肿瘤直径联合ADC值对不同亚型乳腺癌NAC疗效的评估价值  

The evaluation of the tumor diameter combined ADC values for the therapeutic efficacy of neoadjuvant chemotherapy in each subtype of breast cancer

作　　者：张丹丹 庄治国[1] 耿小川[1] 李岚[1] 华佳[1] ZHANG Dandan, ZHUANG Zhiguo, GENG Xiaochuan, L1 Lan, HUA J ia(Department of Radiology,Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院(东院)放射科,上海200127

出　　处：《实用放射学杂志》2018年第3期366-369,385,共5页Journal of Practical Radiology

基　　金：多学科交叉项目培育（医工）（YG2014ZD05）.

摘　　要：目的 探讨动态增强磁共振成像（DCE-MRI）所示肿瘤最长径变化率（ΔD%）与联合ΔD% 和表观扩散系数（ADC）值变化率（ΔADC%）对各亚型乳腺癌新辅助化疗（NAC）后疗效评估价值。方法 回顾分析浸润性乳腺癌患者121例，其中包括Luminal A型56例、Luminal B型42例、Her-2型13例和三阴型乳腺癌10例。结果 单一运用DCE-MRI中肿瘤ΔD%进行疗效评估，对影像评估结果与术后病理结果进行一致性检验，Kappa值在总体患者、Luminal A、Luminal B、Her-2型和三阴型乳腺癌中分别为0.594、0.617、0.401、0.690、0.800。联合ΔD%和ΔADC%，所得一致性检验结果为0.844、0.792、0.854、0.847、0.800。联合指标对诊断病理完全缓解（pCR）的敏感性在Luminal型中升高显著，Her-2型略升高，三阴型不变。结论 ΔD%联合ΔADC%对Luminal 型和Her-2型乳腺癌NAC后的疗效评估价值优于单一运用ΔD%。对于三阴型乳腺癌，单一指标与联合指标的评估结果相同。Objective To study the values of change of diameter （＆D~） on DCE-MRI and ＆D% combined with ADC for the therapeutic effect evaluation in the neoadjuvant chemotherapy（NAC） of each subtype of breast cancer.Methods 121 women with invasive breast cancer were enrolled in this study,including 56 cases of Luminal A type,42 cases of Luminal B type,13 cases of Her-2 type and 10 cases of triple negative type.Results Imaging evaluation results obtained by single applying DCE-MRI was analyzed with the pathological results after surgery for the consistency,and the Kappa values of Luminal A,Luminal B, Her-2 and triple negative type were 0.594,0.617,0.401,0.690,0.800, respectively.When combining ΔD% with ΔADC%, the Kappa values were 0.844,0.792,0.854, 0.847 and 0.800, respectively.The sensitivity of combined parameters in evaluating pCR after NAC was significantly increased in Luminal type cancers, however, with a slightly increasing in Her-2 type,and constant in triple negative type.Conclusion ΔD% combining with ΔADC% is better than single parameter in evaluating pCR for Luminal and Her-2 types cancer,but not for triple negative type.

关 键 词：乳腺癌 新辅助化疗 肿瘤直径 表观扩散系数 

分 类 号：R737.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学]