대한초음파의학회지 2009; 28(2) 유방초음파에서후방그림자를보이는양성병변 : 병리소견과의비교 문주희 1 유재경 1 윤정현 2 김민정 2 곽진영 2 김은경 2 enign Lesions with Posterior coustic Shadowing on Ultrasound: The Pathologic Correlation 1 국민건강보험공단일산병원영상의학과 2 연세대학교신촌세브란스병원영상의학과 J Korean Soc Ultrasound Med 2009; 28: 93-102 Received September 4, 2008; Revised pril 30, 2009; ccepted May 6, 2009. ddress for reprints : Eun-Kyung Kim, MD, Department of Radiology, Yonsei University College of Medicine, Seodaemun-gu Shinchondong 134 Seoul 120-752, Korea. Tel. 82-2-2228-7400 Fax. 82-2-393-3035 E-mail: ekkim@yuhs.ac Ju Hee Moon, MD 1, Jai Kyung You, MD 1, Jung Hyun Yoon, MD 2, Min Jung Kim, MD 2, Jin Young Kwak, MD 2, Eun-Kyung Kim, MD 2 1 Department of Radiology, National Health Insurance Corporation, Ilsan Hospital 2 Department of Radiology, Yonsei University College of Medicine breast lesion with posterior acoustic shadowing is often encountered on sonography and this finding is generally accepted as a sign of malignancy. lthough its detection is important for differentiating a malignant breast mass from a benign breast mass, posterior acoustic shadowing is the result of attenuation of the sound beam by a desmoplastic host response to breast cancer rather than the posterior acoustic shadowing being due to the tumor itself. Therefore, many breast conditions that contain fibrous elements also can induce some degree of acoustic shadowing. In this article, we present various benign breast lesions that display posterior acoustic shadowing and we discuss the radiologic findings along with the pathologic correlation. Key words : reast; reast, US; reast, posterior acoustic shadowing 서론후방그림자는초음파음속이조직을통과하면서발생하는흡수, 반사, 굴절및산란의결과로발생하는에코변화이며이중흡수가이현상의주된원인이된다 [1]. 반사에의한음영은공기나석회화에의해발생하고, 종괴의경계부나지방과결합조직간의굴절에의해정상유방조직에서도후방그림자가발생할수있다. 정상유방조직에서발생하는후방그림자의경우는주로쿠퍼인대와같은결합조직에의해발생하며유방조직에대한압박을가하거나탐촉자의방향을바꾸면사라지거나변함으로써종괴에의해발생하는것이아님을확인할수있다. 또한, 후방그림자는초음파의진동수에영향을받아높은주파수의탐촉자를사용할때심해지고, 복합초음파영상 (compound imaging) 보다고식적초음파에서더심하다 [2, 3]. 그러나초음파의특성외에병변의성격상, 즉병변내부의섬유성조직의양에따라다양한정도의후방그림자를보일수있고, 이는주로악성종괴에서나타나는결합조직증식증 (desmoplasia) 을반영하는결과이다 [2, 4, 5]. 따라서종괴가후방그림자를보일때악성을의심하게되지만섬유화를동반한다양한양성병변에서도이러한소견을보일수있다. 이논문에서는초음파에서흔히후방그림자를동반하여악성으로오인할수있는양성병변에대해알아보고영상과병리소견과비교해보고자한다. 1. 국소섬유화 (Focal fibrosis) 국소섬유화는섬유성질환 (fibrous disease), 섬유성유방병증 (fibrous mastopathy), 섬유성종양 (fibrous tumor), 만성경화성유방염 (chronic indurative mastitis) 의다양한이름으로알려졌으며, 임상소견은비특이적이다. 압통을동반하거나동반하지않을수있고, 주로폐경전의여성에서나타나며당뇨나다른결합조직질환이있을때좀더빈도가높다. 유방의상외측에서가장자주발생하며만져지는단단한종괴로나타나기도하지만무증상으로영상검사상발견되기도한다 [2, 6, 7]. 따라서초음파유도하핵생검후진단되는경우가많아지고있으며, 그빈도는 2.1-8.9% 로보고되었다 [7-9]. - 93-
