메뉴 건너뛰기




Volumn 34, Issue 4 PART 2, 2011, Pages

Testicular biopsy for early cancer detection - objectives, technique and controversies

Author keywords

Carcinoma in situ testis; Double biopsy; Early diagnosis; Intratubular germ cell neoplasia; Testicular biopsy; Testicular germ cell tumour

Indexed keywords

CANCER DIAGNOSIS; CANCER RADIOTHERAPY; CANCER SURGERY; CARCINOMA IN SITU; EARLY CANCER; EARLY DIAGNOSIS; GERM CELL TUMOR; HUMAN; ORCHIECTOMY; POSTOPERATIVE COMPLICATION; PRIORITY JOURNAL; REVIEW; SPERMATOGENESIS; TESTIS BIOPSY; TESTIS CANCER;

EID: 79960853885     PISSN: 01056263     EISSN: 13652605     Source Type: Journal    
DOI: 10.1111/j.1365-2605.2011.01152.x     Document Type: Review
Times cited : (36)

References (65)
  • 2
    • 70349556463 scopus 로고    scopus 로고
    • Testosterone production is better preserved after 16 than 20 gray irradiation treatment against testicular carcinoma in situ cells
    • Bang AK, Petersen JH, Petersen PM, Andersson AM, Daugaard G & Jørgensen N. (2009) Testosterone production is better preserved after 16 than 20 gray irradiation treatment against testicular carcinoma in situ cells. Int J Radiat Oncol Biol Phys 75, 672-676.
    • (2009) Int J Radiat Oncol Biol Phys , vol.75 , pp. 672-676
    • Bang, A.K.1    Petersen, J.H.2    Petersen, P.M.3    Andersson, A.M.4    Daugaard, G.5    Jørgensen, N.6
  • 3
    • 0019853381 scopus 로고
    • Value of testicular biopsy in diagnosing carcinoma in situ testis
    • Berthelsen JG & Skakkebaek NE (1981) Value of testicular biopsy in diagnosing carcinoma in situ testis. Scand J Urol Nephrol 15, 165-168.
    • (1981) Scand J Urol Nephrol , vol.15 , pp. 165-168
    • Berthelsen, J.G.1    Skakkebaek, N.E.2
  • 4
    • 0018778976 scopus 로고
    • Incidence of carcinoma in situ of germ cells in contralateral testis of men with testicular tumours
    • Berthelsen JG, Skakkebaek NE, Mogensen P & Sorensen BL. (1979) Incidence of carcinoma in situ of germ cells in contralateral testis of men with testicular tumours. Br Med J 2, 363-364.
    • (1979) Br Med J , vol.2 , pp. 363-364
    • Berthelsen, J.G.1    Skakkebaek, N.E.2    Mogensen, P.3    Sorensen, B.L.4
  • 5
    • 0023276137 scopus 로고
    • Testicular biopsy as an outpatient procedure in screening for carcinoma-in-situ: complications and the patient's acceptance
    • Bruun E, Frimodt-Moller C, Giwercman A, Lenz S & Skakkebaek NE. (1987) Testicular biopsy as an outpatient procedure in screening for carcinoma-in-situ: complications and the patient's acceptance. Int J Androl 10, 199-202.
    • (1987) Int J Androl , vol.10 , pp. 199-202
    • Bruun, E.1    Frimodt-Moller, C.2    Giwercman, A.3    Lenz, S.4    Skakkebaek, N.E.5
  • 8
    • 0034585437 scopus 로고    scopus 로고
    • Diagnostic and therapeutic testis biopsy
    • Chan PT & Schlegel PN. (2000) Diagnostic and therapeutic testis biopsy. Curr Urol Rep 1, 266-272.
    • (2000) Curr Urol Rep , vol.1 , pp. 266-272
    • Chan, P.T.1    Schlegel, P.N.2
  • 9
    • 84942384422 scopus 로고
    • Testicular biopsy. Its value in male sterility
    • Charny CW. (1940) Testicular biopsy. Its value in male sterility. J Amer Med Ass 115, 1429-1433.
