Original Article pissn 1738-2637 / eissn 2288-2928 J Korean Soc Radiol 2013;69(1):71-77 http://dx.doi.org/10.3348/jksr.2013.69.1.71 Analysis of Breast Imaging Reporting and Data System Category 4 Complex Cystic Masses of the Breast: Do All the Complex Cystic Breast Masses Merit a Biopsy? 카테고리 4 유방복합성에코종양의분석 : 모든복합성에코종양에조직검사가필요한가? Ha Yeon Kim, MD, Yun-Woo Chang, MD Department of Radiology, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Seoul, Korea Purpose: To investigate whether sonographic findings can predict malignancy in complex echoic breast masses using the Breast Imaging Reporting and Data System (BI-RADS) lexicon and to demonstrate the need for biopsy recommendations for all complex breast masses. Materials and Methods: 135 pathologically proven complex echoic masses detected on sonography were identified. We retrospectively reviewed the sonographic findings according to the BI-RADS lexicon which include shape, margin, orientation, lesion boundary, posterior acoustic features, and vascularity. The sonographic findings were correlated with the pathology and mammographic findings. Differentiation between the sonographic appearance of benign and malignant complex cystic lesions was evaluated using the chi-square test or the Mann-Whitney U test. Results: 59.3% (80/135) were benign lesions and 40.7% (55/135) were malignant lesions. Malignant lesions were correlated with irregular (p < 0.001), nonparallel (p = 0.023), noncircumscribed (p < 0.001), echogenic halo (p < 0.001), increased vascularity (p = 0.001) and large size (p = 0.002) compared to benign lesions. However, 12.7% (7/55) of benign looking complex cystic masses were proved to be malignant. All seven lesions had malignant microcalcifications or abnormality on mammography. Conclusion: Using the sonographic BI-RADS lexicon can be useful for differentiating between malignant and benign complex cystic breast masses. Notably, 12.7% of the complex cystic lesions showing a benign appearance on sonography were pathologically proven malignant. Therefore, radiologist should recommend biopsy for complex cystic lesions. Index terms Ultrasonography Complex Cystic Mass Breast Cancer Received February 20, 2013; Accepted April 30, 2013 Corresponding author: Yun-Woo Chang, MD Department of Radiology, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea. Tel. 82-2-709-9396 Fax. 82-2-709-9066 E-mail: ywchang@schmc.ac.kr This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 서론 American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) Ultrasonography Lexicon (1) 에의하면복합성에코종양은낭성과고형의증가된에코부위로구성된종양으로정의하고있다. 