磁共振扩散加权成像表观扩散系数对局部进展期乳腺癌新辅助化疗的评估——不同测量方法比较

Assessment of apparent diffusion coeffient in breast cancer response to neoadjuvant chemotherapy:Comparison of different measuring method

目的分析新辅助化疗(NAC)前后乳腺癌灶最小表观扩散系数(ADC)值对NAC病理反应性的评估效能。方法36例患者,根据术后病理反应性结果(Miller&Payne分级)分为MHR与NMHR两组,采用最小ADC值法于b=1000s/mm2图像上测量癌灶的ADC值。对每个病理组癌灶及正常腺体的ADC值、两组NAC前、NAC第2周期后、NAC第4周期后MR测量的癌灶最小ADC值及其变化率(△ADC%)进行统计学分析。利用ROC曲线评估癌灶最小ADC值对NAC病理反应性。结果NAC第2周期后,MHR组癌灶最小ADC值[(1.19±0.18)×10-3mm2/s]及△ADC1%[中位21.18%,(范围4.27%～50.00%)]分别与NMHR组最小ADC值[(0.98±0.16)×10-3mm2/s]及△ADC1%[中位8.53%,(范围-24.52%～64.79%)]两组间差异有统计学意义(P<0.05);NAC第4周期后,最小ADC值[(1.45±0.22)×10-3mm2/s]及△ADC2%[中位1.04%,范围1.71%～117.24%]均显著高于NMHR组[(1.06±0.19)×10-3mm2/s、中位16.84%,(范围7.68%～61.97%)],差异有统计学意义(P<0.05)。NAC第2周期后癌灶最小ADC值及△ADC1%ROC曲线下面积分别为0.77、0.82。NAC第4周期后癌灶最小ADC值及△ADC2%ROC曲线下面积分别为0.85、0.89。结论最小ADC值法比平均ADC值法能更早期评估进展期乳腺癌NAC的疗效。

Objective To investigate the clinical value of tumor＇s minimum apparent diffusion coefficient（ADC）in assessing pathologic response in locally advanced breast cancer treated with neoadjuvant chemotherapy（NAC）.Methods Thirty-six patients with pathologically confirmed locally advanced breast cancer were divided into major histological response（MHR）group and non-major histological response（NMHR）according to the pathologic response（Miller Payne grading system）.The minimum ADC value（b=1000 s/mm 2）and its changing rate（ADC%）of tumors were analyzed before chemotherapy,after the second cycle and the fourth cycle in NAC.ROC was assessed to obtain the of minimum ADC value for pathologic response.Results After the 2nd cycle,the minimum ADC value（[1.19±0.18]×10^-3 mm 2/s）and ADC1%（median 21.18%,[4.27%-50.00%]）in MHR were significantly higher than those（[0.98±0.16]×10^-3 mm 2/s;median 8.53% [-24.52%-64.79%]）in NMHR（P〈0.05）.After the 4th cycle,the minimum ADC value（[1.45±0.22]×10^-3 mm 2/s）and ADC2%（median 1.04%,range 1.71%-117.24%）in MHR were significantly higher than those in NMHR（[1.06±0.19]×10^-3 mm 2/s;median 16.84%,range 7.68%-61.97%）,respectively（P〈0.05）.After the 2nd cycle,the AUC of the minimum ADC value and ADC1% were 0.77 and 0.82,respectively（P〈0.05）.After the 4th cycle,the AUC of the minimum ADC value and ADC2% were 0.85,and 0.89,respectively（P〈0.05）.Conclusion The method of minimum ADC value can assess the advanced breast cancer response of NAC earlier.