간외담관담석의 발견도 : 조영증강 전.후 전산화 단층촬영의 비교

한부경 대한영상의학회 1994 대한영상의학회지 Vol.30 No.2

목 적: 저자들은 간외담관결석의 진단에 전산화단층촬영(CT)의 이용이 증가됨에 따라서 조영증강여부에 따른 간외담관결석의 발견율의 차이를 비교해 보았다. 대상 및 방법: 조영증강 전.후의 복부 CT를 동시에 시행한 30명의 환자를 대상으로 하였다. 3명의 방사선과 의사가 임상 정보 없이 조영증강 전.후 CT를 보았으며, 간외 담관을 췌장을 중심으로 췌장상부와 췌장내부로 구분하여 결석이 보이는 정도에 따라 보이는 것, 의심스러운 것, 안보이는 것으로 등급을 매기었다. 결 과: 췌장상부가 5예, 췌장내부가 15예, 양쪽에 다 있는 것이 10예였다. 췌장상부결석 발견율은 93%로 조영증강 전.후의 차이가 없었으나, 췌장내부결석 발견율은 조영전이 96%, 조영후가 64%로 조영전이 우수하였다. 총 발견율은 조영전이 95%, 조영후가 75%였다. 결 론: 간외담관, 특히 췌장내부담관결석을 발견하기 위해서 조영증강전 CT를 시행하는 것이 도움이 된다. Purpose: A study was performed to compare the detectability of extrahepatic duct stones between nonenhanced and enhanced computed tomography(CT).Meterials and Methods : Consecutive 30 patients with extrahepatic duct stones were analyzed with special attention to the detectability of stones between nonenhanced and enhanced CT The extrahepatic duct was further divided into two segments, one above(suprapancereatic) and the other in(intrapancreatic) the head of the pancreas. Conspicuity of the stone was graded as "visible", "suspicious", and "invisible". Three radiologists reviewed the CT images without prior information and determined the location of stone and grade of their conspicuity.Results : The stones were located at the suprapancreatic common duct in 5 patients, intrapancreatic common duct, in 15 patients and both portion of the duct in 10 patients. There was no difference in the detection rate of stones between the two images at suprapancreatic common duct, and was 93%, However, the rate at intrapancreatic common duct was 95% and 64% on nonenhanced and enhanced CT scans, respectively. The overall detection rate was 95% on nonenhance CT and 75'/, on enhanced CT.Conclusion . We concluded that nonenhanced CT was prerequisite to evaluate the extrahepatic duct stones in addition to enhanced CT.es in addition to enhanced CT.