유방의낭성종양은다양한양상으로보일수있는데이들중복합에코종양은고형종괴내에낭성부분이있거나 (solid mass with cystic foci), 낭성과고형성분이섞여있는경우 (mixed cystic and solid mass) 또는두꺼운벽이나내부격막이있는낭성종괴 (cystic mass with thick wall and/or thick septations) 등을포함한다 (2). 유방초음파에서낭성종괴의다양한모양에따른처치의권장사항은다음과같다. 단순낭종증상이있는경우세침흡인을하여노란색이거나유즙과같은색인경우세포검사없이그것으로끝내고복잡성낭종 (complicated cyst) 은크기가커지거나농양이의심된다면중재적시술을고려한다. 군집된미세낭종 (clustered microcyst) 의경우카테고리 3( 양성의심소견 ) 으로분류하고매 6개월마다 2년간추적검사를한다 (2, 3). 낭성및고형성의복합성 (complex) 에코종양도낭성종양의하나의양상으로서양성과악성의다양한병리적인질환을보일수있 Copyrights 2013 The Korean Society of Radiology 71
카테고리 4 유방복합성에코종양의분석 다 (2-4). Berg 등 (3) 은 22.7%(18/79) 의유방의복합성에코병변이악성으로진단되었으며조직검사가필요하다고하였다. 복합성에코종양은다른낭성종양들에비해그빈도가덜흔하지만악성가능성을보이므로 BI-RADS 카테고리 4( 악성의심병변 ) 로여겨조직검사를시행하도록권하고있다 (2, 5). 그러나초음파검사를시행하다보면에코양상은복합성에코종양이지만 BI-RADS 의다른소견들은양성의심병변으로보이는경우가종종있어저자들은복합성에코종양이라는이유만으로다른 BI-RADS 소견들이양성의심병변인경우라도모두조직검사를시행하여야하는지에대한의문이생겼다. 이연구의목적은초음파검사에서복합에코종양에대하여 BI- RADS 의초음파기준을적용하였을때병리적으로양성과악성을예측할수있는지를알아보고자하였으며, 복합성에코종양을보이는경우모든예에서조직검사를권유해야하는지를평가해보고자하였다. 대상과방법 본연구는 Institutional Review Board 의허가를받았으며후향적인연구로서환자동의서를면제받았다. 2003 년 9월부터 2011 년 9월까지 152 명의여자환자들이초음파검사에서복합성낭성종양으로진단되었다. 19명은병리적인확진을시행하지않아서제외하였으며최종적으로 133 명의 135 개의병리적으로확진된복합적낭성종양이이연구에포함되었다. 모두여자환자였으며평균연령은 44.4 세 ( 범위, 13~84 세 ) 였다. 이학적검사상만져지는병변이 111예, 만져지지않는병변이 19예였으며 5예는유두분비물을보였다. 병리적인확진은세침검사가 8예, 핵생검이 13예, 맘모톰조직검사가 21예, 외과적조직검사가 93예였다. 환자의병리결과를모르는상태에서영상의학적보고서와초음파영상을후향적으로분석하였다. 본원에서유방종괴를보이는경우의기본검사방법은두개의직각영상 ( 하나는종괴의횡단면, 다른하나는종단면 ) 과컬러도플러영상을얻으며추가적인영상은영상의학과의사의판단에의해얻을수있다. 추가적으로환자의임상소견과유방촬영소견을분석하였으며병리적인소견과비교하였다. 초음파사진은 Picture Archiving and Communication System (PACS) 모니터를사용하여한종괴에서 3개이상의영상을후향적으로분석하였다. 연구기간동안초음파검사는 broadband 5-12-MHz linear array transducer (LOGIQ E9, GE, Wauwatosa, WI, USA), broad band 5-17 MHz linear array transducer (iu22, Philips, Seattle, WA, USA) 장비를사용하여영상을얻었다. 본원의기 본검사방법에따라서유방전체에대하여초음파검사를시행하였다. 유방촬영은 119 명의환자에서분석이가능하였으며나이가 20 대이거나수유중인유방이거나종괴가너무커서환자가유방촬영을시행하기어려운경우에는유방촬영을시행하지않았으며외부병원에서시행한유방촬영으로영상이적절하지않은경우등도분석에서제외되었다. 유방촬영소견은종괴나비대칭음영유무, 석회화나미세석회화등에대하여분석하였다. PACS 모니터를이용하여유방초음파영상을 10년이상의경험이있는유방영상전문의와한명의전공의가협의하에분석하였다. 복합성종양은다음의기준에따라평가되었다 ; 이분류는 Berg 등 (2) 에따라 1) 고형종괴내에낭성부분이있거나 (solid mass with cystic foci), 2) 낭성과고형성분이섞여있는경우 (mixed cystic and solid mass), 3) 두꺼운벽이나내부격막이있는낭성종괴 (cystic mass with thick wall and/or thick septations) 로분류하였다. 초음파소견을 BI-RADS 초음파 lexicon (1) 에의해평가하였으며모양 (oval, round, irregular), 방향성 (parallel, nonparallel), 경계 (circumscribed, not circumscribed), 병변의경계 (abrupt interface, echogenic halo), 후방음영 (enhancement, no enhancement), 컬러도플러영상 (no vascularity, vascularity) 등을평가하였다. 추가적으로종양의낭성성분과고형성분의비를비교하여 50% 이하인종괴와 50% 이상인종괴를분류하였다. 병변의크기를평가하였으며두판독자간의이견이있을경우는협의하에정하였다. 악성진단의병리적인확진은수술적인조직검사결과로하였으며양성진단은세침검사나핵생검, 맘모톰생검결과인경우도인정하였다. 