지연임신의 임상적 고찰

강석선 ( Suk Sun Kang ),김종인 ( Jong In Kim ) 대한주산의학회 1998 大韓周産醫學會雜誌 Vol.9 No.1

질 세척액의 β-hCG치를 이용한 조기양막파수의 진단

강석선 ( Seok Seon Kang ),윤성도 ( Sung Do Yoon ) 대한주산의학회 1998 Perinatology Vol.9 No.4

악성종양을 시사하는 초음파 소견이 보이지 않는 갑상선암의 영상소견

김도연,강석선,지은경,권태희,박해린,심정연 대한영상의학회 2008 대한영상의학회지 Vol.58 No.3

목적: 초음파에서 악성종양으로 분류되지 않았던 갑상선 암의 영상의학적 특징을 후향적으로 분석하고자 하였다. 대상과 방법: 갑상선 암으로 진단받은 338예 중 처음에 초음파에서 악성을 의심하지 못했던 38명 39예를 대상으로 하였다. 남자가 2명, 여자가 36명이었다. 평균 연령은 39세였다. 모양, 경계, 에코, 석회화, 낭성 변화의 유무, 경계를 둘러싸는 저에코의 테두리(peripheral hypoechoic rim) 유무를 후향적으로 분석하였다. 1 cm을 기준으로 크기에 따른 초음파 소견의 차이가 있는지 알아보았다. 결과: 주된 소견은 난원 및 구형 90%, 분명하면서 부드러운 경계 64%, 저에코 54%, 석회화가 없는 경우 92%, 낭성 변화가 없는 경우 77%, 경계를 둘러싸는 저에코의 테두리가 있는 경우 56%였다. 악성을 시사하는 앞뒤로 긴 모양은 10%, 경계가 분명하면서 침상인 경우 36%, 현저한 저에코 10%, 미세 석회화는 8%였다. 1 cm보다 큰 결절은 등에코, 낭성 변화, 경계를 둘러싸는 저에코의 비율이 높았다. 경계가 분명하면서 침상인 경우는 1 cm이하에서 많았다. 56%는 여전히 악성을 시사하는 소견이 없었다. 결론: 처음에 초음파에서 악성을 의심할 수 없었던 경우 중 후향적으로 보아도 여전히 악성을 시사하는 소견을 보이지 않는 경우가 더 많았으나 의심스러운 소견도 찾아볼 수 있었다. 악성을 시사하는 소견은 미미해 작거나 등에코, 낭성 변화, 경계를 둘러싸는 저에코의 테두리가 있을 때 무시되었다. 따라서 좀 더 면밀한 종괴의 관찰로 위음성을 줄이는 것이 필요하다.