T1-2 유방암 환자에서 액와부 초음파의 정확도

한부경,신정희,고은영,임효근,조은윤,남석진,양정현,최윤라 대한초음파의학회 2009 ULTRASONOGRAPHY Vol.28 No.3

Purpose: We wanted to investigate the accuracy of axillary ultrasonography for detecting axillary nodal metastasis in patients with T1-2 breast cancer and we also wanted to determine the factors affecting the sensitivity. Materials and Methods: Two radiologists performed axillary ultrasonography in 119 consecutive patients with T1-2 breast cancer and clinically uninvolved axillae. We analyzed the accuracy of ultrasonography for detecting axillary nodal metastasis with the histologic results being used as a reference standard. We evaluated the number of involved lymph nodes, T staging and the histologic grade of the tumors. Results: Axillary nodes were involved in 39% of total patients (46/119); 30% of the patients with T1 cancer and 55% of the patients with T2 cancer. The sensitivity, specificity, positive predictive value and negative predictive value were for 52%, 92%, 80% and 75%, respectively. The sensitivity was significantly lower for the cases with one to two lymph nodes metastasis and T1 cancer than in those cases with 3 or more lymph nodes metastasis and T2 cancer (35% and 75% in the cases with 1-2 cancer and the cases with > 3 lymph nodes metastasis, respectively, p = 0.009; 38% and 68% in the cases with T1 and the cases with T2 cancer, respectively, p = 0.045). Conclusions: The ultrasonographic sensitivity for detecting axillary lymph node metastasis is low, especially in the cases with one to two lymph nodes metastasis and the cases with T1 cancer. Detailed analysis and adoption of cytologic examination of the axillary lymph nodes are necessary to improue the accuracy of ultrasonography. Purpose: We wanted to investigate the accuracy of axillary ultrasonography for detecting axillary nodal metastasis in patients with T1-2 breast cancer and we also wanted to determine the factors affecting the sensitivity. Materials and Methods: Two radiologists performed axillary ultrasonography in 119 consecutive patients with T1-2 breast cancer and clinically uninvolved axillae. We analyzed the accuracy of ultrasonography for detecting axillary nodal metastasis with the histologic results being used as a reference standard. We evaluated the number of involved lymph nodes, T staging and the histologic grade of the tumors. Results: Axillary nodes were involved in 39% of total patients (46/119); 30% of the patients with T1 cancer and 55% of the patients with T2 cancer. The sensitivity, specificity, positive predictive value and negative predictive value were for 52%, 92%, 80% and 75%, respectively. The sensitivity was significantly lower for the cases with one to two lymph nodes metastasis and T1 cancer than in those cases with 3 or more lymph nodes metastasis and T2 cancer (35% and 75% in the cases with 1-2 cancer and the cases with > 3 lymph nodes metastasis, respectively, p = 0.009; 38% and 68% in the cases with T1 and the cases with T2 cancer, respectively, p = 0.045). Conclusions: The ultrasonographic sensitivity for detecting axillary lymph node metastasis is low, especially in the cases with one to two lymph nodes metastasis and the cases with T1 cancer. Detailed analysis and adoption of cytologic examination of the axillary lymph nodes are necessary to improue the accuracy of ultrasonography.

유방의 초음파 - 병리 소견 비교

한부경 대한초음파의학회 2002 ULTRASONOGRAPHY Vol.21 No.2

유방종괴의 조영증강 후 출력도플러 초음파소견과 조직학적 미세혈관밀도의 상관성

한부경,고영혜,최연현,조경식 대한초음파의학회 2002 ULTRASONOGRAPHY Vol.21 No.1

목적 : 악성 및 양성 유방종괴의 초음파 조영제 주입 전후 출력도플러 초음파소견을 알아보았다.또한, 출력면적율과 조직학적 미세혈관밀도의 상관관계를 알아보고자 하였다. 대상 및 방법 :조영제(Levovist??, Schering AG, Berlin, Germany) 주입 전후의 출력도플러 초음파검사를시행하였다. 컴퓨터 정량화 프로그램을 이용하여 종괴내 출력면적율을 계산하였다. 미세혈관밀도는 항 CD 31 항체로 염색하여 디지털화한 조직 슬라이드를 세 번 세어 평균을 구하test로 검정하였고, 이것이 미세혈관밀도와 상관관계가 있는지를 Pearson 상관계수를 구해조사하였다. 결과 : 조영제 주입 전 출력면적율의 평균은 악성에서 4.3%, 양성에서 3.9% 로 유의한 차이가 없었다 (p>0.3). 조영제 주입 후 30초에 악성과 양성종괴에서의 출력면적율의 평균은 각각종괴의 크기에 따라 다르지 않았다 (p>0.05). 미세혈관밀도는 조영제 주입 후 출력면적율에 중등도의 상관관계를 보였고 (r=0.69), 악성종괴에서 더욱 연관성이 높았다 (r=0.71). 결론 : 조영제 주입 후 출력도플러 초음파검사는 악성과 양성 유방종괴에서의 혈류량의 차이를 더 잘 보여주며, 조영제 주입 후 출력면적율은 조직학적 미세혈관밀도과 중등도의 연관이 있다. PURPOSE : To compare the pre-and postenhanced power Doppler sonographic (PDS) findings in malignant and benign breast masses and to correlate between power Doppler area (PDA) and histologic microvessel density (MVD). MATERIALS and METHODS : Forty-seven women with breast masses (27 malignant and 20 benign) underwent PDS before and after an injection of microbubble contrast agent (LevovistⓇ) for five minutes. Using computer-assisted quantification, intratumoral % PDA was calculated. Microvessel density was counted on the digitized image of slides stained with anti CD 31 monoclonal antibody. The statistical analysis was performed using t-test to determine the difference of % PDA between malignant and benign masses and between <2 cm and ≥2 cm in size. The correlation between % PDA and MVD was investigated by Pearson’s correlation test. RESULTS : % PDA on pre-enhancement PDS did not show a statistically significant difference between malignant and benign breast masses (4.3% and 3.9%, p>0.3). On a 30-second post-enhancement PDS, the difference between malignant and benign masses in % PDA showed a statistical significance (28.3% and 11.0%, p<0.05), but the difference in size of masses was not statistically significant (p>0.05). MVD was well correlated with % PDA on post-enhancement PDS (r=0.69), and a stronger correlation was seen in malignant masses (r=0.71). CONCLUSION : Contrast-enhanced PDS is superior in demonstrating the difference of vascularity between malignant and benign breast masses. % PDA after contrast-enhancement exhibited a statistically significant correlation with histologic MVD.

