增强磁共振成像病灶-背景实质信号增强比预测乳腺癌新辅助化疗病理性完全缓解的临床研究-东南大学学报医学版

增强磁共振成像病灶-背景实质信号增强比预测乳腺癌新辅助化疗病理性完全缓解的临床研究

单位：新疆医科大学附属中医医院影像中心, 新疆乌鲁木齐 830000

分类号：R737.9

出版年·卷·期（页码）：2020·39·第二期（184-190）

摘要：

目的：探讨增强磁共振成像（MRI）病灶-背景实质信号增强比（LBSER）预测乳腺癌新辅助化疗（NAC）后病理性完全缓解（pCR）的价值。方法：选取我院2008年1月至2016年12月行NAC及增强MRI检查的乳腺癌患者136例。记录患者临床病理特征、MRI测量肿瘤大小、MRI图像LBSER值。采用多因素和单因素Logistic回归分析预测pCR的因素。采用受试者工作特征（ROC）曲线分析相关因素预测pCR的价值。结果：单因素Logistic回归分析表明三阴型乳腺癌、MRI增强早期LBSER、MRI增强延迟期LBSER、MRI增强早期微小残余癌（MRC）大小、MRI延迟期MRC大小和MRI延迟期无增强均为pCR的独立预测因素（P<0.05）。多因素Logistic回归分析结果显示MRI增强早期LBSER、MRI增强早期和延迟期MRC大小、MRI延迟期无增强是pCR的独立预测因素（P<0.05）。LBSER≤1.6和MRC≤0.2 cm联合预测pCR特异性最高，为91.3%。结论：MRI增强早期LBSER是乳腺癌NAC患者pCR的独立预测因素，联合MRI增强早期LBSER和MRC大小可提高预测乳腺癌患者NAC后pCR的诊断效能。

Objective: To investigate the predictive value of breast contrast-enhanced MRI with lesion-to-background parenchymal signal enhancement ratio(LBSER) for predicting pathological complete response(pCR) following neoadjuvant chemotherapy(NAC).Methods: One hundred and thirty-six breast cancer patients who had undergone both NAC and contrast-enhanced MRI from January 2008 to December 2016 in our hospital were enrolled. The clinico-pathological features, tumor size measured by MRI, and LBSER on MRI images were recorded. Univariate and multi-univariate logistic regression were used to analyze the predictors of pCR. Receiver operating characteristic curve(ROC) was employed to analyze the diagnostic performance of the relative pCR predictors.Results: The univariate logistic regression results showed that the triple-negative breast cancer, LBSER on early-phase and delay-phase MRI, the MRC size on early-phase and delay-phase MRI, and the delay-phase without enhancement were independently associated with pCR(P<0.05). The multi-univariate logistic regression results showed that the LBSER on early-phase MRI, the MRC size on early-phase and delay-phase MRI, and the delay-phase without enhancement were independent predictors of pCR(P<0.05). Combination of LBSER ≤ 1.6 and MRC ≤ 0.2 cm had the highest specificity of 91.3% for predicting pCR.Conclusion: LBSER on early-phase MRI is independently associated with pCR. The LBSER combined with MRC can improve the diagnostic performance for predicting pCR in breast cancer patients after NAC.

参考文献：

[1] 陈波,张磊.2017年乳腺癌新辅助治疗进展[J].山东大学学报(医学版),2018,56(1):12-16.
[2] 林嘉燕,张建国.乳腺癌新辅助化疗疗效的评估方法及其进展[J].东南大学学报(医学版),2019,38(4):727-731.
[3] SANTAMARIA G,BARGALLO X,FERNANDEZ P L,et al.Neoadjuvant systemic therapy in breast cancer:association of contrast-enhanced MR imaging findings,diffusion-weighted imaging findings,and tumor subtype with tumor response[J].Radiology,2017,283(3):663-672.
[4] KIM S Y,CHO N,SHIN S U,et al.Contrast-enhanced MRI after neoadjuvant chemotherapy of breast cancer:lesion-to-background parenchymal signal enhancement ratio for discriminating pathological complete response from minimal residual tumour[J].Eur Radiol,2018,28(7):2986-2995.
[5] OGSTON K N,MILLER I D,PAYNE S,et al.A new histological grading system to assess response of breast cancers to primary chemotherapy:prognostic significance and survival[J].Breast,2003,12(5):320-327.
[6] 赵娜,阳青松,陆建平.磁共振成像在乳腺癌诊断中的应用进展[J].第二军医大学学报,2018,39(2):193-198.
[7] 黎玉娇,尚乃舰.影像学评估乳腺癌新辅助化疗反应的研究进展[J].实用肿瘤学杂志,2018,32(1):63-67.
[8] BOUZON A,ACEA B,SOLER R,et al.Diagnostic accuracy of MRI to evaluate tumour response and residual tumour size after neoadjuvant chemotherapy in breast cancer patients[J].Radiol Oncol,2016,50(1):73-79.
[9] GU Y L,PAN S M,REN J,et al.Role of magnetic resonance imaging in detection of pathologic complete remission in breast cancer patients treated with neoadjuvant chemotherapy:a meta-analysis[J].Clin Breast Cancer,2017,17(4):245-255.
[10] VAN LA PARRA R F,KUERER H M.Selective elimination of breast cancer surgery in exceptional responders:historical perspective and current trials[J].Breast Cancer Res,2016,18(1):28.
[11] HEIL J,SCHAEFGEN B,SINN P,et al.Can a pathological complete response of breast cancer after neoadjuvant chemotherapy be diagnosed by minimal invasive biopsy?[J].Eur J Cancer,2016,69:142-150.
[12] KUERER H M,RAUCH G M,KRISHNAMURTHY S,et al.A clinical feasibility trial for identification of exceptional responders in whom breast cancer surgery can be eliminated following neoadjuvant systemic therapy[J].Ann Surg,2018,267(5):946-951.
[13] HYLTON N M,GATSONIS C A,ROSEN M A,et al.Neoadjuvant chemotherapy for breast cancer:functional tumor volume by MR imaging predicts recurrence-free survival-results from the ACRIN 6657/CALGB 150007 I-SPY 1 TRIAL[J].Radiology,2016,279(1):44-55.
[14] GOORTS B,DREUNING K M A,HOUWERS J B,et al.MRI-based response patterns during neoadjuvant chemotherapy can predict pathological(complete) response in patients with breast cancer[J].Breast Cancer Res,2018,20(1):34.
[15] KIM Y S,CHANG J M,MOON H G,et al.Residual mammographic microcalcifications and enhancing lesions on MRI after neoadjuvant systemic chemotherapy for locally advanced breast cancer:correlation with histopathologic residual tumor size[J].Ann Surg Oncol,2016,23(4):1135-1142.

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