통계적인분석은복합성에코의종양에서악성으로진단된복합성에코종양의빈도를평가하였다. 복합성에코종양의초음파소견상모양, 경계, 방향성, 낭성부위의정도, 후방음영, 혈류, 종괴의크기등을고려하여 chi-square test 나 Mann-Whitney U test 등을사용하여분석하였다. p 값은 0.05 이하인경우통계적으로유의한것으로하였다. 통계적인분석은 SPSS 소프트웨어를사용하였다 (SPSS version 14, Chicago, IL, USA). 결과 135 개의복합성에코종괴중 80 개 (59.3%) 가양성으로진단되었으며 55개 (40.7%) 가악성으로진단되었다. 복합성에코종괴의초음파양상을분석하였을때대부분낭성성분을가지지만두꺼운낭종벽이나낭종벽에종괴를가지는경우 (cyst with thick wall or septa) 는 27 예 (20%) 로양성은 24 예 (17.8%) 72 대한영상의학회지 2013;69(1):71-77 jksronline.org
김하연외 Table 1. Analysis of Ultrasonography and Pathology Finding No. (%) Thick Wall/ Septa Intracystic Mass Solid & Cystic Mass Diagnostic Method Benign Papilloma 25 8 2 15 CNB (4), Mammotome (7), E&B (14) Fibroadenoma 21 1 1 19 Aspiration (2), CNB (3), Mammotome (8), E&B (8) Fibrocystic change 13 3 0 10 Aspiration (1), CNB (3), Mammotome (3), E&B (6) Abscess/ inflammation 14 8 1 5 Aspiration (3), CNB (3), E&B (8) Mucocele like tumor 3 3 0 0 Mammotome (2), E&B (1) Lactating breast 2 0 0 2 Aspiration (2) Phyllodes tumor 1 0 0 1 E&B (1) Fat necrosis 1 1 0 0 Mammotome (1) 80 (59.3*) 24 (17.8*) 4 (3*) 52 (38.5*) Malignant IDC c/s DCIS 26 1 5 20 Excisional surgery (26) DCIS 6 0 3 3 Excisional surgery (6) Mucinous carcinoma 7 0 0 7 Excisional surgery (7) Papillary carcinoma 6 2 2 2 Excisional surgery (6) Malignant phyllodes 5 0 0 5 Excisional surgery (5) Metaplastic carcinoma 5 0 0 5 Excisional surgery (5) 55 (40.7*) 3 (2.2*) 10 (7.4*) 42 (31.1*) Total 135 (100*) 27 (20*) 14 (10.4*) 94 (69.6*) Note.-*Parenthesis (%). CNB = core needle biopsy, DCIS = ductal carcinoma in situ, E&B = excisional biopsy, IDC c/s DCIS = infiltrative ductal cancer with/without ductal carcinoma in situ 이고악성은 3예 (2.2%) 였으며, 낭성과고형성분을비슷하게가지는종양 (intracystic mass) 은 14예 (10.4%) 로양성 4예 (3%) 이고악성은 10예 (7.4%) 였고, 대부분이고형성분이며일부낭성부분을포함하는종양 (solid and cystic mass) 은 94예 (69.6%) 로양성은 52예 (38.5%) 이며악성은 42예 (31.1%) 로분류되었다 (Table 1). BI-RADS 초음파 lexicon 을이용하여분석하였을때복합성에코종괴의악성과양성을감별하는데악성복합성에코종양은양성복합성에코종양에비해불규칙모양 (p < 0.001), 비평행성방향성 (p = 0.023), 경계가잘그려지지않으며 (p < 0.001), 병변주변의증가된 halo (p < 0.001) 와증가된혈류 (p = 0.001) 를보였다. 악성복합성에코종양의크기는 3.11 ± 2.07 cm로양성복합성에코종양 2.06 ± 1.49 cm에비해종괴의크기가더컸으며 (p = 0.002) 이상의소견들은통계적으로유의한차이를보였다 (Table 2, Fig. 1). 복합성에코종양이지만둥글거나난원의모양을가지며, 경계가잘그려지고, 병변주위얇은경계와혈류의증가를보이지않아서양성의심병변으로보인경우는 39예였다. 이들을병리결과와비교하였을때 7예 (17.9%) 에서침윤성유방암, 상피성암, 유두암의악성병변으로확진되었다 (Table 3). 악성으로진단된이들 7예는모두만져지는병변이었다 (Fig. 2). 유방촬영은 119 명에서분석가능하였으며 fatty or fibroglandular density 24예, heterogeneous dense 77예, extremely dense 18예였다. 유방촬영에서병변이발견되지않는경우가 25예, 종괴나비대칭음영을보인경우가 70 예, 석화를보인예가 24예였다 (Table 4). 39예의양성의심복합성에코종양들중유방촬영소견을분석할수있는 33예를따로분석하였을때악성으로확진된예는 7예 (21.1%) 였고모두 heterogeneous dense 혹은 extremely dense 한치밀유방이었으나유방촬영상병변을발견하기어려운경우는없었다. 