扩散加权成像预测Ki-67高表达HER-2阳性乳腺癌新辅助化疗后Ki-67降级的价值  

Diffusion-Weighted Imaging in Predicting the Degradation of Ki-67 After Neoadjuvant Chemotherapy with High Expression of Ki-67 in Human Epidermal Factor Receptor 2-Positive Breast Cancer

作　　者：黄英 高媛媛 刘新兰 刘岭岭[2] 李艳[2] 李鹏[2] HUANG Ying;GAO Yuanyuan;LIU Xinlan;LIU Lingling;LI Yan;LI Peng(Department of Radiology,the General Hospital of Ningxia Medical University,Yinchuan 750004,China;不详)

机构地区：[1]宁夏医科大学总医院肿瘤医院肿瘤内三科,宁夏银川750004 [2]宁夏医科大学总医院放射科,宁夏银川750004

出　　处：《中国医学影像学杂志》2023年第8期824-827,832,共5页Chinese Journal of Medical Imaging

基　　金：宁夏医科大学科学研究基金资助项目(XM2018112)。

摘　　要：目的 探讨扩散加权成像表观扩散系数(ADC)值预测Ki-67高表达人表皮因子受体-2(HER-2)阳性乳腺癌新辅助化疗(NAC)后Ki-67降级的价值。资料与方法 回顾性分析2018年1月—2021年8月宁夏医科大学总医院经病理证实的32例浸润性HER-2阳性乳腺癌的MRI和Ki-67表达资料,所有患者均在NAC前和NAC 4周期完成后1周内行扩散加权成像,并于NAC 6周期全部结束后获得手术病理结果。测量NAC前、后病灶最小ADC值(ADC_(前)、ADC_(后)),并计算ADC的变化值(△ADC)和变化率(△ADC%)。将Ki-67由高表达(>20%)转为低表达(≤20%)定义为Ki-67降级,比较Ki-67降级组和Ki-67未降级组ADC_(前)、ADC_(后)、△ADC和△ADC%值的差异。应用受试者工作特征曲线确定ADC Ki-67降级的最佳临界点,分析ADC与Ki-67降级的相关性。结果 Ki-67降级组病理完全缓解18例,病理非完全缓解3例;Ki-67未降级组病理完全缓解0例,病理非完全缓解11例;Ki-67降级与病理完全缓解呈明显正相关(r=0.821,P<0.01)。Ki-67降级组和未降级组ADC_(后)、△ADC和△ADC%比较,差异均有统计学意义(t=4.816、5.017、4.275,P均<0.01)。当曲线下面积为0.885,最佳临界点取0.46×10^(-3) mm^(2)/s,△ADC值诊断Ki-67降级的敏感度为95.24%,特异度为90.91%。ADC_(后)、△ADC和△ADC%与Ki-67降级呈负相关(r=-0.670、-0.634、-0.613,P均<0.01),ADC_(前)与Ki-67降级无明显相关性(r=0.171,P>0.05)。结论 HER-2阳性乳腺癌NAC后Ki-67降级组较未降级组更易获得病理完全缓解。ADC相关参数与HER-2阳性乳腺癌NAC后Ki-67降级具有相关性,可以预测NAC后肿瘤细胞增殖活性的变化趋势。Purpose To explore the value of diffusion-weighted imaging(DWI)apparent diffusion coefficient(ADC)value in predicting Ki-67 degradation after neoadjuvant chemotherapy(NAC)in high expression of Ki-67 human epidermal factor receptor 2(HER2)-positive breast cancer.Materials and Methods The data of MRI and Ki-67 expression in 32 patients with invasive HER2-positive breast cancer confirmed by needle biopsy in the General Hospital of Ningxia Medical University from January 2018 to August 2021 were retrospectively analyzed.All patients underwent DWI examination before NAC and within 1 week after the completion of 4 cycles of NAC,and surgical pathological results after all 6 cycles of NAC were completed and obtained.The minimum ADC value of lesions before and after NAC were measured,and the change value(△ADC)and change rate of ADC(△ADC%)were calculated.The transformation of Ki-67 from high expression(>20%)to low expression(≤20%)was defined as the degradation of Ki-67(degraded group),and the differences of ADC parameters between the degraded group and the non-degraded group were compared.The receiver operator characteristic curve was used to determine the cut-off value of Ki-67 degradation,and Spearman correlation method was used to analyze the correlation between ADC and Ki-67 degradation.Results In Ki-67 degraded group,there were 18 cases obtained pathological complete response and 3 cases obtained non-pathological complete response.There were 0 case with pathological complete response and 11 cases with non-pathological complete response in Ki-67 undegraded group.Ki-67 degradation was positively correlated with pathological complete response(r=0.821,P<0.01).There were statistically significant differences in post-ADC,△ADC and△ADC%between Ki-67 degraded group and Ki-67 undegraded group(t=4.816,5.017 and 4.275,all P<0.01).When the area under the curve was 0.885 and the cut-off value was 0.46×10-3 mm^(2)/s,the sensitivity and specificity of△ADC value for the diagnosis of Ki-67 degradation were 95.24%and 90.91%

关 键 词：乳腺肿瘤 人表皮因子受体-2 磁共振成像 扩散加权成像 新辅助化疗 KI-67抗原 

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