유방 아포크린화생의 유방초음파와 유방촬영술 소견

김도연,강석선,지은경,권태희,박해린,심정연 대한초음파의학회 2008 ULTRASONOGRAPHY Vol.27 No.1

PURPOSE : To evaluate the sonographic and mammographic features of apocrine metaplasia of the breast. MATERIALS and METHODS : We retrospectively evaluated the sonographic and mammographic findings of 16 lesions that were diagnosed with only apocrine metaplasia after mammotome excision. The age ranged from 27 years old to 57 years old (mean age; 40 years old). The sonographic features were interpreted by the ACR BI-RADS(American College of Radiology Breast Imaging Reporting and Data System) for shape, orientation, margin, boundary, echo pattern, posterior acoustic feature, calcification and special cases. The mammographic features were interpreted by the ACR BI-RADS (American College of Radiology Breast Imaging Reporting and Data System) for breast composition, shape, margin, density and calcification. RESULTS : Sonographic features were that the shapes were oval (n = 16) in 100%. The orientation was parallel (n =15) in 94%. The margins were circumscribed (n = 8) in 50% and microlobulated (n = 8) in 50%. The echo patterns were hypoechoic (n = 8) in 50%, complex (n = 5) in 31% and anechoic (n = 3) in 19%. Posterior acoustic enhancement was seen in 69% (n = 11). There was internal microcyst (n = 4) in 25%. There was no calcification. Mammography performed for 12 cases demonstrated negative findings (n = 10) for 83%, obscured hypodense mass (n = 1) for 8% in 11 cases of breast composition 3 and 4, and circumscribed isodense mass (n = 1) for 8% in one case of breast composition 2. There was no calcification. The final assessment was category 4a (n= 7) in 44%, category 3 (n = 6) in 38% and category 2 (n = 3) in 19%. CONCLUSION : Although sonographic and mammographic features of apocrine metaplasia are occasionally suspicious malignancy such as microlobulation and complex echo. We consider the possibility of apocrine metaplasia if masses show internal microcyst and abrupt boundary. 목적 : 유방 아포크린화생(apocrine metaplasia)의 유방초음파와 유방촬영술 소견을 알아 보고자 하였다. 대상 및 방법 : 유방촬영술 혹은 유방초음파를 시행 받은 환자 중 맘모톰 절제를 통해 조직학적 으로 아포크린화생으로만 이루어진 16명의 환자 16예를 대상으로 하였다. 환자의 나이는 27세에서 57세로, 평균 40세였다. 유방초음파 소견은 ACR BI-RADS (American College of Radiology Breast Imaging Reporting and Data System)에 따라 모양(shape), 방향(orientation), 변연(margin), 경계(boundary), 에코 양상(echo pattern), 후방음향양상(posterior acoustic feature), 석회화 유무, 특징적 사례를 후향적으로 분석하였다. 유방촬영술은 ACR BI-RADS(American College of Radiology Breast Imaging Reporting and Data System)에 따라 유방실질 구성, 모양(shape), 변연(margin), 밀도(density), 석회화의 유무를 후향적으로 분석하였다. 결과 : 유방초음파에서 종괴의 모양은 16예 모두(100%) 난원형이며, 15(94%)는 피부면과 평행한 방향이었다. 변연은 국한성과 미세소엽형이 각각 8예(50%)였다. 저에코 8예(50%),복합에코 5예(31%), 무에코 3예(19%)였다. 11예(69%)가 후방음향증가를 보였고, 모두 갑자기 끝나는 계면을 보였다. 4예(25%)에서 병변 내부에 미세낭종이 있었고 석회화를 동반한 경우는 없었다. 12예의 유방촬영술에서 11예의 유방실질 유형 3,4 중 10예(83%)는 병변이 보이지 않았고 1예(8%)는 경계가 가려진 저밀도 종괴였으며, 유방실질 유형 2에서 경계가 국한성인 등밀도 종괴가 1예(8%)가 있었다. 석회화를 동반한 경우는 없었다. 최종분류는 7예(44%)가 범주 4a, 6예(38%)가 범주 3, 3예(19%)가 범주 2였다. 결론 : 아포크린화생은 유방초음파와 촬영술에서 일부 미세소엽형 변연, 복합에코의 악성을 의심하는 소견을 나타낼 수 있지만 내부에 미세낭종의 소견이 동반되어 있고 갑자기 끝나는 계면이 보이면 아포크린화생의 가능성을 고려해 볼 수 있을 것이다.

유방의 아포크린암종: 증례 보고

김도연,강석선,김화영,지은경,권태희,박해린,심정연 대한영상의학회 2007 대한영상의학회지 Vol.57 No.2

Apocrine carcinoma is a rare breast cancer and its frequency is about 0.4% of all breast cancers. Little is known about its clinical behavior and prognosis. To our knowledge, few studies have reported the radiologic appearances of apocrine carcinoma in the breast and there has been no such report from Korea. We describe the sonographic findings of a case of apocrine carcinoma in the breast. The sonographic findings are microlobulated heterogeneous hypoechoic lesion that has a central markedly hypoechoic portion and a peripheral mixture of iso and hypoechgenecity. 유방의 아포크린암 (apocrine carcinoma)은 0.4% 빈도의 매우 드문 암으로 임상적 경과, 예후 등이 잘 알려져 있지 않다. 이 질환의 영상의학적 보고 역시 드물며 국내에 보고된 바가 없다. 저자들은 미세소엽형의 중심부는 현저한 저에코를 보이며 주변부는 저에코와 등에코가 섞인 유방의 아포크린암을 1예 경험하였기에 보고하고자 한다.