대한초음파의학회지 2009;28(2) 이병변의영상소견은다양하고비특이적이다. 유방촬영에서는보이지않을때가잦고, 보일때는국한성또는가려진경계를갖는난원형의고밀도종괴로나타나는경우가흔하지만, 비대칭음영이나구조왜곡으로나타나는일도있으며석회화를동반하는경우는드물다 [7, 8]. 유방초음파에서는난원형의평행한방향축과미세소엽성경계를갖는동일에코의종괴로후방음향변화가없는경우가가장흔하다. 그러나불분명하거나불규칙한경계를갖는저에코종괴로나타나거나뚜렷한종괴를보이지않고후방그림자만보이는때도있으며, 최근문헌에서는초음파상보이는국소섬유화중후방그림자를보였던경우는 14-28% 로보고되었다 [7-10]. 조직병리학적으로국소섬유화는유관과소엽을막는, 세포가거의없는치밀한기질결합조직의증식을특징으로하며, 종괴양, 결절성, 부정형, 격막섬유화의 4가지형태로분류할수있고, 영상소견과조직병리학적분류와의연관성은없지만, 부정형섬유화는유방촬영에서구조왜곡으로나타난다고한다 [8, 10]. 초음파영상소견은 I-RDS 범주 4에해당하는경우가가장많으나 (Fig. 1) 악성이매우의심스러울수도있으므로 (Fig. 2) 영상소견과병리학적소견과일치여부를반드시확인하여야한다 [7]. 2. 당뇨병성유방병증 (Diabetic mastopathy) 당뇨병성유방병증은제1형당뇨를앓는폐경기이전의젊은환자에서주로나타나며, 자연히없어질수있는양성병변이다. 이질병은보통당뇨가발생한지 20년정도후에발현하며, 교원질 (collagen) 대사의장애로말미암아기질증식이일 어나섬유성병변을형성하게된다. 병리학적으로는흉터종성 (keloidal) 교원질과증가한방추세포로이루어져있다. 또한, 다형태성상피모양세포가이러한방추형세포사이의교원질내에퍼져있으며, 혈관주위에는림프구침윤을동반한다 [11]. 임상적으로는대부분환자가 30세이하이며, 한쪽또는양쪽유방에서만져지는딱딱하고통증이없는종괴양병변으로나타난다. 유방촬영술소견은비특이적인비대칭음영이나부정형병변으로보이기도하나치밀유방에가려보이지않을수도있다. 초음파에서는경계가불확실하거나, 각진, 또는미세분엽성변연을가진현저한저에코병변으로서강한후방그림자를동반하는것이주된소견이며 (Fig. 3), 색도플러검사상병변내에혈류가보이지않고후방그림자의정도는섬유성조직의양을반영한다 [2, 12]. 다발성양측성병변이라는것이당뇨병성유방병증의특징이기는하나침윤성소엽암의경우에도이러한경향을보이므로악성병변과의감별이초음파소견만으로는힘들다 [2]. 반면몇몇증례보고에따르면당뇨병성유방병증은자기공명영상에서유실 (washout) 이없는점진적인조영증강을보이고후기조영영상에서비균질한점상조영증강을보이는국소종괴가보이거나종괴가뚜렷하지않으면서점진적인미미한조영증강을보인다 [12, 13]. 물론경화성유방암에서도비슷한조영증강양상을보일수있어자기공명영상으로유방암을배제할수는없으나유방촬영술이나유방초음파상악성이의심될때당뇨병유방병증의영상소견을파악하고있는것은중요하며, 환자의영상소견과과거력을종합해볼때진단에도움이될수있고최종적으로조직검사를통한 Fig. 1. -68-year-old woman with incidentally found breast mass during screening ultrasound. Mammogram shows scattered fibroglandular tissue without abnormality (not shown).. Sonogram shows an oval shaped, not-circumscribed hypoechoic mass with posterior shadowing.. Photomicrographs of pathology specimen shows paucicellular fibrous tissue proliferation (arrows) separating atrophic lobules, suggestive of focal fibrosis (H & E, 40). - 94-
문주희외 : 유방초음파에서후방그림자를보이는양성병변 확인이필요하다. 3. 과립세포종양 (Granular cell tumor) 과립세포종양은말초신경의신경집세포기원으로생각되는양성종양으로몸의어디서나발생할수있으나혀및인두에주로나타나며유방에서발생하는경우는 4-9% 에해당한다 [2, 14, 15]. 임상적으로는통증이없는딱딱한종괴로만져지거나유방촬영술에서발견되며, 30-50세의연령층에서가장많이발생하지만, 청소년기나폐경기이후의여성에서도보고된예가있다. 유방의상내측에자주생기는경향이있고, 피하조직이나유륜하에위치할때는주변조직과유착되어피부나유두함몰을유발할수있다 [11]. 유방촬영술에서는주로 3 cm 이하의석회화가없고침상형이나불분명한경계를갖는고밀도의종괴로보이는경우가전형적이며, 섬유화를동반한침습성성장양식을보이므로유방암, 특히경화성유방암과의감별이어렵다 [16]. 과립세포종양은내부가섬유소형태로구성되어있기때문에이방성 (anisotropy) 을보일수있어초음파음속의각도에따라내부의에코가다양하게보일수있으나초음파상주로경계가불분명한저에코의고형종괴로나타나며, 섬유화가풍부하여강한후방그림자를동반하는경우가많고 (Fig. 4) 저에코병변의앞쪽경계면이고에코를보일수있다 [2, 15-17]. 따라서영상소견이악성과매우유사하므로불필요한수술을피하기위해서는조직검사로확인할필요가있다 [16]. 