乳腺癌新辅助化疗前后MR表观扩散系数变化与病理反应性分级的相关性研究  

Prediction of response of breast cancer to neoadjuvant chemotherapy by MR diffusion-weighted imaging： a study of correlation between apparent diffusion coefficient value and pathologic response

作　　者：武春雪[1] 王霄英[1] 秦乃姗[1] 李挺[2] 张虹[2] 刘荫华[3] 徐玲[3] 蒋学祥[1] 

机构地区：[1]北京大学第一医院医学影像科北京大学前沿交叉学科研究院功能成像研究中心,100034 [2]北京大学第一医院病理科,100034 [3]北京大学第一医院乳腺中心,100034

出　　处：《中华放射学杂志》2009年第12期1286-1290,共5页Chinese Journal of Radiology

基　　金：医学物理和工程北京市重点实验室开放课题（2008P03）

摘　　要：目的研究乳腺癌患者新辅助化疗前、后各周期ADC值及其变化率（△ADC％），探讨两种参数对新辅助化疗病理反应性评估的价值。方法35例穿刺活检证实为乳腺癌的患者分别于新辅助化疗前、化疗第2和第3周期之间、化疗第4周期后行MRDWI及增强扫描，根据其术后病理对化疗反应的分级将其分为组织学反应显著（MHR）与非显著（NMHR）2组，利用重复测量的单因素方差分析及t检验分析2组患者癌灶区与对应正常腺体的ADC值，采用秩和检验分析3次ADC值及么ADC％，并应用ROC分析其对病理反应性评估的效能。结果MHR组的乳腺癌灶手术前ADC值[中位数（范围）]为1．54×10^-3mm^2／s[（1．01～1．88）×10^-3mm^2／s]，ΔADC％为42．70％（6．31％～67．86％）；在化疗第4周期后明显高于NMHR组的1．22×10^-3mm^2／s[（0．83～1．83）×10^-3mm^2／s]和14．88％（-28．87％-39．69％），差异有统计学意义（Z值分别为-2．77、-4．10，P值均〈0．05），而化疗早期MHR组ADC值为1．15×10^-3mm^2／s[（0．85～1．62）×10^-3mm^2／s]，ΔADC％值为12．00％（-12．96％～30．65％）；NMHR组ADC值为1．15×10^-3mm^2／s[（0．94～1．60）×10^-3mm^2／s]，ΔADC％值为10．74％（-20．80％～41．81％）；2组差异无统计学意义（P〉0．05）。分别以病灶ADC及ΔADC％为评估值，对MHR和NMHR组进行ROC分析，其中只有ΔADC，％的评估效能较高（AzΔADC，％=0．88）。结论化疗晚期ΔADC％可以较准确预测乳腺癌对新辅助化疗的最终病理反应性。Objective To characterize the value of ADC and their changes （ ΔADC% ） before and during the neoadjuvant chemotherapy, and their value in predicting the pathologic response of breast cancer to neoadjuvant chemotherapy. Methods Diffusion weighted imaging and dynamic contrast enhanced magnetic resonance examinations were performed in 35 women with breast cancer before treatment and after the second and the forth cycle of neoadjuvant chemotherapy. All patients were divided into MHR （major histological response） group and NMHR （non-major histological response） group according to the final pathologic response. One-way ANOVA and t test were used to compare the differences of cancer tissue and normal tissue. Rank sum test was used to compare the difference of ADC and Δ ADC% between two groups. ROC analysis of ADC values and ΔADC% were used to identify which parameter could be used to predict the pathologic response to neoadjuvant chemotherapy. Results After the forth cycle, the ADC value and ΔADC% in MHR group [ 1.54 ×10^-3mm^2/s （ 1.01--1.88 ）×10^-3mm^2/s and 42.70% （ 6. 31%-- 67.86% ） ] were significant higher than those in NMHR group [ 1.22×10^-3mm^2/s （0. 83-1.83 ） ×10^-3mm^2/s,14. 88% （ -28.87%--39.69% ,P〈0. 05） ]. However, the ADC value and Z3 ADC% in the two groups were not different before treatment and after second cycle treatment： 1.15 ×10^-3mm^2/s （0. 85--1.62） ×10^-3mm^2/s and 12. 00% （ - 12. 96%--30. 65% ）in MHR; 1.15 ×10^-3mm^2/s（0. 94--1.60） ×10^-3mm^2/s and 10. 74% （ -20. 80%--41.81% ,P 〉0. 05）in NMHR. Only the Δ ADC3% showed high efficacy in predicting the pathologic response （ area under ROC curve was 0. 88 ）. Conclusion The rate of ADC change in late cycle could be used to predict the pathologic response of breast cancer to neoadjuvant chemotherapy.

关 键 词：乳腺肿瘤 药物疗法 联合 磁共振成像 扩散 

分 类 号：R737.9[医药卫生—肿瘤] R245.3[医药卫生—临床医学]