이전 정맥포트 삽입 부위의 유방촬영술 및 초음파 소견 = Mammographic and Ultrasonographic Findings of the Chemoport Insertion Site

다국어 초록 (Multilingual Abstract)

Purpose: To describe mammographic and ultrasonographic findings of previous chemoport insertion sites.
Materials and Methods: We included patients who had abnormal findings at chemoport insertion sites on mammography and ultrasonography from 224 patients who underwent chemoport insertion and breast imaging at our institution between January, 2005, and December, 2007. Abnormal findings were identified in 16 mammographies and 14 ultrasonographies in 10 patients. The mean age was 50.9 years and the age range was from 44 to 67 years. Abnormal findings on mammography and ultrasonography were retrospectively analyzed according to ACR/BI-RADS. All cases were followed up with imaging studies for 2 years to confirm changes after chemoport insertion.
Results: Of the abnormal findings identified on mammography, focal asymmetry (7/16) was the most common. Other abnormal findings included mass (6/16), skin retraction (2/16), residual chemoport tip (1/16), and trabecular thickening (1/16). Of the abnormal findings seen on ultrasonography, skin thickening (12/14) was the most common. Other abnormal findings included mass (5/14), diffuse increased echogenicity of subcutaneous tissue (1/14), and a localized skin nodule (1/14). Abnormal findings on mammography and ultrasonography were located in the upper outer quadrant in 5 patients, upper inner quadrant in 3 patients, and mid upper portion in 1 patient. In 1 patient, the abnormal finding was only identified in the mediolateral oblique view of her mammography.
Conclusion: Radiologists should be aware of potential abnormal findings on mammography and ultrasonography following chemoport insertion. In particular, ultrasonography is a very useful modality for detecting skin complications after chemoport insertion.

국문 초록 (Abstract)

목적: 이전에 케모포트를 삽입했던 부위의 유방촬영술과 초음파검사 소견을 알아보고자 하였다.
대상 및 방법: 2005년 1월부터 2007년 12월까지 본원에서 케모포트 삽입 시술을 받은 기왕력이 있고 유방 검사를 시행한 224명 환자들 중 케모포트 삽입 자리에 유방촬영술과 초음파검사에서 이상소견을 보인 환자를 대상으로하였다. 10명 환자의 유방촬영술 16건, 초음파 14건에서이상소견이 관찰되었다. 환자의 평균 나이는 50.9세, 나이범위는 44세에서 67세였다. 유방촬영술과 유방초음파 소견은 ACR/BI-RADS에 따라 후향적으로 분석하였다. 모두 2년간의 추적 영상검사를 통해 케모포트 삽입술에 의한변화임을 확인하였다.
결과: 유방촬영술 소견 중 비대칭 음영 (7/16)이 가장흔하게 보였다. 그 외에 종괴 (6/16), 피부 퇴축 (2/16),포트의 첨단이 남아있는 경우 (1/16), 비대칭 음영과 동반되어 섬유지주의 비후 (1/16)가 있었다. 유방초음파검사소견은 피부 비후 (12/14)가 가장 흔하게 보였다. 그 외에종괴 (5/14), 피하지방층에 고에코 병변 (1/14), 피부에국한된 결절 (1/14)이 있었다. 10명의 환자에서 이상소견이 있던 위치를 살펴보면, 5명이 유방의 상외사분에, 3명이 상내사분에, 1명이 상위중앙부에 보였다. 1명은 유방촬영술의 내외사위영상의 상부에 보였다.
결론: 영상의학과 의사는 케모포트 시술 후 생길 수 있는다양한 유방촬영술과 초음파검사의 소견을 잘 숙지해야한다. 특히 초음파검사는 피부 병변을 잘 발견할 수 있어케모포트 삽입 후에 추적검사에 유용한 진단 기법이다.

참고문헌 (Reference)

1 Taboada JT, "The many faces of fat necrosis in the breast" 192 : 815-825, 2009

2 Hogge JP, "The mammographic spectrum of fat necrosis of the breast" 15 : 1347-1356, 1995

3 Cil BE, "Subcutaneous venous port implantation in adult patients: a single center experience" 12 : 93-98, 2006

4 Franquet T, "Spiculated lesions of the breast: mammographic-pathologic correlation" 13 : 841-852, 1993

5 Huang BK, "Sonographic appearance of a retained tunneled catheter cuff causing a foreign body reaction" 28 : 245-248, 2009

6 Ellis RL, "Mammography of breasts in which catheter cuffs have been retained : normal, infected, and postoperative appearances" 169 : 713-715, 1997

7 Krishnamurthy R, "Mammographic findings after breast conservation therapy" 19 : S53-S62, 1999

8 Beyer GA, "Mammographic appearance of the retained dacron cuff of a Hickman catheter" 155 : 1203-1204, 1990

9 Korean society of interventional radiology, "Interventional radiology" Ilchokak 652-661, 2007

10 Chala LF, "Fat necrosis of the breast: mammographic, sonographic, computed tomography, and magnetic resonance imaging findings" 33 : 106-126, 2004

11 Bilgen IG, "Fat necrosis of the breast: clinical, mammographic, sonographic features" 39 : 92-99, 2001

12 Gatta G, "Clinical, mammographic and ultrasonographic features of blunt breast trauma" 59 : 327-330, 2006

13 Korean society of breast imaging, "Breast diagnostic imaging" Ilchokak 269-275, 2006