조직학적으로는풍부한호산성과립을포함하고있으며, 둥글거나난원형의핵을갖는다각형또는방추형세포로구성되어있으며, 전형적으로세포의경계가좋고, 풍부한섬유성조직과다양한양의교원성기질을포함한다. 그러나종괴의경계부에서는인접한유방조직의유관과소엽을탐식하여침습성경계를보이며, 아포크린세포암종이나침습성경성유방암, 아포크린화생, 지방괴사등으로오인될수있어광범위한국소절제를통한치료가필요하다 [11, 15]. S-100 단백과 NSE(neuron-specific enolase) 에양성반응을보이며에스트로겐이나프로게스테론수용체에음성반응을보이는것으로 Fig. 2. -55-year-old woman with abnormality in screening mammogram.. Craniocaudal magnification mammogram shows a focal asymmetry in the left breast (arrows).. Sonogram shows an irregular shaped, spiculated, isoechoic mass with posterior shadowing. C. US-guided 14 gauge core needle biopsy revealed focal fibrosis. Directional vacuum assisted removal of the mass was performed due to imaging-pathologic discordance. Histologic specimen shows dense fibrous tissue with few ductal and lobular elements, suggestive of focal fibrosis (H & E, 40). C - 95-
대한초음파의학회지 2009;28(2) 신경세포기원종괴임을확인하여유방암과의감별이가능하다. 대부분에서양성이지만 1% 이하에서악성을보이며, 다발성, 높은세포분열률, 다형태성세포, 핵이나세포의괴사를보일때는악성화를시사한다 [2, 11]. 4. 섬유선종 (Fibroadenoma) 섬유선종은종말관소엽단위의상피와섬유기질에서발생하는양성종양이다. 에스트로겐에의한자극이성장에중요한요소가되므로청소년기나젊은여성에서가장흔한종양이지만 5% 이하에서 50세이상에서나타날수있고, 호르몬대체요법과연관성이있다 [2, 11]. 비교적빠른성장을보이지만보통은 2-3 cm 이상으로커지지않는것이일반적이며 15-25% 에서다발성을보인다. 조직학적으로는다양한양의증식된섬유기질과상피성요소로구성되어있으며, 기질은세포가 많거나적을수있고, 점액성변성을보일때는비교적부드럽지만, 경화, 유리질화및석회화를보일때는움직임이있는단단한종괴로만져질수있다 [2]. 유방촬영술에서는치밀한유방조직에가릴수있으나, 경계가좋은원형또는난원형의등밀도의종괴로보이는것이일반적이며, 퇴행성섬유선종에서는팝콘모양이나가장자리석회화의특징적인양성석회화를보일수있다. 그러나임신기나수유기에경색이있었던섬유선종의경우각지거나불규칙한모양을보일수있고, 때로는석회화가시작되는단계에서다형성의또는부정형의석회화로보여악성을배제할수없는때도있다. 유방초음파에서는저에코또는동일에코의경계가좋은타원형의종괴로서균일한내부에코를보이며, 얇은고에코의가장자리및후방음향이없거나증가되는것이전형적인소견 Fig. 3. 29-year-old insulin dependent diabetic woman with a 1 month history of a lump in her left breast.. Mediolateral oblique mammograms show dense parenchymal pattern, more prominent on the left breast than on the right breast.. Sonogram shows an irregular shaped, hypoechoic mass with posterior shadowing in the left breast. C. US-guided 14 gauge core biopsy specimen shows dense fibrosis with mononuclear inflammatory cell infiltration around the vessel and duct, suggestive of diabetic mastopathy (H & E, 100). C - 96-
문주희외 : 유방초음파에서후방그림자를보이는양성병변 이다 [2, 6, 18]. 간혹유방촬영술을시행하지않고초음파를처음으로시행한젊은여성은섬유선종이후방그림자를보이는경우가있는데, 이때유방촬영술을시행하면특징적인중앙부의팝콘모양석회화나가장자리석회화를쉽게확인할수있는경우가있다. 그러나기질이경화성또는유리질화를보이는섬유선종에서는석회화없이후방그림자를보이며 (Fig. 5) 유방촬영술에서도고밀도를보이는경향이있어악성을의심할수있으며, 석회화없는섬유선종의약 10-30% 에서후방그림자를볼수있다고한다 [2, 17, 18]. 그러나이때관찰되는섬유선종의후방그림자는유방암에비해약하고, 중앙보다는경계부에서발생하며, 종종후벽에서고에코의선이보인다는점에서감별에도움을줄수있다 [17]. 5. 유낭종 (Galactocele) 유낭종은수유중인여성에서가장많은양성유방병변이며, 전형적으로수유를중단한후몇주또는몇달후에통증없이만져지는종괴로나타나지만드물게는신생아나유방축소술이후에도발생가능하며, 최근에는임신이나수유와상관없이발생하는유낭종이중년이후의여성에서도보고되었다 [2, 19]. 