유방암의 가음성 선별 유방촬영술에서의 컴퓨터보조발견장치의 유용성

한부경,김지영,신정희,최연현 대한영상의학회 2004 대한영상의학회지 Vol.51 No.4

Purpose: To analyze retrospectively the abnormalities visible on the false-negative screening mammograms of patients with breast cancer and to determine the performance of computer-aided detection (CAD) in the detection of cancers. Materials and Methods: Of 108 consecutive cases of breast cancer diagnosed over a period of 6 years, of which previous screening mammograms were available, 32 retrospectively visible abnormalities (at which locations cancer later developed) were found in the previous mammograms, and which were originally reported as negative. These 32 patients ranged in age from 38 to 72 years (mean 52 years). We analyzed their previous mammographic findings, and assessed the ability of CAD to mark cancers in previous mammograms, according to the clinical presentation, the type of abnormalities and the mammographic parenchymal density. Results: In these 32 previous mammograms of breast cancers (20 asymptomatic, 12 symptomatic), the retrospectively visible abnormalities were identified as densities in 22, calcifications in 8, and densities with calcifications in 2. CAD marked abnormalities in 20 (63%) of the 32 cancers with false-negative screening mammograms; 14 (70%) of the 20 subsequent screening-detected cancers, 5 (50%) of the 10 interval cancers, and 1 (50%) of the 2 cancers palpable after the screening interval. CAD marked 12 (50%) of the 24 densities and 9 (90%) of the 10 calcifications. CAD marked abnormalities in 7 (50%) of the 14 predominantly fatty breasts, and 13 (72%) of the 18 dense breasts. Conclusion: CAD-assisted diagnosis could potentially decrease the number of false-negative mammograms caused by the failure to recognize the cancer in the screening program, although its usefulness in the prevention of interval cancers appears to be limited. 목적: 유방암 환자의 가음성 선별 유방촬영술에서 후향적으로 보이는 소견을 분석하고 컴퓨터 보조발견장치(computer-aided detection, CAD)의 유용성을 알아보고자 하였다. 대상과 방법: 6년 간 이전 선별 유방촬영술을 가진 108명의 유방암 환자 중, 이전 유방촬영술이 정상으로 보고되었으나 후향적 분석상 암 발생 부위에 이상 소견이 있었던 32명(38-72세, 평균 52세)의 환자를 대상으로 하였다. 이전 유방촬영술에서 보인 이상 소견을 분석하고 이를 CAD로 분석하여 CAD가 임상 소견, 유방촬영술 소견의 종류와 유방실질음영에 따라 얼마나 암의 이상 소견을 잘 지적하는지를 알아보았다. 결과: 총 32예의 유방암(무증상 암 20예, 유증상 암 12예) 환자의 이전 유방촬영술에서 나타난 이상 소견은 음영이 22예, 석회화가 8예, 음영 및 석회화가 2예였다. CAD는 이들 가음성 선별 유방촬영술을 가진 유방암 32예 중 20예(63%) [다음 선별검사 발견 암 20예 중 14예(70%), 선별검사 후 1년 내 만져져 발견된 간격암 10예 중 5예(50%), 1년 이후 만져져 발견된 암 2예 중 1예(50%)]에서 이상 부위를 지적하였다. CAD는 음영 24개 중 12개(50%), 석회화 10개 중 9개(90%)를 지적하였다. CAD는 지방 우세 유방 14예 중 7예(50%), 치밀 유방 18예 중 13예(72%)에서 이상 부위를 지적하였다. 결론: CAD의 도움을 받는 판독은 간격암 방지에는 한계가 있지만, 선별 유방촬영술상 발견하지 못한 가음성 유방암을 줄일 수 있다.

