Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Analysis of Previous Screening Examinations for Patients with Breast Cancer

유방암환자들의 이전 선별검사 분석

Lee, Eun-Hye;Cha, Joo-Hee;Han, Dae-Hee;Ryu, Dae-Sik;Choi, Young-Ho;Hwang, Ki-Tae;Kwak, Jin-Ho;Moon, Woo-Kyung
이은혜;차주희;한대희;류대식;최영호;황기태;곽진호;문우경

  • Published : 2007.02.01
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Abstract

Purpose: We wanted to improve the quality of subsequent screening by reviewing the previous screening of breast cancer patients. Materials and Methods: Twenty-four breast cancer patients who underwent previous screening were enrolled. All 24 took mammograms and 15 patients also took sonograms. We reviewed the screening retrospectively according to the BI-RADS criteria and we categorized the results into false negative, true negative, true positive and occult cancers. We also categorized the causes of false negative cancers into misperception, misinterpretation and technical factors and then we analyzed the attributing factors. Results: Review of the previous screening revealed 66.7% (16/24) false negative, 25.0% (6/24) true negative, and 8.3% (2/24) true positive cancers. False negative cancers were caused by the mammogram in 56.3% (9/16) and by the sonogram in 43.7% (7/16). For the false negative cases, all of misperception were related with mammograms and this was attributed to dense breast, a lesion located at the edge of glandular tissue or the image, and findings seen on one view only. Almost all misinterpretations were related with sonograms and attributed to loose application of the final assessment. Conclusion: To improve the quality of breast screening, it is essential to overcome the main causes of false negative examinations, including misperception and misinterpretation. We need systematic education and strict application of final assessment categories of BI-RADS. For effective communication among physicians, it is also necessary to properly educate them about BI-RADS.

목적: 유방암환자들의 이전 선별검사를 재검토함으로써 앞으로 선별검사의 질적 수준을 높이고자 하였다. 대상과 방법: 최근 2년간 진단된 유방암환자 중 이전에 선별검사를 시행했던 24명의 환자를 대상으로 하였다. 모든 환자가 유방촬영검사를 했고 15명은 초음파검사를 같이 받았다. 이전선별검사에서 유방암 의심소견이 보이는지 BI-RADS 체계를 적용하여 후향적으로 재검토하여 가음성, 진음성, 진양성, 잠재암 여부를 판단하였다. 또한, 가음성 선별검사의 원인을 인지오류, 해석오류, 기술오류 등으로 나누고 유발요인을 분석하였다. 결과: 이전 선별검사를 재검토했을 때 가음성 유방암은 66.7%(16/24), 진음성은 25.0%(6/24), 진양성은 8.3%(2/24)였다. 가음성 유방암 중 유방촬영이 원인인 경우는 56.3%(9/16), 초음파검사가 원인인 경우는 43.7%(7/16)였다. 가음성 선별검사의 인지오류는 모두 유방촬영에서 나타났고 유발요인은 치밀유방, 병변의 위치가 유선조직이나 영상의 변연부인 경우, 한 영상에서만 보이는 경우였다. 해석오류는 대부분 초음파검사였고 최종평가분류를 엄격하게 적용하지 않은 것이 주요 유발요인이었다. 결론: 유방선별검사의 수준을 높이려면 가음성 검사의 주요 원인인 인지오류와 해석오류를 극복해야 하며 이를 위하여 BI-RADS 체계에 대한 교육과 최종평가분류의 엄격한 적용이 필요하다. 또한, 판독결과가 임상에 제대로 반영되려면 임상의사도 BI-RADS에 대한 적절한 교육이 필요하다.

Keywords

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