난관임신에서 영양배엽세포의 침투 깊이의 예측

이정호(Jeong Ho Rhee),강석선(Seok Seon Kang),김종인(Jong In Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10

목적: 난관임신에서 임상적 진단 요소들과 영양배엽세포의 침투 깊이와의 관계를 평가하고 가장 예측능이 우수한 임상적 진단 요소를 확인하기 위하여 본 연구를 실시하였다. 연구방법: 조직 병리학적으로 확진된 50명의 난관임신 환자를 연구 대상군으로 설정 하였다. 임신기간과 임신 위치의 크기 및 혈중 β-hCG 가 측정 되었고 수술 표본 조직의 병리학적소견에 따라 두 군으로, 즉 영양배엽세포의 난관내 성장군(군I)과 근육층내 침투군(군II)으로 분류하였으며 각각 22, 28명이었다. 세가지 임상적 진단 요소 간과 각각의 진단요소와 영양배엽세포의 침투 깊이 사이의 관계에 대하여 통계학적 검증을 실시하였으며 통계적 분석은 SPSS 프로그램을 이용하여 Student's t-test, Chi square, 선형회귀(linear regression), 선형상관(linear correlation)을 통하여 연관성과 유의성을 검증하였고 통계학적 유의성은 P<0.05일 때로 정했다. 결과: β-hCG의 정량은 군 I에서는 1843.7±1524.7 mIU/ml(평균±표준편차), 군 II에서는 12144.3±10561.6 mIU/ ml(평균±표준편차) 이었다. 임신 위치의 크기와 β-hCG 사이에는 연관성이 있었으나(P<0.05), β-hCG와 임신기간, 임신위치의 크기와 임신 기간 사이에는 연관성이 없었다. β-hCG의 혈중치는 영양배엽세포의 침투 깊이를 예측하는데 통계적 유의성이 있었으며(P<0.05) 기준치 3,500 mIU/ml가 가장 높은 민감도, 특이도, 양성 예측도, 음성 예측도를 보였고 각각 0.79, 0.86, 0.88, 0.76 이었다. 임신 기간이나 임신 위치의 크기는 영양막세포의 침투 깊이를 예측하기 위한 요소로는 통계적 유의성이 없었다. 결론: 난관임신에서 내과적 치료의 성공은 약제 전달을 위한 병변 부위 혈관 구조의 완전성에 의존할 것으로 추측됨으로 내과적 치료를 위한 환자의 선택에서 영양배엽세포의 침투 깊이를 예측하는 것이 매우 중요하리라 사료된다. 본 연구에서는 난관임신 진단을 위한 여러 가지 임상 요소 중 β-hCG만이 유일하게 영양배엽세포의 침투 정도를 예측하는데 유의성이 있었으며 그 기준치 3,500 mIU/ml가 가장 이상적이라고 사료된다. Objectives: To evaluate the relation between diagnostic clinical parameters and the depth of trophoblastic invasion in tubal pregnancy and decide the most predictable parameter. Methods: Total 50 patients who were confirmed as tubal pregnancy pathologically, from Jan. to Dec. 1997, were included in this study. Menstrual missed periods was calculated by clinical history, volume of gestational mass was calculated as sphere, β-hCG was titered with preoperative blood sample. All surgical specimens were examined pathologically and divided into two groups such as intraluminal and extraluminal, defined as intact tubal musculature and trophoblastic invasion beyond musculature, n=22 and n=28, respectively. Statistical analysis was performed among three parameters and between each parameter and the depth of trophoblastic invasion. Statistical analysis included were Student's t-test, Chi square, linear regression, and linear correlation analysis using SPSS statistical package and statistical significance was determined as P<0.05. Results: There was a correlation between volume of gestational mass and β-hCG(P<0.05), but not between β-hCG and missed period or volume of gestational mass and missed period. β-hCG level was 1843.7±1524.7 mIU/ml(Mean±SD) in intraluminal and 12144.3±10561.6 mIU/ml(Mean±SD) in extraluminal. There was a predictive correlation between β-hCG and the depth of trophoblastic invasion(P<0.05), and cut off level 3,500 mIU/ml showed the highest sensitivity, specificity, positive predictive value, negative predictive value, 0.79, 0.86, 0.88, 0.76, respectively. Two parameters(volume of gestational mass and missed period) had no ability to predict whether intraluminal or extraluminal. Conclusion: We suggest that successful medical treatment of tubal pregnancy depend on lesional intactness of vasculature for drug delivery. In patient selection for medical treatment, it should be important to predict intraluminal type because of intact vasculature. Of clinical parameters, β-hCG is single most predictive parameter, cut off level of 3,500 mIU/ml was the most reasonable level in this study.