    • (1940) J Amer Med Ass , vol.115 , pp. 1429-1433
    • Charny, C.W.1
  • 10
    • 24944536731 scopus 로고    scopus 로고
    • Variability in testis biopsy interpretation: implications for male infertility care in the era of intracytoplasmic sperm injection
    • Cooperberg MR, Chi T, Jad A, Cha I & Turek PJ. (2005) Variability in testis biopsy interpretation: implications for male infertility care in the era of intracytoplasmic sperm injection. Fertil Steril 84, 672-627.
    • (2005) Fertil Steril , vol.84 , pp. 672-627
    • Cooperberg, M.R.1    Chi, T.2    Jad, A.3    Cha, I.4    Turek, P.J.5
  • 12
    • 0029962516 scopus 로고    scopus 로고
    • Prevalence of contralateral testicular intraepithelial neoplasia in patients with testicular germ cell neoplasms
    • Dieckmann KP & Loy V. (1996) Prevalence of contralateral testicular intraepithelial neoplasia in patients with testicular germ cell neoplasms. J Clin Oncol 14, 3126-3132.
    • (1996) J Clin Oncol , vol.14 , pp. 3126-3132
    • Dieckmann, K.P.1    Loy, V.2
  • 13
    • 0037967307 scopus 로고    scopus 로고
    • False-negative biopsies for the diagnosis of testicular intraepithelial neoplasia (TIN) - an update
    • Dieckmann KP & Loy V. (2003) False-negative biopsies for the diagnosis of testicular intraepithelial neoplasia (TIN) - an update. Eur Urol 43, 516-521.
    • (2003) Eur Urol , vol.43 , pp. 516-521
    • Dieckmann, K.P.1    Loy, V.2
  • 14
    • 0032727290 scopus 로고    scopus 로고
    • Carcinoma in situ of the testis: a review of biological and clinical features
    • Dieckmann KP & Skakkebaek NE. (1999) Carcinoma in situ of the testis: a review of biological and clinical features. Int J Cancer 83, 815-822.
    • (1999) Int J Cancer , vol.83 , pp. 815-822
    • Dieckmann, K.P.1    Skakkebaek, N.E.2
  • 15
    • 0036624928 scopus 로고    scopus 로고
    • Testicular germ cell cancer despite previous local radiotherapy to the testis
    • Dieckmann KP, Lauke H, Michl U, Winter E & Loy V. (2002) Testicular germ cell cancer despite previous local radiotherapy to the testis. Eur Urol 41, 643-649.
    • (2002) Eur Urol , vol.41 , pp. 643-649
    • Dieckmann, K.P.1    Lauke, H.2    Michl, U.3    Winter, E.4    Loy, V.5
  • 16
    • 1842728507 scopus 로고    scopus 로고
    • Four testicular biopsies failing to detect a case of testicular intraepithelial neoplasia
    • Dieckmann KP, Pottek T, Heinemann V, Höpker WW & Loy V. (2004) Four testicular biopsies failing to detect a case of testicular intraepithelial neoplasia. Acta Oncol 43, 212-214.
    • (2004) Acta Oncol , vol.43 , pp. 212-214
    • Dieckmann, K.P.1    Pottek, T.2    Heinemann, V.3    Höpker, W.W.4    Loy, V.5
  • 17
    • 24644474628 scopus 로고    scopus 로고
    • How harmful is contralateral testicular biopsy? An analysis of serial imaging studies and a prospective evaluation of surgical complications
    • Dieckmann KP, Heinemann V, Frey U & Pichlmeier U. (2005) How harmful is contralateral testicular biopsy? An analysis of serial imaging studies and a prospective evaluation of surgical complications. Eur Urol 48, 662-672.
    • (2005) Eur Urol , vol.48 , pp. 662-672
    • Dieckmann, K.P.1    Heinemann, V.2    Frey, U.3    Pichlmeier, U.4
  • 18
    • 33751427389 scopus 로고    scopus 로고
    • Diagnosis of contralateral testicular intraepithelial neoplasia (TIN) in patients with testicular germ cell cancer: systematic two-site biopsies are more sensitive than a single random biopsy
    • Dieckmann KP, Kulejewski M, Pichlmeier U & Loy V. (2007) Diagnosis of contralateral testicular intraepithelial neoplasia (TIN) in patients with testicular germ cell cancer: systematic two-site biopsies are more sensitive than a single random biopsy. Eur Urol 51, 175-185.