검진센터에서의 선별 유방촬영술: 6년간의 의학적 감사

한부경,최연현,Han, Bu-Gyeong,Choe, Yeon-Hyeon 대한영상의학회 2003 대한영상의학회지 Vol.49 No.2

목적:검진센터에서 시행된 유방촬영술의 결과를 임상적 추적검사와 중앙암등록사업소의 자료를 토대로 의학적 감사 결과를 보고하고자 한다. 대상과 방법:6년간 본원 검진센터에서 시행된 32,289건(실인원 25,541명)의 유방촬영술을 대상으로 하였다.유방촬영술 결과를 미국방사선의학회 유방영상판독 및 데이터체계 (American College of Radiology Breast Imaging Reporting and Data System;ACR BI-RADS)의 추적 및 결과분석편에 따라 의학적 감사를 시행하였다.판독은 ACR-BIRADS에 따라 category를 정하였으며,category 0,4,5에 해당되는 경우를 추적검사하였다.위음성을 확인하기 위하여 본원 의무기록실과 중앙암등록 사업소에서 유방암으로 등록된 환자 중,암 진단 전 1년 이내 본원 검진센터 유방촬영술이 정상 또는 양성으로 평가된 적이 있는가를 조사하였다. 결과:대상군의 평균연령은 48.6세로 서구의 보고에 비해 10년 가량 낮았다.32,289건의 유방 촬영술 중 2,016건이 비정상 판정으로 재검을 권유 받았으며 (재검율:6.2%),재검 후 cate- gory 4,5로 조직검사나 수술을 권유 받은 256명중 51명이 암으로 진단되었다.유방암 발견율은 2.0/1,000명 (51/25,541),양성예측도1 (PPV1:선별 유방촬영 상 이상 소견을 보고한 예 중 실제로 암이었던 예의 비율)은 2.5%,양성예측도2(PPV2:조직검사를 권유한 예 중 실제로 암으로 진단된 예의 비율)는 20%였다.유방촬영술 소견 중 미세 석회화로만 보인 경우가 23예 (45%)로 가장 흔하였다.최소 유방암은 관상피내암 25예(49.0%)를 포함하여 37예(72.5%)였다.림프절 양성율은 6예(27%)였다.본원 의무기록실 기록을 토대로 한 유방촬영술의 민감도는 85.0%이며,중앙암등록사업소 기록을 추가로 조사한 경우의 민감도는 78.5%이고,특이도는 99%이다. 결론:검진센터에서 시행된 유방촬영술의 암 발견율은 2.0/1,000명이며,이중 최소 유방암율은 72.5%로 매우 높았으나,측정 가능한 민감도는 78.5%로 다소 낮았다.향후 선별 유방촬영술에 대한 적극적인 의학적 감사를 통해 가음성과 가양성례를 확인 분석하여 유방촬영술의 실적(performance)을 향상시킬 필요가 있다. Purpose: To report the findings of a six-year medial oudit performed at our mammographic screening centre, comparing those findings with the follow-up data stored at our hospital and at the Korea Central Cancer Registry. Materials and Methods: We analyzed the findings of 32,289 mammographic examinations of 25,541 women performed at our screening center between 1994 and 1999. For follow-up and outcome monitoring, the guideline of the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) was used. All mammograms were categorized by means of BI-RADS, and cases in categories 0, 4, and 5 were followed up through a review of our hospital information system. To determine whether any cases were false negative, we compared breast cancer patients registered in our medical record department and in the Korean Central Cancer Registry during the study period, with women whose mammograms were interpreted as normal or benign at our screening center within a year prior to cancer diagnosis. Results: The mean age of women enrolled in this study was 48.6 years, ten years less than reported in the West. The recall rate was 6.2%. Among 256 women whose final assessment category was 4 or 5, breast cancer was diagnosed in 51. The cancer detection rate was 2.0/1,000 women; positive predictive value 1 (PPV1: PPV, based on abnormal findings at screening examination) was 2.5% of cases and PPV2 (PPV when biopsy or surgical consultation was recommended) was 20%. The most common mammographic finding was microcalcifications only (45%). The rate of minimal breast cancer, including invasive cancer less than 1 cm in diameter and ductal carcinoma in situ, was 72.5%. Node positivity was 27%. Sensitivity was 85.0% based on the tumor registry of our institution's medical record department, and 78.5% based on the tumor registry of the Korea Central Cancer Registry. Specificity was 99.0%. Conclusion: In our study, the cancer detection rate at screening mammography was 2.0/1,000 women. The rate of minimal breast cancer (72.5%) was very high but measurable sensitivity was 78.5%, somewhat lower than the ACR guideline of 85%. To improve the performance of screening mammography, appropriate interpretation of mammography and constant, follow-up and outcome monitoring are important

