多普勒US及DCE-MRI对乳腺癌NAC后残留肿瘤的诊断价值  

Diagnostic value of Doppler US and DCE-MRI in residual tumor of breast cancer after NAC

作　　者：贺春燕 张啸飞[1] 刘兵[1] 仝伟兵 吉茹[1] 艾伦 高岩峰[1] HE Chun-yan;ZHANG Xiao-fei;LIU Bing;TONG Wei-bing;JI Ru;AI Lun;GAO Yan-feng(Department of Radiology,the Affiliated People’s Hospital of Inner Mongolia Medical University,Huhhot 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5期309-314,共6页Journal of China Clinic Medical Imaging

基　　金：内蒙古医科大学青年创新基金YKD2018QNCX074。

摘　　要：目的:探讨DCE-MRI和多普勒超声(US)检测乳腺癌新辅助化疗(NAC)后残留肿瘤的准确性,并评价辅助多普勒US能否提高DCE-MRI的准确性。方法:选择2018年1月—2021年1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189例作为研究对象,所有患者分别在穿刺活检之前和NAC治疗之后40天内进行两次多普勒US及DCE-MRI检查,以术后病理学结果为金标准,分析多普勒US、DCE-MRI检测乳腺癌NAC后残留肿瘤的准确度(ACC)、敏感度、特异度、阳性预测值(PPV)及阴性预测值(NPV),并进一步分析辅助多普勒US能否提高DCE-MRI的准确性。结果:189例患者中,多普勒US和DCE-MRI分别诊断79例(42%)、45例(24%)乳腺癌获得影像完全反应,而病理诊断43例(23%)获得病理完全应答(pCR)。多普勒US、DCE-MRI检测乳腺癌NAC后残留肿瘤的敏感性分别为88%和72%,特异性分别为79%和91%,ACC分别为82%和69%,PPV分别为90%和95%,NPV分别为58%和38%。多普勒US、DCE-MRI诊断Luminal A型及基底细胞样型残留肿瘤的敏感性及ACC高于HER2过表达型及Luminal B型。DCE-MRI诊断的17例假阴性病例中,多普勒US正确诊断为阳性4例(24%)。结论:DCE-MRI诊断乳腺癌NAC后残留肿瘤的准确率达82%,高于多普勒US,对于DCE-MRI诊断为临床完全反应的病例可以辅助多普勒US检查,从而降低假阴性,提高DCE-MRI诊断残留肿瘤的NPV。Objective:To evaluate the accuracy of DCE-MRI and Doppler ultrasound(US) in detecting residual tumors of breast cancer after neoadjuvant chemotherapy(NAC),and to evaluate whether auxiliary Doppler US can improve the accuracy of DCE-MRI.Methods:From January 2018 to January 2021,189 female patients with breast cancer confirmed by puncture biopsy or operation and pathology were selected from the Affiliated People’s Hospital of Inner Mongolia Medical University.All patients were examined by Doppler US and DCE-MRI twice before puncture biopsy and within 40 days after NAC treatment.Taking the postoperative pathological results as the gold standard,the accuracy(ACC),sensitivity,specificity,positive predictive value(PPV) and negative predictive value(NPV) of Doppler US and DCE-MRI in detecting residual tumors in breast cancer after NAC were analyzed,and whether auxiliary Doppler US could improve the accuracy of DCE-MRI was further analyzed.Results:Among the 189 patients,79 cases(42%) were diagnosed by Doppler US and 45 cases(24%) were diagnosed by DCE-MRI,and 43 cases(23%) were diagnosed by pathology.pCR was obtained in 43 cases.The sensitivity,specificity,the ACC,the PPV,and the NPV of Doppler US and DCE-MRI for detecting residual tumors after breast cancer NAC were 88%and 72%,79% and 91%,82% and 69%,90% and 95%,58% and 38%,respectively.The sensitivity and ACC of Doppler US and DCE-MRI in diagnosing residual tumors of Luminal A type and basal cell-like type were higher than those of HER2 overexpression type and Luminal B type.Of the 17 false negative cases diagnosed by DCE-MRI,4 cases(24%) were correctly diagnosed as positive by Doppler US.Conclusion:The accuracy of DCE-MRI in diagnosing residual tumors after NAC of breast cancer is 82%,which is higher than that of Doppler US.Doppler US examination can be assisted in cases with complete clinical response diagnosed by DCE-MRI,so as to reduce false negative and improve the NPV of residual tumors diagnosed by DCE-MRI.

关 键 词：乳腺肿瘤 磁共振成像 超声检查 多普勒 彩色 

分 类 号：R737.9[医药卫生—肿瘤] R445.1[医药卫生—临床医学] R445.2