병리학적으로는유즙으로찬말단유관및유소관의낭성확장을의미하며, 정상적인유방상피세포와근상피의두층의벽으로이루어져있다 [2]. 유낭종의내부는다양한비율의단백질, 지방, 젖당으로차있으며, 낭종은유관확장으로말미암은염증반응에의해다양한두께의섬유성낭종벽으로둘러싸이게된다. 따라서낭종을흡인하여유즙을확인하는것이진단과동시에치료가된다 [20]. 임신및수유와관련된유낭종의유방촬영술소견은낭종의시기에따른구성성분비율의변화로기름낭종, 지방과물의경계면을포함한병변, 지방을포함하는가성과오종의형태에이르기까지다양하다. 초음파소견역시시기에따라다양한데무에코의낭종, 복합낭종, 고에코와저에코의경계면을갖는낭종, 경계가좋고후방음향증강을보이는양성고형종괴의모습을보이는것이일반적이다 [20]. 반면수유와관계없는유낭종은비교적크기가작고둥글거나부정형의모양을보이고소분엽성, 불분명, 또는침상형의경계를갖는저에코또는복합에코의고형종괴의양상으로나타나며, 약 39.4% 에서후방그림자를보여악성을시사하는소견을보이므로초음파유 Fig. 4. 46-year-old woman with palpable left breast mass. Reprinted with permission from [16].. Spot compression mammogram of the left breast shows a 20- mm sized spiculated mass in the upper inner quadrant. No associated microcalcifications or skin thickening were observed.. Sonogram shows a 20-mm diameter, hypoechoic, irregular shaped mass with posterior shadowing. C. Histologic specimen is composed of small irregular islands or solid nests of uniform rounded or polygonal cells with granular eosinophilic cytoplasm and small dark nuclei (arrows), suggestive of granular cell tumor (H & E, 200). C - 97-
대한초음파의학회지 2009;28(2) 도하핵생검이필요하다 (Fig. 6, 7). 따라서우연히발견된작고둥근저에코의종괴가불분명하거나소분엽성의경계와약한후방그림자를보이고, 특히앞또는뒤쪽경계부에곡선의고에코선이보일때는유낭종의가능성을염두에두어야하며, 이는악성종괴와의감별에도움이된다 [19]. 6. 지방괴사 (Fat necrosis) 지방괴사는외상으로인한지방손상에의해발생하며주로수술이나방사선치료등이원인이된다. 임상적으로는주로지방형유방을가진여성에서많이발생하며, 보통은증상이 없지만유륜하부및유륜주위유방의표면에있는무통성종괴양병변으로만져지거나통증을동반하는예도있으며, 피부비후나퇴축또는유두함몰을동반할수있다 [11]. 병리학적으로지방괴사는무균성, 염증성과정으로병변의시기에따라다양한형태를띠게된다. 초기에출혈과대식세포의침윤에의한지방세포의파괴는대식세포로둘러싸인액포를형성하고, 괴사한지방과세포찌꺼기를둘러싼경계를만들어낭종성변화를보일수있다. 이러한지질낭종은후기로가면주변부의석회화를동반한낭종으로남을수도있지만, 병변의주변부부터섬유화가진행되어전체가심한섬유화 Fig. 5. -48-year-old woman with incidentally found breast mass.. Sonogram shows an oval, circumscribed, isoechoic mass with posterior shadowing.. Photomicrographs of biopsy specimen shows the paucicellular, abundant hyalinized stroma with collagen materials, which is compatible with fibroadenoma with hyalinization (H & E, 40). Fig. 6. -64-year-old woman with incidentally found breast mass.. Sonogram shows a 7-mm, round shaped isoechoic mass with an indistinct margin and posterior shadowing.. Core biopsy specimen shows flat epithelial cell lining which is encompassed by a thick fibrous wall, suggestive of galactocele (H & E, 40). - 98-