태반조기박리에 대한 임상적 고찰

김종인,이정호,박성규,김판조,강석선,은명희 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.2

Abruptio placentae is the separation of a normally implanted placenta after the 20th week of gestation and before the birth of fetus. It is the one of third trimester obstetric hemorrhage disease that the need emergency treatment. Clinical investigation of abruptio placentae is needed for its early diagnosis and adequate treatment. This study was investigated of the 126 cases of abruptio placentae among 23,848 deliveries, which admitted to the Department of Obstetrics and Gynecology, College of Medicine, Keimyung University, during 5 years of period from January, 1992 to December, 1996. The results were as follows; 1. The incidence of abruptioplacentae was 0.53%. 2. In the timing of diagnosis, 50.8% of abruptio placentae was diagnosed before delivery. 3. Abruptio placentae occurred between 26 and 30 years old mostly. 4. The majority of abruptio placentae occurred between 33 and 37 weeks of gestational age(47.7%), and with occurred before 37 weeks was about 83.8%. 5. The incidence of unknown etiology was 56 cases(44.4%) and pregnancy induced hypertension was 48 cases(38.1%). 6. The most common symptom and sign in this study was vaginal bleeding(66.6%). Intrauterine fetal death was found in 32.5% and uterine tenderness in 25.4%. 7. As for the distribution of birth weight 33 cases(25.5%) were 1,500 to 2,000 gm and 22 case(16.9%) were 2,000 to 2,500 gm. The weight of neonates was under 2,500 gm in 74.7%. 8. Perinatal mortality and morbidity were closely related with grade of placental abruptio and gestational weeks. 9. In 56 cases(44.5%) blood transfusion was necessary. 10. The complication of abruptio placentae of this study were followed. Couvelaire uterus occurred in 15 patients, disseminated intravascular coagulation in 12 patients. The others were retinal detachment, acute renal failure, pulmonary edema. 11. Cesarean birth was performed in 43.7% and vaginal delivery in 56.3%. Fetal distr-ess was most common indication of cesarean birth. 12. Perinatal mortality rate was 51.6% including stillbirth(40.8%) and neonatal death (12.8%).

맘모톰 시술에 의해 진단된 양성 엽상낭 종양은 반드시 재수술이 필요한가?

박해린(Hai-Lin Park),강석선(Seok Seon Kang),김도연(Do Youn Kim),심정연(Jung Yeon Shim) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.3

