검진센터에서의 선별 유방촬영술: 6년간의 의학적 감사 = Screening Mammogram in Health Center:Medical Audit for Six Years

국문 초록 (Abstract)

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.

다국어 초록 (Multilingual Abstract)

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