    • (2007) Eur Urol , vol.51 , pp. 175-185
    • Dieckmann, K.P.1    Kulejewski, M.2    Pichlmeier, U.3    Loy, V.4
  • 19
    • 77952007552 scopus 로고    scopus 로고
    • Intratubular germ cell neoplasia of the testis and its associated cancers: the use of novel biomarkers
    • Emerson RE & Ulbright TM. (2010) Intratubular germ cell neoplasia of the testis and its associated cancers: the use of novel biomarkers. Pathology 42, 344-355.
    • (2010) Pathology , vol.42 , pp. 344-355
    • Emerson, R.E.1    Ulbright, T.M.2
  • 22
    • 0025976239 scopus 로고
    • Prevalence of carcinoma in situ and other histopathological abnormalities in testes from 399 men who died suddenly and unexpectedly
    • Giwercman A, Muller J & Skakkebaek NE. (1991) Prevalence of carcinoma in situ and other histopathological abnormalities in testes from 399 men who died suddenly and unexpectedly. J Urol 145, 77-80.
    • (1991) J Urol , vol.145 , pp. 77-80
    • Giwercman, A.1    Muller, J.2    Skakkebaek, N.E.3
  • 23
    • 0027402980 scopus 로고
    • Should the contralateral testis be biopsied? Round table discussion
    • Grigor KM & Rorth M. (1993) Should the contralateral testis be biopsied? Round table discussion. Eur Urol 23: 129-135.
    • (1993) Eur Urol , vol.23 , pp. 129-135
    • Grigor, K.M.1    Rorth, M.2
  • 25
    • 0035930098 scopus 로고    scopus 로고
    • Incidence of metachronous testicular cancer in patients with extragonadal germ cell tumors
    • Hartmann JT, Fossa SD, Nichols CR, Droz JP, Horwich A, Gerl A et al. (2001) Incidence of metachronous testicular cancer in patients with extragonadal germ cell tumors. J Natl Cancer Inst 93, 1733-1738.
    • (2001) J Natl Cancer Inst , vol.93 , pp. 1733-1738
    • Hartmann, J.T.1    Fossa, S.D.2    Nichols, C.R.3    Droz, J.P.4    Horwich, A.5    Gerl, A.6
  • 26
    • 70350437735 scopus 로고    scopus 로고
    • Contralateral testicular biopsy in testis cancer: current concepts and controversies
    • Heidenreich A. (2009) Contralateral testicular biopsy in testis cancer: current concepts and controversies. BJU Int 104, 1346-1350.
    • (2009) BJU Int , vol.104 , pp. 1346-1350
    • Heidenreich, A.1
  • 27
    • 0030864540 scopus 로고    scopus 로고
    • Is biopsy of the contralateral testis necessary in patients with germ cell tumors?
    • Herr HW & Sheinfeld J. (1997) Is biopsy of the contralateral testis necessary in patients with germ cell tumors? J Urol 158, 1331-1334.
    • (1997) J Urol , vol.158 , pp. 1331-1334
    • Herr, H.W.1    Sheinfeld, J.2
  • 28
    • 0037899183 scopus 로고    scopus 로고
    • Histological evidence of testicular dysgenesis in contralateral biopsies from 218 patients with testicular germ cell cancer
    • Hoei-Hansen CE, Holm M, Rajpert-De Meyts E & Skakkebaek NE. (2003) Histological evidence of testicular dysgenesis in contralateral biopsies from 218 patients with testicular germ cell cancer. J Pathol 200, 370-374.
    • (2003) J Pathol , vol.200 , pp. 370-374
    • Hoei-Hansen, C.E.1    Holm, M.2    Rajpert-De Meyts, E.3    Skakkebaek, N.E.4
  • 29
    • 21344465850 scopus 로고    scopus 로고
    • Carcinoma in situ testis, the progenitor of testicular germ cell tumours: a clinical review
    • Hoei-Hansen CE, Rajpert-De Meyts E, Daugaard G & Skakkebaek NE. (2005) Carcinoma in situ testis, the progenitor of testicular germ cell tumours: a clinical review. Ann Oncol 16, 863-868.
