MRI对乳腺癌新辅助化疗后腋窝淋巴结的评估  

Evaluation of MRI for axillary lymph node in breast cancer after neoadjuvant chemotherapy

作　　者：李富[1] 曾健[1] 李春燕[2] 罗铭[1] 孔震[1] 

机构地区：[1]广西医科大学第一附属医院胃肠腺体外科,530021 [2]广西医科大学第一附属医院放射科,530021

出　　处：《天津医药》2016年第1期94-97,共4页Tianjin Medical Journal

基　　金：广西壮族自治区卫生厅自筹经费科研课题(Z2011328)

摘　　要：目的探讨MRI对乳腺癌新辅助化疗后腋窝淋巴结(ALN)评估的价值。方法对44例乳腺癌患者进行新辅助化疗(NAC),比较患者NAC前和NAC4周期后MRI测量患侧ALN直径、肿瘤表观扩散系数(ADC)值变化及其间接相关性;比较MRI与病理对患侧腋窝阳性淋巴结的检测结果。结果所有患者均完成了4周期的NAC,有反应(CR+PR)率为72.73%(32/44),无反应(SD+PD)率为27.27%(12/44)。有反应组NAC前后的ALN最大直径由(1.37±1.06)cm缩短为(0.90±0.76)cm,NAC前后的ADC值由(0.91±0.28)×10-3mm2/s增加到(1.01±0.32)×10-3mm2/s(P<0.01);NAC前后的ADC值变化(△ADC)与腋窝淋巴结NAC前后最大直径的变化(△L)不相关(r=0.131,P=0.413)。NAC后MRI评估ALN的敏感度100%,特异度62.5%,Kappa值0.68。结论 MRI功能指标ADC值不能作为早期间接反映NAC后ALN的疗效的独立指标,但MRI仍是评估NAC后ALN状态的敏感指标。Objective To explore and evaluate the clinical value of MRI for status of axillary lymph node after neoadju- rant chemotherapy （NAC） in patients with breast cancer. Methods Forty-four patients with locally advanced breast cancer （LABC） were underwent NAC for four cycles. The longest diameter of axillary lymph node （ALN） measured by MRI scan. Val- ue of apparent diffusion coefficient （ADC） and their correlation were compared before NAC and four cycles after NAC. Re- sults of MRI and pathological data for ALN were compared between two groups of patients. Results All patients finished four cycles of NAC. The total response rate （CR±PR） was 72.7% （32/44）, and the total non-response rate （SD±PD） was 27.3% （12/44）. The longest diameter of ALN was significantly shortened in response group. The longest diameter was （1.37± 1.06） cm before NAC and （0.90±0.76） cm after NAC （P 〈 0.01）. The ADC value of the tumor was significantly increased in re- sponse group [（0.91±0.28） ×10-3 mm2/s before NAC and （1.01±0.32）×10 3 mm2/s after NAC, P 〈 0.01）]. There was no signifi- cant correlation between ADC value change （A ADC） and the longest diameter change of ALN （A L, r=0.131, P=0.413）. The sensitivity, specificity and Kappa value of ALN evaluation after NAC were 100%, 62.5% and 0.68 measured by MRI. Con- clusion The change of tumor longest diameter reflects the effect of chemotherapy directly. The tumor ADC value of MRI can not be used as an independent indicator of chemotherapy effect of ALN, eventhouth MRI was the sensitive index for eval- uating the status of axillary lymph node after neoadjuvant chemotherapy for breast cancer.

关 键 词：乳腺肿瘤 化学疗法 辅助 磁共振成像 信号处理 计算机辅助 淋巴转移 治疗结果 新辅助化疗 表观扩散系数 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]