악성으로확진된예에서비대칭음영이나종양을보이는경우가 4예 (12.1%) 였으며종괴들은둥글거나소엽성이면서경계의일부가명확하지않은양상을보였다. 미세석회화를보이는경우가 3예로모두불규칙한종괴에동반된미세석회화로한예는다형성, 군집의카테고리 5였으며두예에서는카테고리 4의이상석회화였다 (Table 5, Fig. 3). 고찰 복합성에코종양은낭성과고형성분을모두포함한경우이며이들은다양한양성, 비전형적그리고악성병리학적소견과연관성이있다 (2-6). 복합성에코소견을보이는양성종양은섬유낭종성변화 (fibrocystic changes), 유두관내혹은낭종내유두종 (intracystic papilloma) 과섬유선종 (fibroadenoma) 등이며이들은유방암의위험성증가와는관련성이없다. 비전형적혹은고위험의병변중에서는비전형적유관증식 (atypical ductal hyperplasia), 유두암종, 상피내암과침윤암에서복합성 jksronline.org 대한영상의학회지 2013;69(1):71-77 73
카테고리 4 유방복합성에코종양의분석 Table 2. Sonographic Features of 136 Complex Echo Mass of the Breast Feature, Finding No. (%) of Benign Lesions (n = 80) No. (%) of Malignant Lesions (n = 55) p Value Shape < 0.001 Oval or round 75 (55) 36 (27) Irregular 5 (4) 19 (14) Orientation 0.023 Parallel 48 (35) 21 (16) Nonparallel 32 (24) 34 (25) Margin < 0.001 Circumscribed 58 (42) 20 (15) Noncircumscribed 22 (17) 35 (26) Lesion boundary < 0.001 Thin 57 (42) 21 (15) Echogenic halo 23 (18) 34 (25) Posterior acoustic features NS 0.593 Enhancement 46 (34) 35 (26) No enhancement 34 (25) 20 (15) Vascularity 0.001 Not available 3 (2) 2 (1) Present 42 (31) 13 (10) Absent 35 (27) 40 (29) Cystic component NS 0.178 > 50% 26 (20) 12 (9) < 50% 54 (40) 43 (31) Size 2.06 ± 1.49 3.11 ± 2.07 0.002 Note.-chi-square test; p < 0.05 is considered as statistically significant. NS = not significant A B Fig. 1. A 42-year-old women with palpable mass. A. Sonography shows about 5.4 cm sized, round, non parallel, noncircumscribed, complex echoic mass with posterior acoustic enhancement. B. Color Doppler image shows increased vascularity of the mass. Pathology revealed infiltrative ductal carcinoma. 에코악성종양을보일수있다 (2-4). 몇몇연구에서는 23~ 31% 의복합성에코종양이악성으로진단되었다고보고하였다 (3, 7). 본연구에서는 40.7%(55/135) 의복합성에코종양이악성으로진단되었다. 이들중 53예는만져지는종괴였고 2예는유즙분비를보였다. 이처럼복합성에코종양은상당수에서 악성종양으로진단된다. 유방초음파검사에서복합성에코종양을보이는경우초음파의다른 BI-RADS lexicon 을같이적용하면양성과악성종양을예측할수있었다. 본연구에서는악성으로진단된복합성에코종양은불규칙모양, 경계가잘그려지지않고주변의에 74 대한영상의학회지 2013;69(1):71-77 jksronline.org
김하연외 코증가와혈류증가를보여서양성으로진단된복합성에코종 양과의구별에도움이되었다. Berg 등 (3) 은초음파검사에서 경계가잘그려지는낭성종괴의 67% 에서악성으로진단되었 다고하였고, 이결과는복합성에코종양은 BI-RADS 4 로평 가하여야하며이들종양은조직검사를시행하여야한다고하 였다. 본연구에서는종양의경계뿐아니라초음파의다른 BI- Table 3. Analysis of Masses That Ultrasonographic Features of Oval/Round, Circumscribed, Thin Lesion Boundary and Absent of Vascularity Ultrasound Appearance Thick Wall/Septa (n = 11) Intracystic Mass (n = 2) Solid and Cystic Mass (n = 26) Total (n = 39) Benign FA 0 0 10 10 FCD 3 0 6 9 Papilloma 2 0 6 8 Abscess 1 0 1 2 Fat necrosis 1 0 0 1 Mucocele like lesion 2 0 0 2 9 (23.1*) 0 (0*) 23 (59*) 32 (82.1*) Malignant IDC 0 0 2 2 DCIS 0 1 1 2 Papillary carcinoma 2 1 0 3 2 (5.1*) 2 (5.1*) 3 (7.7*) 7 (17.9*) Note.