    • (2005) Ann Oncol , vol.16 , pp. 863-868
    • Hoei-Hansen, C.E.1    Rajpert-De Meyts, E.2    Daugaard, G.3    Skakkebaek, N.E.4
  • 31
    • 0026028298 scopus 로고
    • Asynchronous bilateral testicular tumour without previous carcinoma in situ
    • Hoeltl W, Gabriel C & Marberger M. (1991) Asynchronous bilateral testicular tumour without previous carcinoma in situ. Eur J Cancer 27, 110.
    • (1991) Eur J Cancer , vol.27 , pp. 110
    • Hoeltl, W.1    Gabriel, C.2    Marberger, M.3
  • 32
    • 0029891252 scopus 로고    scopus 로고
    • Histologic diagnostics of early testicular germ-cell tumor
    • Holstein AF & Lauke H. (1996) Histologic diagnostics of early testicular germ-cell tumor. Int J Urol 3, 165-172.
    • (1996) Int J Urol , vol.3 , pp. 165-172
    • Holstein, A.F.1    Lauke, H.2
  • 33
    • 0013998926 scopus 로고
    • Vermeidbare Risiken bei der Hodenbiopsie
    • Hundeiker M & Mulert Lv. (1966) Vermeidbare Risiken bei der Hodenbiopsie. Hautarzt 17, 546-547.
    • (1966) Hautarzt , vol.17 , pp. 546-547
    • Hundeiker, M.1    Mulert, L.2
  • 34
    • 0025360534 scopus 로고
    • Intratesticular arterial anatomy
    • Jarow JP. (1990) Intratesticular arterial anatomy. J Androl 11, 255-259.
    • (1990) J Androl , vol.11 , pp. 255-259
    • Jarow, J.P.1
  • 35
    • 34247891602 scopus 로고    scopus 로고
    • ITGCN of the testis, contralateral testicular biopsy and bilateral testicular cancer
    • Karellas ME, Damjanov I & Holzbeierlein JM. (2007) ITGCN of the testis, contralateral testicular biopsy and bilateral testicular cancer. Urol Clin North Am 34, 119-125.
    • (2007) Urol Clin North Am , vol.34 , pp. 119-125
    • Karellas, M.E.1    Damjanov, I.2    Holzbeierlein, J.M.3
  • 36
    • 0037547110 scopus 로고    scopus 로고
    • Update on the diagnostic safety for detection of testicular intraepithelial neoplasia (TIN)
    • Kliesch S, Thomaidis T, Schütte B, Puhse G, Kater B, Roth S & Bergmann M. (2003) Update on the diagnostic safety for detection of testicular intraepithelial neoplasia (TIN). APMIS 111, 70-74.
    • (2003) APMIS , vol.111 , pp. 70-74
    • Kliesch, S.1    Thomaidis, T.2    Schütte, B.3    Puhse, G.4    Kater, B.5    Roth, S.6    Bergmann, M.7
  • 37
    • 38949169584 scopus 로고    scopus 로고
    • European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus group (EGCCCG): Part I
    • Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F et al. (2008) European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus group (EGCCCG): Part I. Eur Urol 53, 478-496.
    • (2008) Eur Urol , vol.53 , pp. 478-496
    • Krege, S.1    Beyer, J.2    Souchon, R.3    Albers, P.4    Albrecht, W.5    Algaba, F.6
  • 38
    • 0030683537 scopus 로고    scopus 로고
    • Rapid method to detect CIS-cells
    • Lauke H. (1997) Rapid method to detect CIS-cells. Adv Exp Med Biol 424, 69-70.
    • (1997) Adv Exp Med Biol , vol.424 , pp. 69-70
    • Lauke, H.1
  • 39
    • 17144387569 scopus 로고    scopus 로고
    • Prevalence of testicular intraepithelial neoplasia in healthy males
    • Linke J, Loy V & Dieckmann KP. (2005) Prevalence of testicular intraepithelial neoplasia in healthy males. J Urol 173, 1577-1579.
