MRI对浸润性乳腺癌新辅助化疗疗效的评估价值  

Evaluation of the therapeutic effects of neoadjuvant chemotherapy in invasive breast cancer using magnetic resonance imaging

作　　者：胡静[1] 赵亚娥 汪登斌[1] 沈坤炜[3] 李亚芬[3] 陈伟国[3] 柴维敏[1] 姜婷婷[1] 王露岚[1] 李志[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院放射科,上海200025 [2]上海市东医院放射科,上海200438 [3]上海交通大学医学院附属瑞金医院乳腺疾病诊治中心,上海200025

出　　处：《外科理论与实践》2011年第1期29-34,共6页Journal of Surgery Concepts & Practice

基　　金：上海市科委创新行动计划纳米专项研究项目(0852nm04600);上海市教育委员会科研创新重点项目(09zz112)

摘　　要：目的:探讨MRI在评价新辅助化疗治疗浸润性乳腺癌方面的价值。方法:回顾性分析20例行术前新辅助化疗,并行化疗前、后MRI检查的浸润性乳腺癌病人。将其病理学反应分为5级;4级和5级为组织学显著反应(majorhistological response,MHR),并以此作为参考标准,以图像表现作为对照。所有影像资料由两位医师通过诊断工作站共同阅片,判断是否属MHR;意见不一致时,咨询另一位资深医师。用Kappa分析对MRI判读结果与参考标准间进行一致性检验。结果:MRI对化疗后浸润癌残余的诊断与参考标准间的一致性较好,Kappa值为0.6。新辅助化疗后乳腺癌病灶明显缩小(P<0.001),乳腺癌新辅助化疗前、后病灶的时间-信号强度曲线改变有统计学意义(P=0.014)。乳腺癌新辅助化疗前病灶平均ADC值为(0.89±0.14)×10-3mm2/s,化疗后病灶平均ADC值为(1.13±0.31)×10-3mm2/s,新辅助化疗前、后病灶ADC值的变化有统计学意义(P<0.05)。结论:MRI在乳腺癌新辅助化疗疗效的无创性评价方面具有较大价值。Objective To explore the value of magnetic resonance imaging（MRI） in evaluating the therapeutic effects of neoadjuvant chemotherapy in invasive breast cancer.Methods Twenty cases of invasive breast cancers with MRI examination both before and after neoadjuvant chemotherapy were retrospectively analyzed.The pathological response was divided into 5 grades： grade 4 and 5 were referred to as major histological response（MHR）.The imaging features of the cases were compared with this notation.All the images were reviewed by two radiologists using an interactive workstation in order to give a grading score with the reference of pathological grading system;they were required to consult a third experienced radiologist when they could not reach a consensus.Kappa test was performed for the comparison of the MRI and pathological outcome after surgery.Results The MRI diagnosis had a good correlation with the pathological results in evaluating the residual cancerous lesion after the neoadjuvant chemotherapy in invasive breast cancer（Kappa=0.6）.The size of the lesion showed remarkable reduction after the treatment（P0.001）.The time-signal intensity curve of the breast cancer changed greatly when comparing the pre-treatment data with that of the post-treatment（P=0.014）.The mean of the apparent diffusion coefficient（ADC） value was 0.89±0.14×10-3mm2/s before the new adjuvant chemotherapy while it rose higher to 1.13±0.31×10-3mm2/s after the treatment,demonstrating a statistical significance（P=0.05）.Conclusions Breast MRI is valuable in noninvasive evaluation of the therapeutic effects of neoadjuvant chemotherapy in invasive breast cancer.Thus,the breast MRI can be used to predict the postoperative pathologic response.

关 键 词：乳腺癌 新辅助化疗 磁共振成像 病理学反应性 治疗疗效 

分 类 号：R737.9[医药卫生—肿瘤]