-*Parenthesis (%). DCIS = ductal carcinoma in situ, FA = fibroadenoma, FCD = fibrocystic disease, IDC = infiltrative ductal carcinoma Table 4. Mammographic Evaluation for Complex Echoic Masses Mammographic Findings (n = 119) Benign Malignant Total No visible abnormalities 23 2 25 Mass or asymmetry 36 34 70 Calcifications with/without mass 24 Probably Calcifications 9 0 Suspicious 2 0 Microcalcifications 0 13 Total 70 49 119 Note.-Mammography was available in 88.1% of patients (119/135). A B Fig. 2. A 52-year-old women with palpable mass. A. Sonography shows about 2 cm sized, oval, parallel, circumscribed complex echoic mass with posterior acoustic enhancement. B. Color Doppler image shows no increased vascularity of the mass. Pathology revealed papillary carcinoma. jksronline.org 대한영상의학회지 2013;69(1):71-77 75
카테고리 4 유방복합성에코종양의분석 Table 5. Mammographic Evaluation for Benign Looking Complex Echogenic Mass Ultrasound Appearance n (%) Mammographic Finding (n = 33) No Visible Abnormalities Mass or Asymmetry Microcalcifications c/s Mass Benign Malignant Benign Malignant Benign Malignant Thick wall/septa 9 (27.3) 1 (3.03) 0 (0) 4 (12.1) 0 (0) 3 (9.1) 1 (3.03) Intracystic mass 1 (3.0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 1 (3.03) Solid and cystic mass 23 (69.7) 6 (18.2) 0 (0) 12 (36.4) 4 (12.1) 0 (0) 1 (3.03) Total 33 (100) 7 (21.2) 0 (0) 16 (48.5) 4 (12.1) 3 (9.1) 3 (9.1) Note.-Six patient was not performed mammography because of younger age (teenage or the twenties). A B Fig. 3. A 43-year-old women with palpable mass. A. Sonography shows oval, parallel, circumscribed, complex echoic mass with posterior acoustic enhancement. B. Mammography revealed partial obscured hyperdense mass in left upper inner quadrant. Pathology revealed infiltrative ductal carcinoma. RADS lexicon 을모두사용하여평가하였을때둥글거나난원의모양을가지는경계가잘그려지는복합성에코종양으로병변주위경계가얇고혈류의증가도없는경우에악성으로진단된예가 17.9%(7/39) 로 Berg 등 (3) 의연구에비해서는낮았으나이는종양의경계뿐아니라다른인자들을모두고려하였기때문으로생각된다. 복합성에코라는인자를제외한나머지 BI-RADS lexicon 들을적용하였을경우양성의심으로보인다고하더라도 BI-RADS 3로보고추적검사를시행할수있는기준인 2% 보다는높은악성률을보였으므로복합성에코종양으로보이는모든종괴들은다른소견들이양성의심양상을보이더라도조직검사를권유해야한다는결론을얻었다. 복합성에코종양의경우고등급침윤성유방암이가장빈도가많지만유두암종, 점액종, 악성가엽종 (malignant phyllodes) 이나화생암 (metaplastic carcinoma) 등의악성종양이지만양성의심병변으로보일수있는암종에서복합성에코종양으로나타난다 (2-6). 유방촬영술소견을같이고려하는것은종괴의특징을평가하고미세석회화유무그리고추가적인이상소견을발견할수있다 (7). 본연구에서도초음파에서양성의심복합성에코종 양을보였던 7예의유방촬영소견을분석하였을때악성미세석회화나명확하지않은경계의종괴를보였다. 초음파검사전시행한조직검사나외상에의해생긴혈종혹은지방괴사가복합성에코의양상을가질수있으므로환자의임상소견을확인하는것도도움이될수있다. 이런경우초음파를통한추적검사 (2~3개월) 로병변을재평가함으로써감별에도움을받을수있다 (8). 복합성에코종양을조직검사할경우초음파유도하에고형성분부위에서표본을얻어야한다. 조직검사에서양성유두종으로진단된경우는악성부위가표본으로얻어지지않았을위험성이 8~14% 까지보고되고있기때문에외과적절제를고려하여야한다 (2). 본연구의제한점으로는이미얻어진초음파영상을후향적으로분석하였다는점이다. 그러나전향적으로해석된결과와후향적인분석사이에는차이가없었으며고정된초음파영상을분석하였으나종괴하나당 3개이상의영상에서분석하였다. 결론적으로초음파 BI-RADS lexicon 을사용하면복합성에코종양의악성가능성을예측할수있다. 그러나의미있는수의양성의심복합성에코종양들이악성으로판명되므로영상 76 대한영상의학회지 2013;69(1):71-77 jksronline.org