    • (2005) J Urol , vol.173 , pp. 1577-1579
    • Linke, J.1    Loy, V.2    Dieckmann, K.P.3
  • 40
    • 0025406848 scopus 로고
    • Carcinoma in situ of the testis: intratubular germ cell neoplasia or testicular intraepithelial neoplasia?
    • Loy V & Dieckmann K-P. (1990) Carcinoma in situ of the testis: intratubular germ cell neoplasia or testicular intraepithelial neoplasia? Hum Pathol 21, 457.
    • (1990) Hum Pathol , vol.21 , pp. 457
    • Loy, V.1    Dieckmann, K.-P.2
  • 41
    • 0025349930 scopus 로고
    • Incidence and distribution of carcinoma in situ in testes removed for germ cell tumour: possible inadequacy of random testicular biopsy in detecting the condition
    • Loy V, Wigand I & Dieckmann KP. (1990) Incidence and distribution of carcinoma in situ in testes removed for germ cell tumour: possible inadequacy of random testicular biopsy in detecting the condition. Histopathology 16, 198-200.
    • (1990) Histopathology , vol.16 , pp. 198-200
    • Loy, V.1    Wigand, I.2    Dieckmann, K.P.3
  • 42
    • 27144485163 scopus 로고    scopus 로고
    • Is a contralateral testicular biopsy in patients with unilateral germ cell testicular cancer indicated as a routine procedure?
    • Maase H van der. (2005) Is a contralateral testicular biopsy in patients with unilateral germ cell testicular cancer indicated as a routine procedure? Acta Oncol 44, 523-525.
    • (2005) Acta Oncol , vol.44 , pp. 523-525
    • Maase, H.V.D.1
  • 43
    • 80955178453 scopus 로고    scopus 로고
    • NCCN NCCN Practice Guidelines in Oncology. Testicular Cancer. V.2.2009. Available at: Accessed September 05, 2010.
    • NCCN (2009) NCCN Practice Guidelines in Oncology. Testicular Cancer. V.2.2009. Available at: Accessed September 05, 2010.
    • (2009)
  • 44
    • 0032851720 scopus 로고    scopus 로고
    • Testicular biopsy. Contemporary interpretation
    • Nistal M & Paniagua R. (1999) Testicular biopsy. Contemporary interpretation. Urol Clin North Am 26, 555-593.
    • (1999) Urol Clin North Am , vol.26 , pp. 555-593
    • Nistal, M.1    Paniagua, R.2
  • 45
    • 0024462517 scopus 로고
    • Carcinoma in situ of the testis in infertile men. A histological, immunocytochemical, and cytophotometric study of DNA content
    • Nistal M, Codesal J & Paniagua R. (1989) Carcinoma in situ of the testis in infertile men. A histological, immunocytochemical, and cytophotometric study of DNA content. J Pathol 159, 205-210.
    • (1989) J Pathol , vol.159 , pp. 205-210
    • Nistal, M.1    Codesal, J.2    Paniagua, R.3
  • 46
    • 14644396631 scopus 로고    scopus 로고
    • Testicular germ-cell tumours in a broader perspective
    • Oosterhuis JW & Looijenga LH. (2005) Testicular germ-cell tumours in a broader perspective. Nat Rev Cancer 5, 210-222.
    • (2005) Nat Rev Cancer , vol.5 , pp. 210-222
    • Oosterhuis, J.W.1    Looijenga, L.H.2
  • 50
    • 0027936598 scopus 로고
    • Carcinoma -in-situ of the human testis: tumour cells are distributed focally in the seminiferous tubules
    • Prym C & Lauke H. (1994) Carcinoma -in-situ of the human testis: tumour cells are distributed focally in the seminiferous tubules. Andrologia 26, 231-234.
    • (1994) Andrologia , vol.26 , pp. 231-234
    • Prym, C.1    Lauke, H.2
  • 51
    • 33645835375 scopus 로고    scopus 로고
    • Developmental model for the pathogenesis of testicular carcinoma in situ: genetic and environmental aspects
    • Rajpert-De Meyts E. (2006) Developmental model for the pathogenesis of testicular carcinoma in situ: genetic and environmental aspects. Hum Reprod Update 12, 303-323.
