치밀유방조직을 가진 한국여성에서의 유방암 검진

신희정,고은숙,이안 대한영상의학회 2015 대한영상의학회지 Vol.73 No.5

Asian women, including Korean, have a relatively higher incidence of dense breast tissue, compared with western women. Dense breast tissue has a lower sensitivity for the detection of breast cancer and a higher relative risk for breast cancer, compared with fatty breast tissue. Thus, there were limitations in the mammographic screening for women with dense breast tissue, and many studies for the supplemental screening methods. This review included appropriate screening methods for Korean women with dense breasts. We also reviewed the application and limitation of supplemental screening methods, including breast ultrasound, digital breast tomosynthesis, and breast magnetic resonance imaging; and furthermore investigated the guidelines, as well as the study results. 서양여성과 비교하여 한국을 포함한 아시아 여성은 상대적으로 치밀유방조직을 갖는 경우가 많다. 치밀유방인 경우 유방암 발견에 있어 유방촬영술의 민감도가 떨어지며, 지방형 유방에 비하여 유방암의 상대위험도가 증가한다고 하였다. 따라서, 치밀유방인 여성에서 유방촬영술만으로 검진을 시행하는 것에 제한이 있으며, 추가로 시행 가능한 검진 방법에 대한 연구들이 있었다. 이 종설에서는 치밀유방을 갖는 한국여성에 적합한 검진 방법에 대해 살펴보고자 한다. 또한, 추가 검진 방법으로 사용될 수 있는 유방초음파 검사, 디지털 단층촬영술, 자기공명영상검사에 대한 적용과 제한점에 대해 알아보고, 이에 대한 연구 결과와 가이드라인을 살펴보고자 한다.

치밀형 유방에서 Molecular Breast Imaging 검사의 유용성에 관한 고찰

백송이,강천구,이한울,박민수,최영숙,김재삼,Baek, Song Ee,Kang, Chun Goo,Lee, Han Wool,Park, Min Soo,Choi, Young Sook,Kim, Jae Sam 대한핵의학기술학회 2016 핵의학 기술 Vol.20 No.1

[목 적] 유방촬영술은 유방의 해부학적 구조를 관찰할 수 있어 유방암의 조기 진단 및 발견에 가장 널리 이용하는 검사법이지만 치밀형 유방을 가진 고위험군 환자에서는 민감도가 현저히 감소한다. Molecular Breast Imaging (MBI) 검사는 고해상도로 유방의 기능적 영상 획득이 가능하고, 치밀 조직에서 종양의 위치 확인이 유용하여 더욱 향상된 진단적 정보를 얻을 수 있는 새로운 영상 기법이다. 이에 본 연구는 치밀형 유방을 가진 환자에게서 종양 진단을 위한 MBI의 유용성을 평가하고자 한다. [대상 및 방법] 2015년 9월 1일부터 10월 10일까지 본원에 내원한 여성 유방암 환자 중 치밀형 유방 환자 10명을 대상으로 연구하였으며, 대상 환자는 MBI와 유방촬영술을 모두 시행하였다. MBI (Discovery 750B; General Electric Healthcare, USA) 검사는 $^{99m}Tc-MIBI$ 20 mCi를 병변이 있는 반대 측 팔에 주사한 후 20분 뒤 양측 유방의 상하 방향, 내외 사 방향 영상을 얻었고, 유방촬영술 또한 동일한 자세로 시행하였다. MBI와 유방촬영 영상을 각각의 영상과, 두 영상을 모두 활용한 경우의 민감도와 특이도를 블라인드 테스트로 비교 평가하였다. [결 과] 유방촬영술에서는 민감도 63%, 특이도 38.6%였으며, MBI 검사에서는 민감도 88.5%, 특이도 87%였다. 유방촬영술과 MBI 검사를 모두 활용한 경우 민감도 93%, 특이도 91.7%로 나타났다. [결 론] 본 연구에서는 유방촬영술에서 쉽게 판별할 수 없었던 치밀 조직의 종양이 MBI 검사상 육안적 평가가 용이해져 보다 정확한 진단이 가능하였다. 그러나 MBI 검사는 미세석회화를 영상화 하는 데에 어려움이 있으므로 유방촬영술과 함께 진행된다면 더욱 많은 진단적 정보를 제공해 줄 것으로 생각된다. Purpose Mammography is the most widely used scan for the early diagnosis since it is possible to observe the anatomy of the breast. however, The sensitivity is markedly reduced in high-risk patients with dense breast. Molecular Breast Imaging (MBI) sacn is possible to get the high resolution functional imaging, and This new neclear medicine technique get the more improved diagnostic information through It is useful for confirmation of tumor's location in dense breast. The purpose of this study is to evaluate the usefulness of MBI for tumor diagnosis in patients with dense breast. Materials and Methods We investigated 10 patients female breast cancer with dense breast type who had visited the hospital from September 1st to Octorber 10th, 2015. The patients underwent both MBI and Mammography. MBI (Discovery 750B; General Electric Healthcare, USA) scan was 99mTc-MIBI injected with 20 mCi on the opposite side of the arm with the lesions, after 20 minutes, gained bilateral breast CC (CranioCaudal), MLO (Medio Lateral Oblique) View. Mammography was also conducted in the same posture. MBI and Mammography images were compared to evaluate the sensitivity and specificity of each case utilizing both image and two images in blind tests. Results The results of the blind test for breast cancer showed that the sensitivity of Mammography, MBI scan was 63%, 89%, respectively, and that their specificity was 38%, 87%, respectively. Using both the Mammography and MBI scan was Sensitivity 92%, specificity 90%. Conclusion This research has found that, The tumor of dense tissue that can not easily distinguishable in Mammography is possible to more accurate diagnosis since It is easy to visually evaluation. But MBI sacn has difficulty imaging microcalcificatons, If used in conjunction with mammography it is thought to give provide more diagnostic information.

