乳腺癌新辅助化疗早期肿瘤直径MRI变化率和病理分级评价化疗疗效的意义

Breast tumor diameter on MRI and histological grading system for predicting response to neoadjuvant chemotherapy

目的 探讨乳腺癌新辅助化疗早期肿瘤最大径变化率,以及肿瘤治疗前和术后组织病理学变化,评价化疗疗效的意义.方法 49例乳腺癌患者,新辅助化疗前和术后均具有完整的组织病理结果;新辅助化疗前和化疗第2周期后及术前行3次乳腺增强MR检查,分别于注入对比剂前和注药后连续采集8次（8个时相）.注射对比剂后2 min的图像与蒙片减影后行MIP重组.在MIP图像上测量肿块的最大径线（△d）,根据△d值将直径变化率分为6级.根据实体肿瘤的疗效评价标准（RECIST）设△d晚≥30%为金标准,通过ROC分析观察△d早在判断疗效时的敏感度和特异度.病理分级与RECIST标准间进行Spearman相关分析.结果 新辅助化疗有效30例,无效19例.Ad早 10%时,评价疗效的敏感度为96.7%（29/30）,特异度为84.2%（16/19）;曲线下面积0.960.病理分级与RECIST标准间具有相关性（r=0.613,P=0.000）.结论 新辅助化疗早期通过直径评价疗效,将阈值设为10%,其敏感度和特异度均较高.病理评价疗效与RECIST径线评价疗效间具有一定相关性,但病理评价会导致高估疗效.

Objective To assess the value of initial MRI measurements of breast tumor diameter and pathological responses for predicting response to neoadjuvant chemotherapy （NAC）. Methods Fortynine patients who underwent neoadjuvant chemotherapy were included in this study. The longest diameter of each tumor was measured on MRI before and after two cycles of NAC and just before operation. Pathological responses were evaluated by Miller and Payne grading system criteria by comparing post-operation breast tissue with large core biopsy tissue. Changes of diameter after two cycles of NAC and before operation were compared and pathological responses were evaluated. ROC and spearman correlation analysis was used.Results The sensitivity and specificity of initial diameter for predicting response to NAC were 96. 7% （29/30） and 84.2% （16/19）. There was a moderate correlation between pathological responses and diameter measured pre-operation （ r = 0. 613, P = 0. 000 ）. Conclusion The initial diameter changes of breast tumor could predict response to neoadjuvant chemotherapy, pathological response have moderate correlation with changes of tumor diameter.