动态增强MRI预测乳腺癌新辅助化疗后病理完全缓解的准确性  

Accuracy of dynamic contrast-enhanced MR in predicting pathological complete remission of breast cancer after neoadjuvant chemotherapy

作　　者：贺春燕 张啸飞[1] 刘兵[1] 高岩峰[1] HE Chun-yan;ZHANG Xiao-fei;LIU Bing;GAO Yan-feng(Department of Radiology,People’s Hospital Affiliated to Inner Mongolia Medical University,Hohhot 010020,China)

机构地区：[1]内蒙古医科大学附属人民医院放射科,内蒙古呼和浩特010020

出　　处：《中国临床医学影像杂志》2022年第2期96-100,共5页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨动态增强MRI预测新辅助化疗(Neoadjuvant chemotherapy,NAC)后不同乳腺癌分子亚型病理完全应答率(p CR)的准确性。方法:选择2017年1月—2020年12月在内蒙古医科大学附属人民医院就诊的经穿刺活检或手术病理证实的乳腺癌女性患者104例作为研究对象,所有患者完成NAC后手术切除且符合纳入标准,分析DCE-MRI评估NAC疗效的影像学资料,以术后病理学结果为金标准,分析DCE-MRI预测pCR的准确度(ACC)、敏感度、特异度、阳性预测值(PPV)及阴性预测值(NPV),并进一步分析其对不同亚型乳腺癌pCR的评估价值。结果:104例患者中18例(17.3%)获得放射学完全应答率(rCR),21例(20.2%)获得pCR。21例pCR患者中DCE-MRI诊断为rCR的为15例(71.4%),DCE-MRI诊断的86例非rCR患者中病理证实为非pCR的为80例(93.0%),其余6例病理证实为pCR。r CR与pCR呈显著正相关(P<0.001)。rCR预测乳腺癌NAC后pCR的敏感度、特异度、ACC、PPV及NPV分别为71.43%、93.02%、91.35%、83.33%及93.02%。结论:乳腺DCE-MRI能够较准确的预测NAC后乳腺癌患者的pCR,并且DCE-MRI预测各乳腺癌分子亚型的pCR的敏感度、特异度、ACC、PPV及NPV有显著的统计学差异,DCE-MRI评估HER2过表达型和基底细胞样型乳腺癌的准确性较高,而其对Luminal A及Luminal B型乳腺癌的评估价值有限。Objective:To investigate the accuracy of dynamic contrast-enhanced MRI in predicting pCR of different molecular subtypes of breast cancer after neoadjuvant chemotherapy(NAC).Methods:One hundred and four female patients with breast cancer confirmed by needle biopsy or operation and pathology in the Affiliated People’s Hospital of Inner Mongolia Medical University from January 2017 to December 2020 were selected as the study subjects.All patients underwent surgical resection after NAC and met the inclusion criteria.The imaging data of DCE-MRI in evaluating the efficacy of NAC were analyzed.Taking the postoperative pathological results as the gold standard,the accuracy(ACC),sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of DCE-MRI in predicting pCR were analyzed,and its value in evaluating pCR of different subtypes of breast cancer was further analyzed.Results:Eighteen cases(17.3%)obtained rCR,21 cases(20.2%)obtained pCR.Among the 21 cases of pCR,15 cases(71.4%)were diagnosed as rCR by DCE-MRI,80 cases(93.0%)were pathologically confirmed as non-pCR in 86 cases of non-rCR diagnosed by DCE-MRI,and the remaining 6 cases were pathologically confirmed as pCR.There was a significant positive correlation between rCR and pCR(P<0.001).The sensitivity,specificity,ACC,PPV and NPV of rCR for predicting pCR after breast cancer NAC were 71.43%,93.02%,91.35%,83.33%and 93.02%respectively.Conclusion:Breast DCE-MRI can accurately predict pCR of breast cancer patients after NAC,and there are significant differences in sensitivity,specificity,ACC,PPV and NPV of DCE-MRI in predicting pCR of different breast cancer molecular subtypes.DCE-MRI is more accurate in evaluating HER2 overexpression type and basal cell-like type breast cancer,but its evaluation value in Luminal A and Luminal B type breast cancer is limited.

关 键 词：乳腺肿瘤 放化疗 辅助 磁共振成像 

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