문주희외 : 유방초음파에서후방그림자를보이는양성병변 나주변부조직이왜곡되는반흔으로대치될수있어유방암의경화성변화와비슷하게보이기도하며, 유관주변에섬유화가있을때에는유두의함몰을일으키기도한다 [2, 11, 21]. 유방촬영술에서도기름낭종성분의양과섬유성반흔의정도에따라다양한형태를보이며, 투과성밀도의중심부와특징적인계란껍질모양석회화를갖는기름낭종으로나타나거나부정형의석회화로발견되는경우가많다. 그러나드물게는 침상형경계를가진고밀도병변으로나타나거나군집성의다형성미세석회화를보일수있어악성병변과의감별대상에해당하기도한다 [22]. 초음파에서초기에는균질하거나비균질한고에코의부종이수술반흔이나혈종과함께보이는경우가많으며, 작고경계가좋은무에코의병변으로보이는경우가전형적인기름낭종의초음파소견이다. 그러나시간이지나면서낭종내물질의에코가증가하면복합에코나고형의종 Fig. 7. 28-year-old woman with palpable mass after delivery.. Sonogram shows a 20-mm circumscribed hyperechoic mass with extensive posterior acoustic shadowing (arrows). During the 19 gauge needle aspiration, the thick milkish materials were aspirated.. Cytology of aspirated material shows amorphous proteinous material, which is compatible with galactocele. Fig. 8. 62-year-old woman with palpable mass in her left chest wall. year ago, she underwent the left mastectomy and flap reconstruction due to the breast cancer.. Sonogram shows a 25-mm sized, ill-defined, irregular, hypoechoic mass with posterior shadowing at palpable area.. Histologic specimen of a biopsy shows multiple cysts from fusion of necrotic fat cells surrounded by dense fibrous tissues and inflammatory cells, suggestive of fat necrosis (H & E, 100). - 99-
대한초음파의학회지 2009;28(2) 괴로보일수도있다 [23]. 그러나좀더후기로가면섬유화가지방괴사의주병리소견이되며, 이때는불분명하거나각진변연이나침상형경계를갖는현저한저에코의병변이강한후방그림자를동반할수있어초음파상악성과의구별이힘들다 (Fig. 8) [2, 22]. 이러한환자에게수술이나외상의과거력이있고, 임상소견이들어맞는다면즉각적인조직검사보다는영상소견과검진을통한단기추적관찰이권고되며, 그럼에도지속적으로악성이의심스러운영상소견을보이는경우조직검사를통한확인이필요하다 [22]. 7. 방사형반흔 (Radial scar) 방사형반흔은방사형경화성병변 (radial sclerosing lesion), 경화성유방병증 (indurative mastopathy), 탄력섬유증 (elastosis), 비봉입성경화성병변 (nonencapsulated sclerosing lesion), 경화성유두성증식 (sclerosing papillary proliferation) 등의다양한이름을갖는양성병변이며, 크기가 1센티미터가넘을때복합경화성병변 (complex sclerosing lesion) 으로부르기도하나대부분은크기에관계없이방사형반흔으로통칭한다 [2, 24, 25]. 병리학적으로방사형반흔은섬유화가섞여있는탄력성조직으로이루어진중심핵이이를둘러싼증식성유관및유선을당기고있어주변부조직이왜곡되고방사형으로배열된다. 또한, 증식성요소중경화성선증과관련된미세석회화가동반될수있어유방암과유사한양상을보인다 [25]. 방사형반흔은크기가작을때유방초음파에서관찰되지않는경우가많다. 그러나초음파상발견되는경우초기단계에서는등에코나약한저에코의각진형태나침상형병변으로보이고, 중심부의탄력섬유증이우세하고주변부의증식성변화가적은후기단계에서는강한후방음영을동반한침상형의저에코병변으로보여 (Fig. 9) 유방암과의감별이불가능하다 [2]. Fig. 9. 52-year-old woman with abnormality on screening mammogram.. Craniocaudal magnification mammogram shows a focal asymmetry with spiculation in the right breast (arrows).. Sonogram shows a 8-mm sized, ill-defined, hypoechoic, irregular mass with posterior shadowing in her right breast. C. US-guided vaccum-assisted biopsy for the removal of the breast lesion was performed. Histologic specimen shows stellate arrangement of peripheral ductules with central hypocellular fibrocollagenous zone, suggestive of radial scar (H & E, 40). C - 100-