    • (2006) Hum Reprod Update , vol.12 , pp. 303-323
    • Rajpert-De Meyts, E.1
  • 52
    • 20444442853 scopus 로고    scopus 로고
    • Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction
    • Ramasamy R, Yagan N & Schlegel PN. (2005) Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology 65, 1190-1194.
    • (2005) Urology , vol.65 , pp. 1190-1194
    • Ramasamy, R.1    Yagan, N.2    Schlegel, P.N.3
  • 54
    • 77954345456 scopus 로고    scopus 로고
    • Testicular seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    • Schmoll HJ, Jordan K, Huddart R, Pes MP, Horwich A, Fizazi K & Kataja V. (2010) Testicular seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl.5), v140-v146.
    • (2010) Ann Oncol , vol.21 , Issue.SUPPL. 5
    • Schmoll, H.J.1    Jordan, K.2    Huddart, R.3    Pes, M.P.4    Horwich, A.5    Fizazi, K.6    Kataja, V.7
  • 55
  • 56
    • 0036135348 scopus 로고    scopus 로고
    • The role of testicular biopsy in the modern management of male infertility
    • Schoor RA, Elhanbly S, Niederberger CS & Ross LS. (2002) The role of testicular biopsy in the modern management of male infertility. J Urol 167, 197-200.
    • (2002) J Urol , vol.167 , pp. 197-200
    • Schoor, R.A.1    Elhanbly, S.2    Niederberger, C.S.3    Ross, L.S.4
  • 58
    • 0015499388 scopus 로고
    • Possible carcinoma in situ of the testis
    • Skakkebaek NE. (1972) Possible carcinoma in situ of the testis. Lancet 2: 516-517.
    • (1972) Lancet , vol.2 , pp. 516-517
    • Skakkebaek, N.E.1
  • 59
    • 0023243854 scopus 로고
    • Carcinoma in situ of the testis: possible origin from gonocytes and precursor of all types of germ cell tumours except spermatocytoma
    • Skakkebaek NE, Berthelsen JG, Giwercman A & Müller J. (1987) Carcinoma in situ of the testis: possible origin from gonocytes and precursor of all types of germ cell tumours except spermatocytoma. Int J Androl 10, 19-28.
    • (1987) Int J Androl , vol.10 , pp. 19-28
    • Skakkebaek, N.E.1    Berthelsen, J.G.2    Giwercman, A.3    Müller, J.4
  • 61
    • 77956523833 scopus 로고    scopus 로고
    • Testicular microlithiasis predicts concurrent testicular germ cell tumors and intratubular germ cell neoplasia of unclassified type in adults: a meta-analysis and systematic review
    • Tan IB, Ang KK, Ching BC, Mohan C, Toh CK & Tan MH. (2010) Testicular microlithiasis predicts concurrent testicular germ cell tumors and intratubular germ cell neoplasia of unclassified type in adults: a meta-analysis and systematic review. Cancer 116, 4520-4532.
    • (2010) Cancer , vol.116 , pp. 4520-4532
    • Tan, I.B.1    Ang, K.K.2    Ching, B.C.3    Mohan, C.4    Toh, C.K.5    Tan, M.H.6
  • 62
    • 0002877283 scopus 로고
    • Häufigkeit und Verteilungsmuster des carcinoma in situ in tumorbefallenen Hoden
    • Walz PH, Eitner S, Tan HK & Böhm E. (1992) Häufigkeit und Verteilungsmuster des carcinoma in situ in tumorbefallenen Hoden. Aktuelle Urol 23, 73-77.
    • (1992) Aktuelle Urol , vol.23 , pp. 73-77
    • Walz, P.H.1    Eitner, S.2    Tan, H.K.3    Böhm, E.4
  • 64
    • 0034838936 scopus 로고    scopus 로고
    • Pathologie und pathomorphologische Diagnostik von Keimzelltumoren des Hodens
    • Wittekind C & Loy V. (2001) Pathologie und pathomorphologische Diagnostik von Keimzelltumoren des Hodens. Pathologe 22, 316-325.
    • (2001) Pathologe , vol.22 , pp. 316-325
    • Wittekind, C.1    Loy, V.2


* 이 정보는 Elsevier사의 SCOPUS DB에서 KISTI가 분석하여 추출한 것입니다.