김하연외 의학과의사는유방촬영술소견과환자의임상양상을고려할필요가있으며초음파상의복합성에코종양이발견된다면조직검사를권유하는것이바람직하다. 참고문헌 1. American College of Radiology. ACR BI-RADS_ ultrasound. In: ACR breast imaging reporting and data system, breast imaging atlas. Reston, VA: American College of Radiology, 2003 2. Berg WA, Sechtin AG, Marques H, Zhang Z. Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am 2010;48:931-987 3. Berg WA, Campassi CI, Ioffe OB. Cystic lesions of the breast: sonographic-pathologic correlation. Radiology 2003;227: 183-191 4. Chang YW, Kwon KH, Goo DE, Choi DL, Lee HK, Yang SB. Sonographic differentiation of benign and malignant cys- tic lesions of the breast. J Ultrasound Med 2007;26:47-53 5. Yoo JL, Woo OH, Kim YK, Cho KR, Yong HS, Seo BK, et al. Can MR Imaging contribute in characterizing well-circumscribed breast carcinomas? Radiographics 2010;30: 1689-1702 6. Doshi DJ, March DE, Crisi GM, Coughlin BF. Complex cystic breast masses: diagnostic approach and imaging-pathologic correlation. Radiographics 2007;27 Suppl 1:S53-S64 7. American College of Radiology. ACR practice guidelines for the performance of diagnostic mammography. In: ACR guidelines and technical standards. Reston, VA: American College of Radiology, 2006 8. Doshi DJ, March DE, Coughlin BF, Crisi GM. Accuracy of ultrasound: guided percutaneous biopsy of complex cystic breast masses [abstr]. In: Radiological Society of North America scientific assembly and annual meeting program. Oak Brook, IL: Radiological Society of North America, 2006:655 카테고리 4 유방복합성에코종양의분석 : 모든복합성에코종양에조직검사가필요한가? 김하연 장윤우 목적 : 초음파검사상카테고리 4 복합성에코종양에서에코패턴을제외한나머지 Breast Imaging Reporting and Data System (BI-RADS) lexicon 을사용하여악성과양성의구별을알아보고조직검사의권유유무를알아보고자하였다. 대상과방법 : 135 개의병리적으로확진된복합성에코종양에서에코패턴외의 BI-RADS lexicon 을사용하여모양, 경계, 방향성, 병변의경계, 후방음영, 혈류등을분석하였다. 초음파소견은병리결과및유방촬영소견과비교하였다. 양성과악성복합성에코종양의초음파소견을 chi-square test 와 Mann-Whitney U test 를사용하여분석하였다. 결과 : 복합성에코종양중 59.3%(80/135) 는양성, 40.7%(55/135) 는악성이었다. 악성복합성에코종양은불규칙모양 (p < 0.001), 비평행방향성 (p = 0.023), 불규칙경계 (p < 0.001), 병변주위고에코 halo (p < 0.001) 와증가된혈류 (p = 0.001) 및크기 (p = 0.002) 에서양성종양과의미있는차이를보였다. 그러나, 둥글거나난원형모양에경계가잘그려지고, 병변의주변이얇으며혈류의증가가없었던복합성에코종양의 12.7%(7/55) 는악성이었다. 이들 7예모두유방촬영에서악성의심미세석회화나비대칭음영및종괴를보였다. 결론 : 복합성에코종양에서에코패턴외의나머지초음파 BI-RADS lexicon 을사용하는것은악성과양성감별에유용하였다. 그러나 12.7% 의양성의심복합성에코종양이악성으로진단될수있으므로영상들은조직검사를권유하여야한다. 순천향대학교의과대학서울병원영상의학과 jksronline.org 대한영상의학회지 2013;69(1):71-77 77