乳腺癌新辅助化疗前后扩散加权成像ADC值变化与化疗疗效关系研究  

Analysis on the relationship between changes in ADC value and chemotherapy response before and after neoadjuvant chemotherapy in patients with breast cancer

作　　者：李玉萍[1] 唐伟亮[1] 李朋飞[1] 王爱国[1] LI Yu-ping;TANG Wei-liang;LI Peng-fei(Department of Radiology,Chinese People's Liberation Army Joint Logistics and Security Force No 981 Hospital,Chengde Hebei 067000,China)

机构地区：[1]中国人民解放军联勤保障部队第981医院放射科

出　　处：《临床和实验医学杂志》2019年第21期2339-2342,共4页Journal of Clinical and Experimental Medicine

基　　金：河北省承德市科技计划项目(编号:201601A081)

摘　　要：目的探讨乳腺癌MR功能成像检查技术扩散加权成像(DWI)参数表观扩散系数(ADC)值的早期变化与新辅助化疗(NAC)疗效的关系。方法回顾性分析2015年1月至2018年12月中国人民解放军联勤保障部队第981医院收治的60例治疗前经穿刺病理证实的浸润性乳腺癌患者的MR图像资料,共计60个病灶,所有患者均在NAC前、NAC 2个周期后、NAC 4个周期后14 d内行MR检查,化疗全过程结束后,以术后病理结果为金标准,分为病理完全反应组(p CR)7例和非病理完全反应组(non-p CR)53例。检查使用GE Signa HDxt 1.5TMR完成,记录每个时间节点的最小ADC值,并以NAC之前值为对比基线,分别计算不同时间节点ADC值变化值(ΔADC 1、ΔADC 2)及变化率(ΔADC 1%、ΔADC 2%)。NAC后不同时间节点最小ADC与NAC前差异比较采用配对样本t检验,p CR组与non-p CR组病灶最小ADC值差异采用两独立样本t检验比较,p CR组与non-p CR组ADC值变化值及变化率采用Mann-Whitney U检验比较。应用受试者工作特征ROC曲线下面积(AUC)分析每一个独立参数的预测价值。结果60个浸润性乳腺癌病灶,其中p CR为7个,non-p CR为53个。NAC前基线两组病灶最小ADC值p CR组为(0.92±0.08)×10^-3mm^2/s,nonp CR组为(1.01±0.16)×10^-3mm^2/s,两组之间无显著差异(P>0.05)。NAC 2个周期后病灶最小ADC值p CR组为(1.23±0.11)×10^-3mm^2/s;non-p CR组为(1.23±0.11)×10^-3mm^2/s;4个周期后病灶最小ADC值p CR组为(1.39±0.11)×10^-3mm^2/s,non-p CR组为(1.20±0.26)×10^-3mm^2/s,最小ADC值non-p CR组均小于p CR组,两组间差异具有统计学意义(P<0.05)。NAC后在不同时间节点间的最小ADC值在不同病理反应组之间差异均具有统计学意义(P<0.05),ADC值均呈上升趋势,但p CR组ΔADC及ΔADC%变化更显著,两组之间差异具有统计学意义(P<0.05)。使用DWI-ADC进行预测p CR的最佳AUC(0.88)是在NAC 2个周期后最小ADC值变化值(ΔADC 1)。结论乳腺癌NAC治疗2个周期后,病灶最小AObjective To explore the relationship between change in early DWI parameter ADC and the effect of neoadjuvant chemotherapy(NAC).Methods The retrospective analysis on 60 patients with invasive breast cancer confirmed by puncture and pathological examination before treatment during January 2015 to December 2018 in Chinese People's Liberation Army Joint Logistics and Security Force No 981 Hospital,a total of 60 lesions,all patients before NAC,after 2 cycle and 4 cycles of NAC,MRI scanning was performed within 14 days.At the end,postoperative pathological results were used as the golden standard.7 cases in pathological complete reaction group(pCR)and 53 cases in non-pathological complete reaction group(non-pCR).The check is done by using GE Signa HDxt 1.5TMR,recording the minimum ADC value at each examination period,and calculating the change in ADC value(ΔADC 1,ΔADC 2)and rate of change(ΔADC)in different time periods with the minimum ADC value before NAC(ΔADC 1%,ΔADC 2%).By using paired sample t test,the difference between minimum ADC at different time point was analyzed.Through two independent sample t tests,the difference between the minimum ADC value and value change in PCR group and non-PCR group was compared.The rate of change was compared by using Mann-Whitney U test.The area under the ROC curve(AUC)was used to analyze the predicted value of each individual parameter.Results Sixty invasive breast cancer lesions,including 7 pCR and 53 non-pCR.The minimum ADC values in these two groups before NAC were(0.92±0.08)×10^-3mm^2/s in pCR group and(1.01±0.16)×10^-3mm^2/s in non-pCR group.There was no significant difference between these two groups(P>0.05).The minimum ADC value of lesions after 2 cycles of NAC was(1.23±0.11)×10^-3mm^2/s in pCR group and(1.23±0.11)×10^-3mm^2/s in non-pCR group;and the minimum ADC value of pCR after 4 cycles in the group was(1.39±0.11)×10^-3mm^2/s,and it in non-pCR group was(1.20±0.26)×10^-3mm^2/s.The minimum ADC value in non-pCR group was smaller than that of pCR group.Th

关 键 词：乳腺癌 新辅助化疗 扩散加权成像 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]