Automated Breast Ultrasound Screening for Dense Breasts

Sung Hun Kim,Hak Hee Kim,Woo Kyung Moon 대한영상의학회 2020 Korean Journal of Radiology Vol.21 No.1

Mammography is the primary screening method for breast cancers. However, the sensitivity of mammographic screening is lower for dense breasts, which are an independent risk factor for breast cancers. Automated breast ultrasound (ABUS) is used as an adjunct to mammography for screening breast cancers in asymptomatic women with dense breasts. It is an effective screening modality with diagnostic accuracy comparable to that of handheld ultrasound (HHUS). Radiologists should be familiar with the unique display mode, imaging features, and artifacts in ABUS, which differ from those in HHUS. The purpose of this study was to provide a comprehensive review of the clinical significance of dense breasts and ABUS screening, describe the unique features of ABUS, and introduce the method of use and interpretation of ABUS.

Evaluation of the Value of Multiplex MicroRNA Analysis as a Breast Cancer Screening in Korean Women under 50 Years of Age with a High Proportion of Dense Breasts

Ji Young Jang,Eun Young Ko,Ji Soo Jung,Kyung Nam Kang,Yeon Soo Kim,Chul Woo Kim 대한암예방학회 2021 Journal of cancer prevention Vol.26 No.4

This study was conducted to confirm the performance of the microRNA (miRNA) biomarker combination as a new breast cancer screening method in Korean women under the age of 50 with a high percentage of dense breasts. To determine the classification performance of a set of miRNA biomarkers (miR-1246, 202, 21, and 219B) useful for breast cancer screening, we determined whether there was a significant difference between the breast cancer and healthy control groups through box plots and the Mann– Whitney U-test, which was further examined in detail by age group. To verify the classification performance of the 4 miRNA biomarker set, 4 classification methods (logistic regression, random forest, XGBoost, and generalized linear model plus random forest) were applied, and 10-fold cross-validation was used as a validation method to improve performance stability. We confirmed that the best breast cancer detection performance was achievable in patients under 50 years of age when the set of 4 miRNAs were used. Under the age of 50, the 4 miRNA biomarkers showed the highest performance with a sensitivity of 85.29%, specificity of 93.33%, and area under the curve (AUC) of 0.961. Examining the results of 4 miRNA biomarkers was found to be an effective strategy for diagnosing breast cancer in Korean women under 50 years of age with dense breasts, and hence has the potential as a new breast cancer screening tool. Further validation in an appropriate screening population with large-scale clinical trials is required. Key Words MicroRNA, Breast cancer, Screening, Dense breast, Korean women under the age of 50