문주희외 : 유방초음파에서후방그림자를보이는양성병변 따라서초음파의역할은유방촬영술에서보이는병변을초음파로확인하여위치를결정하여조직검사를용이하게한다는데의의가있다 [26]. 8. 수술후반흔 (Postsurgical scar) 수술후반흔은양성병변의절개생검이나유방암으로말미암은보존수술후에동반될수있으며, 영상소견상구조왜곡을일으키거나침상형병변으로흔히나타나악성과유사한소견을보이지만양성병변의수술후에는대부분 1년이나 1년반내에사라지므로영구적으로남는경우가드물다 [25]. 유방촬영술을시행할때는수술부위의피부에표식 (marker) 을대고촬영하면수술후반흔이라는것을알수있지만, 종종병변이있던위치가깊어피부의절개부위와수술후반흔의자 리가떨어져있을수있으므로수술전의유방촬영술영상과비교하는것이도움된다. 또한, 수술후반흔은시간이지남에따라크기가감소하므로환자의과거력및시간에따른유방촬영술영상을비교하는것이매우중요하다 [17, 25]. 수술후반흔은교원질침착으로이루어진섬유화이므로유방초음파에서는중심종괴없이후방음영을보이는병변으로나타나는경우가가장많은데한쪽방향에서는각진경계나침상형종괴처럼보이며강한후방음영을동반하지만, 직각으로탐촉자의방향을바꾸면납작한선상병변으로나타나고후방음영도약해지므로재발유방암과의감별에도움이되며, 종종반흔이절개면을따라피부까지이어지는것을확인할수있다 (Fig. 10) [2, 17]. Fig. 10. 53-year-old woman with abnormality after excision of the fibrocystic disease.. Cranioca udal mammogram shows spiculation with parenchymal distortion at the previous excision site in her right breast (arrows)., C. Transverse () sonogram shows angular, hypoechoic mass-like lesion with posterior shadowing. ut longitudinal (C) sonogram reveals slit-like postsurgical scar along the length of the scar without true mass. C - 101-
대한초음파의학회지 2009;28(2) 결 초음파에서후방그림자소견은악성병변에서볼수있는소견중의하나이지만, 다양한양성병변에서도동반될수있다. 따라서후방그림자가동반된결절이있는경우악성병변외에섬유화를동반한많은양성병변의가능성도생각해야한다. 요 유방초음파에서후방그림자를동반한병변이종종발견되는데이러한초음파소견은일반적으로악성을시사하는소견으로알려져있다. 이는양성과악성유방병변을감별하는데중요한소견이지만후방그림자는유방암자체보다는종양의결합조직증식반응에의해발생한초음파음속의감쇠에따른결과이므로섬유성조직을가진많은양성병변에서도다양한정도의후방그림자를유발할수있다. 본화보에서는후방그림자를보이는다양한양성병변에대해알아보고영상소견과병리소견을비교해보고자한다. 론 약 References 1. Mesurolle, riche-cohen M, Mignon F, Guinebreti?re JM, Tardivon, Goumot P. Small focal areas of acoustic shadowing in the breast. J Clin Ultrasound 2002;30:88-97 2. Stavros T. reast ultrasound. Philadelphia:Lippincott Williams & Wilkins, 2004;351-797 3. Kwak JY, Kim EK, You JK, Oh KK. Variable breast conditions: comparison of conventional and real-time compound ultrasonography. J Ultrasound Med 2004;23:85-96 4. Stavros T, Thickman D, Rapp CL, Dennis M, Parker SH, Sisney G. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology 1995;196:123-134 5. Harper P, Kelly-Fry E, Noe JS, ies JR, Jackson VP. Ultrasound in the evaluation of solid breast masses. Radiology 1983;146:731-736 6. Goel N, Knight TE, Pandey S, Riddick-Young M, de Paredes ES, Trivedi. Fibrous lesions of the breast: imaging-pathologic correlation. Radiographics 2005;25:1547-1559 7. You JK, Kim EK, Kwak JY, et al. Focal fibrosis of the breast diagnosed by a sonographically guided core biopsy of nonpalpable lesions: imaging findings and clinical relevance. J Ultrasound Med 2005;24:1377-1384 8. Revelon G, Sherman ME, Gatewood OM, rem RF. Focal fibrosis of the breast: imaging characteristics and histopathologic correlation. Radiology 2000;216:255-259 9. Rosen EL, Soo MS, entley RC. Focal fibrosis: a common breast lesion diagnosed at imaging-guided core biopsy. JR m J Roentgenol 1999;173:1657-1662 10. Venta L, Wiley EL, Gabriel H, dler YT. Imaging features of focal breast fibrosis: mammographic-pathologic correlation of noncalcified breast lesions. JR m J Roentgenol 1999;173:309-316 11. Rosen PP. Rosen s breast pathology. