVID-19 vaccination, in whom the follow-up ultrasonography (US) showed resolution of a previously noted unilateral axillary adenopathy. From March 2021 to March 2022, 2,599 consecutive women underwent breast US in Jeju National University Hospital. We identified 10 patients with unilateral axillary lymphadenopathy following COVID-19 vaccination detected on the breast US. The 10 patients were recommended for follow-up US. Two patients were lost to follow-up, whereas the remaining eight patients underwent follow-up US, in whom resolution of the unilateral axillary lymphadenopathy was noted. Radiologists should be aware of evolving guidelines for evaluating and managing axillary lymphadenopathy to avoid false positive biopsies. Recent studies on lymphadenopathy following COVID-19 vaccination show that a prolonged duration until resolution is often observed. Therefore, a follow-up US examination at least 12 weeks after vaccination may be reasonable. Furthermore, management guidelines should include a risk-stratified approach considering both vaccination timing and the patient's overall risk of metastatic disease.

• 대한영상의학회지
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• 제83권4호
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• pp.898-903
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• 2022

선별 유방촬영술이 널리 사용됨에 따라 관상피내암의 빈도는 증가해왔다. 뿐만 아니라, 이의 발견에 있어서는 자기공명영상이 유방촬영술보다 더 높은 민감도를 가진다. 이에 저자들은 침윤성 유방암에 동반된 광범위한 범위의 관상피내암의 비정형적인 자기공명영상 소견을 소개하고자 한다.

• 대한영상의학회지
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• 제82권6호
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• pp.1606-1612
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• 2021

비대성 골관절증은 곤봉지, 근막골형성 및 윤활막 삼출액을 특징으로 하는 증후군이다. 이차성 비대성 골관절증은 대부분의 경우 흉부 내 악성 종양과 연관이 있으나, 드물게 흉강 외 악성 종양에 의해 발생할 수 있다. 이에 우리는 유방암의 과거력이 있는 환자에서 발생한 비대성 골관절증의 초음파, 전산화단층촬영, 자기공명영상 및 뼈 신티그래피의 초기 영상의학적 소견에 대해 서술하고자 한다. 악성 종양으로 오인된 본 증례의 모호한 임상 및 영상 소견은 독자에게 흥미롭고 유익할 것으로 생각된다.

• The Korean Journal of Pain
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• 제33권4호
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• pp.378-385
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• 2020

Background: The thoracic paravertebral block is an effective analgesic technique for postoperative pain management after breast surgery. The ultrasound-guided retrolaminar block (RLB) is a safer alternative to conventional paravertebral block. Thus, we assessed the analgesic efficacy of ultrasound-guided RLB for postoperative pain management after breast surgery. Methods: Patients requiring breast surgery were randomly allocated to group C (retrolaminar injection with saline) and group R (RLB with local anesthetic mixture). The RLB was performed at the level of T3 with local anesthetic mixture (0.75% ropivacaine 20 mL + 2% lidocaine 10 mL) under general anesthesia before the skin incision. The primary outcome was cumulative morphine consumption using intravenous patient-controlled analgesia (IV-PCA) at 24 hour postoperatively. The secondary outcomes were the visual analogue scale (VAS) scores at 1, 6, 24, and 48 hour postoperatively and the occurrence of adverse events and patient satisfaction after the surgery. Results: Forty-six patients were included, 24 in group C and 22 in group R. The cumulative morphine consumption using IV-PCA did not differ between the two groups (P = 0.631). The intraoperative use of remifentanil was higher in group C than in group R (P = 0.025). The resting and coughing VAS scores at 1 hour postoperatively were higher in group R than in group C (P = 0.011, P = 0.004). The incidence of adverse events and patient satisfaction was not significantly different between the two groups. Conclusions: A single injection of ultrasound-guided RLB did not reduce postoperative analgesic requirements following breast surgery.