치밀형 유방에서 유방특이감마영상검사의 유용성 평가

정은미,김호성,Jeong, Eun-Mi,Kim, Ho-Seong 대한핵의학기술학회 2012 핵의학 기술 Vol.16 No.1

Purpose: This study was to evaluate usefulness of $^{99m}Tc$-MIBI scintimammography for dense breast by comparing concordance in test results between Tc-99m MIBI scintimammography and mammography whose effect was proved the most as an imaging tool depending on breast density and at the same time by examining limitation on evaluation depending on density of breast tissue. [Materials and Methods] In the period from December 2010 to July 2011, this study targeted 150 patients who took both of $^{99m}Tc$-MIBI scintimammography and mammography conducted by using breast gamma camera in this hospital. Breast density was classified to the four levels of pattern 1~4 based on the results of mammography. $^{99m}Tc$-MIBI scintimammography was conducted with the LCC, the RCC, the LMLO, and the RML one minute after intravenous injection of 99mTc-MIBI 7400 MBq (20 mCi) while analysis was made for concordance in test results of $^{99m}Tc$-MIBI scintimammography and mammography. [Results] Among the 150 patients, pattern 1 was found in 3 patients, pattern 2 in 44 patients, pattern 3 in 61 patients, and pattern 4 in 37 patients. There were 5 patients who showed the case where it was impossible to determine density of breast tissue due to foreign body inserted to breast. The concordance ratio of the results between $^{99m}Tc$-MIBI scintimammography and mammography was 95.5% for pattern 2, 95.1% for pattern 3 and 94.6% for pattern 4. This demonstrated that the concordance rate decreased according to the increase in breast density. [Conclusion] When there was limitation on evaluation of breast specific gamma imaging test results due to increased intake in breast tissue or surgical site, the concordance rate was 6.8% for pattern 2, 16.3% for pattern 3 and 18.9% for pattern 4. This demonstrated that the degree of limitation on evaluation of breast specific gamma imaging test results increased according to the increase in breast density.

Glandular Tissue Component on Breast Ultrasound in Dense Breasts: A New Imaging Biomarker for Breast Cancer Risk

Lee Su Hyun,Moon Woo Kyung 대한영상의학회 2022 Korean Journal of Radiology Vol.23 No.6

Diffusion-Weighted Magnetic Resonance Imaging of the Breast: Standardization of Image Acquisition and Interpretation

Lee Su Hyun,Shin Hee Jung,Moon Woo Kyung 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.1

Diffusion-weighted (DW) magnetic resonance imaging (MRI) is a rapid, unenhanced imaging technique that measures the motion of water molecules within tissues and provides information regarding the cell density and tissue microstructure. DW MRI has demonstrated the potential to improve the specificity of breast MRI, facilitate the evaluation of tumor response to neoadjuvant chemotherapy and can be employed in unenhanced MRI screening. However, standardization of the acquisition and interpretation of DW MRI is challenging. Recently, the European Society of Breast Radiology issued a consensus statement, which described the acquisition parameters and interpretation of DW MRI. The current article describes the basic principles, standardized acquisition protocols and interpretation guidelines, and the clinical applications of DW MRI in breast imaging.

Evaluation of Screening Whole-Breast Sonography as a Supplemental Tool in Conjunction With Mammography in Women With Dense Breasts

Chae, Eun Young,Kim, Hak Hee,Cha, Joo Hee,Shin, Hee Jung,Kim, Hyunji American Institute of Ultrasound in Medicine 2013 Journal of ultrasound in medicine Vol.32 No.9

<P><B>Objectives—</B></P><P>The purpose of this study was to evaluate the use and performance of supplemental screening whole-breast sonography in conjunction with mammography in asymptomatic women with dense breast tissue.</P><P><B>Methods—</B></P><P>A total of 28,796 asymptomatic women underwent screening mammography. Among 20,864 women with dense breasts (72%), 8359 underwent additional sonography as part of their screening examinations. We classified women with mammographically dense breasts into mammography-only and mammography-plus-sonography groups. The reference standard was a combination of pathologic results and clinical follow-up at 2 years. We compared the recall rate, cancer detection yield, sensitivity, specificity, and positive predictive value in each group.</P><P><B>Results—</B></P><P>Among the 20,864 women with dense breasts, 35 cancers were diagnosed, with a mean size of 13 mm. The cancer detection yield was 0.480 per 1000 women in the mammography-only group and increased to 2.871 in the mammography-plus-sonography group. Of 24 cancers detected in the mammography-plus-sonography group, the mean size was 11 mm, and the axillary lymph nodes were negative in 19 of 20. The sensitivity was significantly higher in the mammography-plus-sonography group than the mammography-only group (100% versus 54.55%; <I>P</I> = .002). The positive predictive values of sonographically prompted biopsy were 11.1% for the mammography-plus-sonography group and 50% for the mammography-only group.</P><P><B>Conclusions—</B></P><P>Supplemental screening whole-breast sonography increases the cancer detection yield by 2.391 cancers per 1000 women with dense breast tissue over that of mammography alone. It is beneficial for increased detection of breast cancers that are predominantly small and node negative; however, it also raises the number of false-positive results.</P>