Purpose: Phyllodes tumors are characterized by a double-layered epithelial component arranged in cleft-like ducts surrounded by a hypercellular spindle-celled stroma. Currently, phyllodes tumors are classified as benign, borderline, or malignant based on microscopic features. The relatively high rate of recurrence is an unsolved management problem. If a malignant phllodes tumor is treated inadequately, it may show a propensity for rapid growth and metastatic spread. However, benign phyllodes tumor are often indistinguishable from fibroadenoma, and can be cured by local surgery. Percutaneous removal of benign breast tumors using the Mammotome system has recently been regarded as a feasible, safe method without serious complications. The Mammotome system has an expanding role in the surgical treatment of benign breast disease, and may further extend its role to the excision of small malignant lesions. The aim of this study was to evaluate the efficacy and the safety of the Mammotome biopsy device in the treatment of benign phyllodes tumor, and to identify whether surgical excision is necessary for benign phyllodes tumors diagnosed and excised by Mammotome. Methods: From Jan. 2003 to Feb. 2007, a total of 2,751 US- guided mammotome excisions were performed in 2,226 patients at Kangnam Cha hospital. Out of 2,751 lesions, 30 lesions were proved to be benign phyllodes tumors. All lesions were removed using an 8-gauge probe without any residual lesions. Ultrasonographic follow-up was performed at a 3- to 6-month interval to assess recurrence. The mean follow-up period was 33.2 months (max, 51 months; min, 2 months). Results: The mean patient age was 31.4 years. The average size of the lesion was 1.5 ㎝ (SD+0.43 ㎝). The majority of lesions, 73.3% (22 cases), were palpable, and 26.7% (8 cases) were nonpalpable. Twenty-two lesions (73.8%) were classified as BIRADS category 3, eight lesions (26.7%) were classified as category 4A by ultrasound. During the follow-up period, local recurrence developed in only one patient, making the local recurrence rate 3.3%. No distant metastasis was observed. Conclusion: Benign phyllodes tumors found on mammotome excision may not require surgical reexcision if surgeons are sure that the targeted lesions were excised completely and the follow-up ultrasound does not show any residual lesions, especially in small phyllodes tumors, the greatest dimension of which is less than 3 ㎝.