Changing Trends in the Diagnosis

한부경 대한외과학회 2004 대한외과학회 학술대회 초록집 Vol.2004 No.10

의학강좌/놓친 유방암의 영상소견: 후향적 분석

한부경 대한의사협회 2008 대한의사협회지 Vol.51 No.9

Screening mammography has been proved to be an effective tool to detect early breast cancers and to decrease mortality. However, the rate of false-negative mammograms has been reported to be still high as 10~30%. Missed breast cancers are cancers that are visible at previous mammograms only retrospectively and can be classified as three types; interval cancers, subsequent screen-detected cancers, and alternative imaging-detected cancers. In a small group, screen-detected abnormalities recalled for further evaluation may be dismissed due to false negative diagnostic assessment, leading to delays in breast cancer diagnosis. Possible causes for missing include perception errors, interpretation errors, and technical errors. Furthermore, every diagnostic examination has inherent limitations. Perception errors are often attributed to combined multiple factors; peripheral lesions, single view abnormalities, subtle findings, distracting lesions, and dense parenchyma obscuring a lesion. To decrease the false negative rate, radiologists should be alert to take additional mammograms and ultrasonography, and should try to improve the image quality and interpretation techniques comparing with the previous imaging, considering the use of computer-aided detection or double reading.

Comparison of New and Established Full-Field Digital Mammography Systems in Diagnostic Performance

고은숙,한부경,김선미,고은영,장미정,류채연,장정민,문우경,김록범 대한영상의학회 2013 Korean Journal of Radiology Vol.14 No.2

Objective: To compare the diagnostic performance of new and established full-field digital mammography (FFDM) systems. Materials and Methods: During a 15-month period, 1038 asymptomatic women who visited for mammography were prospectively included from two institutions. For women with routine two-view mammograms from established FFDM systems, bilateral mediolateral oblique (MLO) mammograms were repeated using the new FFDM system. One of the four reviewers evaluated two-sets of bilateral MLO mammograms at 4-week intervals by using a five-point score for the probability of malignancy according to a Breast Imaging Reporting and Data System. The lesion type and breast density were determined by the consensus of two readers at each institution. The dichotomized mammographic results correlated with a final pathologic outcome and follow-up data. Receiver operating characteristic (ROC) curves, sensitivity, and specificity were compared in general and according to the lesion type and breast density. Results: Of the 1038 cases, 193 (18.6%) had cancer. The areas under the ROC curve (AUC), sensitivity, and specificity of the established system were 0.815, 65.3%, and 90.2%, respectively. Those of the new system were 0.839, 68.4%, and 91.7%, respectively. There were no significant differences in the AUCs, sensitivities or the specificities in general between new and established systems (Ps = 0.194, 0.590, 0.322, respectively). We found no significant difference in these parameters according to lesion type or breast density. Conclusion: The new FFDM system has a comparable diagnostic performance with established systems.

Parenchymal Cavernous Hemangioma of the Breast showing Atypical Imaging Features: A Case Report

신수영,한부경,고은숙,조은윤 대한초음파의학회 2013 ULTRASONOGRAPHY Vol.32 No.3

Vascular tumors of the breast are uncommon and most are angiosarcomas. Breast hemangioma, a rare benign vascular tumor, is usually found as a superficially located mass. We present an unusual case of breast hemangioma located in parenchyma with atypical imaging features.