Abbreviated MRI Protocols for Detecting Breast Cancer in Women with Dense Breasts

Shuang-Qing Chen,Min Huang,Yu-Ying Shen,Chen-Lu Liu,Chuan-Xiao Xu 대한영상의학회 2017 Korean Journal of Radiology Vol.18 No.3

Objective: To evaluate the validity of two abbreviated protocols (AP) of MRI in breast cancer screening of dense breast tissue. Materials and Methods: This was a retrospective study in 356 participants with dense breast tissue and negative mammography results. The study was approved by the Nanjing Medical University Ethics Committee. Patients were imaged with a full diagnostic protocol (FDP) of MRI. Two APs (AP-1 consisting of the first post-contrast subtracted [FAST] and maximum-intensity projection [MIP] images, and AP-2 consisting of AP-1 combined with diffusion-weighted imaging [DWI]) and FDP images were analyzed separately, and the sensitivities and specificities of breast cancer detection were calculated. Results: Of the 356 women, 67 lesions were detected in 67 women (18.8%) by standard MR protocol, and histological examination revealed 14 malignant lesions and 53 benign lesions. The average interpretation time of AP-1 and AP-2 were 37 seconds and 54 seconds, respectively, while the average interpretation time of the FDP was 3 minutes and 25 seconds. The sensitivities of the AP-1, AP-2, and FDP were 92.9, 100, and 100%, respectively, and the specificities of the three MR protocols were 86.5, 95.0, and 96.8%, respectively. There was no significant difference among the three MR protocols in the diagnosis of breast cancer (p > 0.05). However, the specificity of AP-1 was significantly lower than that of AP-2 (p = 0.031) and FDP (p = 0.035), while there was no difference between AP-2 and FDP (p > 0.05). Conclusion: The AP may be efficient in the breast cancer screening of dense breast tissue. FAST and MIP images combined with DWI of MRI are helpful to improve the specificity of breast cancer detection.

Impact of Awareness of Breast Density on Perceived Risk, Worry, and Intentions for Future Breast Cancer Screening among Korean Women

Anh Thi Ngoc Tran,황지혜,최은지,이윤영,서미나,이찬화,김열,최귀선 대한암학회 2021 Cancer Research and Treatment Vol.53 No.1

Purpose This study sought to examine perceived risk and concerns for breast cancer according to awareness of breast density and states thereof among Korea women and to identify the impact of such awareness on screening intentions. Materials and Methods This study was based on the 2017 Korean National Cancer Screening Survey of a nationally representative and randomly selected sample of Koreans. Ordinal logistic regression was conducted to examine associations for awareness of and knowledge on breast density in relation to psychological factors. Multivariate logistic regression analyses were conducted to investigate significant factors associated with intentions to undergo breast cancer screening. Results Among a total of 1,609 women aged 40-69 years, 62.0% were unaware of their breast density, and only 29.7% had good breast density knowledge. Awareness of one’s breast density and knowledge about breast density were positively associated with perceptions of absolute and comparative risk and cancer worry. Women aware of their breast density (adjusted odds ratio [aOR], 1.35 for women aware of having a non-dense breast; aOR, 4.17 for women aware of having a dense breast) and women with a good level of breast density knowledge (aOR, 1.65) were more likely to undergo future breast cancer screening. Conclusion Breast density awareness and knowledge showed positive associations with psychological factors and breast cancer screening intentions. However, the majority of Korean women were not aware of their breast density status and demonstrated poor knowledge about breast density. These results demonstrate a need for better health communication concerning breast density.