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2001; 29-777 12. Tuncbilek N, Karakas HM, Okten O. Diabetic fibrous mastopathy: dynamic contrast-enhanced magnetic resonance imaging findings. reast J 2004;10:359-362 13. Sakuhara Y, Shinozaki T, Hozumi Y, Ogura S, Omoto K, Furuse M. MR imaging of diabetic mastopathy. JR m J Roentgenol 2002;179:1201-1203 14. Yang WT, Edeiken-Monroe, Sneige N, Fornage D. Sonographic and mammographic appearances of granular cell tumors of the breast with pathological correlation. J Clin Ultrasound 2006;34:153-160 15. Irshad, Pope TL, ckerman SJ, Panzegrau. Characterization of sonographic and mammographic features of granular cell tumors of the breast and estimation of their incidence. J Ultrasound Med 2008;27:467-475 16. Kim EK, Lee MK, Oh KK. Granular cell tumor of the breast. Yonsei Med J 2000;41:673-675 17. Weinstein SP, Conant EF, Mies C, cs G, Lee S, Sehgal C. Posterior acoustic shadowing in benign breast lesions: sonographic-pathologic correlation. J Ultrasound Med 2004;23:73-83 18. Fornage D, Lorigan JG, ndry E. Fibroadenoma of the breast: sonographic appearance. Radiology 1989;172:671-675 19. Kim MJ, Kim EK, Park SY, Jung HK, Oh KK, Seok JY. Galactoceles mimicking suspicious solid masses on sonography. J Ultrasound Med 2006;25:145-151 20. Sabate JM, Clotet M, Torrubia S, et al. Radiologic evaluation of breast disorders related to pregnancy and lactation. Radiographics 2007;27 Suppl 1:S101-124 21. ilgen IG, Ustun EE, Memis. Fat necrosis of the breast: clinical, mammographic and sonographic features. Eur J Radiol 2001;39:92-99 22. Park YM, Kim EK. Fat Necrosis Simulating reast Malignancy Following Reduction Mammoplasty: Case Report. J Korean Radiol Soc 2004;51:573-576 23. Soo MS, Kornguth PJ, Hertzberg S. Fat necrosis in the breast: sonographic features. Radiology 1998;206:261-269 24. renner RJ, Jackman RJ, Parker SH, et al. Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? JR m J Roentgenol 2002;179:1179-1184 25. Kopans D. reast imaging. 3rd ed. altimore, MD: Lippincott Williams & Wilkins, 2007;422-838 26. Cohen M, Sferlazza SJ. Role of sonography in evaluation of radial scars of the breast. JR m J Roentgenol 2000;174:1075-1078 - 102-