수술 후 국소 재발한 유방암의 초음파 소견

이광희,신정희,한부경,강석선,한수연,고은영 대한영상의학회 2009 대한영상의학회지 Vol.60 No.3

Purpose: We wanted to evaluate the sonographic findings of recurrent breast cancer in the patients who underwent mastectomy or breast conserving surgery (BCS). We also wanted to evaluate the characteristics of recurrent cancer that’s detected on follow up sonography only. Materials and Methods: We retrospectively reviewed 87 patients with recurrent breast cancer and who were operated on during the previous 10 years. We analyzed the method of detection and the sonographic appearance of tumor, including the location, size, shape, margin, internal echogenicity and BI-RADS categories, in 52 patients who had abnormal sonographic findings. We compared the sonographic findings of the recurrent cancer between the patients who underwent mastectomy and the patients who underwent BCS. We also analyzed the characters of the recurrent cancer that was only detectable on follow-up sonography. Results: Among the 87 patients with recurrent breast cancer, 37 patients had undergone previous mastectomy and 50 patients had undergone previous BCS. The most common mode of detection was a palpable mass on physical examination for the patients who underwent mastectomy (64.9%, 24/37) and the most common mode of detection was the follow-up sonography for the patients who underwent BCS (40%, 20/50). The sonographic appearance of the recurrent cancer was similar for both the patients who underwent mastectomy or BCS. The most common locations were the breast parenchymal layer in 82% (36/44) of the patients who underwent BCS and the subcutaneous fat layer of the operated area in 67% (14/21) of the patients who underwent mastectomy. The type of recurrent cancer detected on sonography only was small nodules in the patients who underwent BCS, and that for the patients who underwent mastectomy was nodules, regardless of size, that were located in the deep muscle layer. Conclusion: Recurrent breast cancer, regardless of size, was frequently detected on a physical examination in the patients who underwent previous mastectomy, and this was detected on sonography in the patients who underwent with previous BCS. Follow up sonography was valuable to evaluate for tumor recurrence after breast cancer surgery, and this detected 16% (6/37), 28% (14/50) of the recurrent cancers that were otherwise occult tumor. 목적: 유방 전절제술을 시행한 환자와 유방보존술을 시행한 환자에서 수술 후 재발한 암의 초음파 소견을 알아보고, 추적 초음파 검사에서만 발견된 재발암의 특징에 어떠한 차이가 있는지 알아보고자 하였다. 대상과 방법: 최근 10년 동안 본원에서 유방암 수술 후 국소 재발암으로 재수술을 시행 받은 87명의 환자를 대상으로 재발암이 발견된 경위를 조사하고, 이중 초음파에서 종괴가 발견되었던 52명의 병변의 위치와 크기, 모양, 경계, 내부의 에코, 그리고 BI-RADS 분류를 분석하였다. 유방 전절제술과 유방보존술을 받았던 환자군 간에 초음파 소견의 차이가 있는지를 비교하고, 초음파 검사에서만 발견되었던 재발암들의 특징을 조사하였다. 결과: 총 재발암 87명 중 37예는 유방 전절제술을, 50명은 유방보존술을 시행 받았다. 37예의 유방 전절제술을 받은 환자 중 재발암은 만져져서 발견된 경우가 가장 많았고(64.9%, 24/37), 50명의 유방보존술을 시행 받았던 환자 중 재발암은 정기적 유방촬영술에서 발견된 경우가 가장 많았으며(40%, 20/50), 만져져서 발견된 경우는 14예였다. 초음파에서 종괴가 발견되었던 52명에서 재발한 암의 초음파 소견은 유방 전절제술이나 유방보존술을 시행한 환자에서 차이가 없었으나 유방보존술을 받은 환자는 82%(36/44)는 수술 반흔 주변의 실질 내에, 유방 전절제술을 받은 환자의 재발은67%(14/21)는 수술 부위의 피하지방층에 재발암이 생겼다. 초음파 검사만 발견되었던 재발암은 유방보존술의 경우에는 크기가 작은 결절이었고, 전절제술의 경우에는 크기와 상관없이 근육층에서 생긴 경우였다. 결론: 유방암으로 수술 후 재발암은 유방 전절제술 후에는 주로 이학적검사에서 발견되고 유방보존술을 시행한 경우는 주로 정기적 유방촬영술에서 발견된다. 초음파로만 발견된 재발암도 16%(6/37), 28%(14/50)로 유방암 수술 환자의 재발을 평가하는데 초음파가 중요하다.

Role of BRAFV600E Mutation Analysis for Thyroid Nodules Classified as Indeterminate on Ultrasonography

남상유,신정희,한부경,고은영,강석선,한수연,황지영,남미영,김종원,정재훈 대한초음파의학회 2010 ULTRASONOGRAPHY Vol.29 No.1

Purpose: We aimed to evaluate a possible role for BRAFV600E mutation analysis of aspiration specimens in the work up of thyroid nodules classified as indeterminate on US. Materials and Methods: A total of 122 nodules from 122 patients were prospectively classified as indeterminate nodules based on US findings. US-guided fine needle aspiration (FNA) was done for all 122 nodules. The presence of a BRAFV600E mutation in FNA specimens was determined by allele-specific PCR. Results: US-indeterminate nodules were confirmed as malignant in 20.5% (25/122)of cases and benign in 76.2% (93/122) after FNA or surgery. A few (3.3% (4/122),remained indeterminate. A BRAFV600E mutation was identified in 14.8% (18/122) of USindeterminate nodules. Of those 18 nodules, three were benign and 13 were malignant after the initial FNA. One (0.8%, 1/122) with an initially benign cytology and a BRAFV600E mutation was confirmed to be malignant after surgery. The remaining two benign nodules with a mutation were not followed-up. All 9 initial FNA-nondiagnostic nodules were mutation negative but 2 (11.8%) of 17 indeterminate nodules on initial FNAs were mutation positive. Conclusion: BRAFV600E mutation analysis prevents false negative cytology for only 0.8% of cases and reduces ambiguous diagnoses for 1.6% of all US-indeterminate thyroid nodules. Therefore, adding BRAFV600E mutation analysis to FNA for US-indeterminate nodules is of limited usefulness.