磁共振扩散加权成像评估乳腺癌新辅助化疗疗效

MR diffusion weighted imaging in evaluation on the therapeutic effect of neoadjuvant chemotherapy for breast cancer

目的探讨MR DWI评估乳腺癌新辅助化疗（NAC）疗效的价值。方法对36例经穿刺病理证实的乳腺癌患者在NAC前、后不同疗程末行DWI。依据手术病理结果分为有效组和无效组,比较有效组和无效组化疗前ADC值的差异及化疗前、后不同疗程肿瘤ADC值的差异。结果 36例中,有效组（24例）化疗前肿瘤平均ADC值为（0.98±0.18）×10-3mm2/s,无效组（12例）化疗前肿瘤平均ADC值为（0.95±0.15）×10-3mm2/s（t=0.694,P=0.411）。有效组化疗后ADC值升高,化疗前肿瘤ADC值与化疗第2-8个疗程后比较差异均有统计学意义;无效组化疗前、后肿瘤ADC值差异无统计学意义。有效组化疗前20例患者的对侧正常乳腺组织平均ADC值为（1.98±0.30）×10-3mm2/s,化疗4个疗程后12例患者的对侧正常乳腺组织平均ADC值为（1.96±0.28）×10-3mm2/s,差异无统计学意义。结论化疗有效组乳腺癌ADC值较化疗前升高;根据ADC值可以早期预测乳腺癌NAC疗效。

Objective To explore the value of DWI in assessing the therapeutic effect of neoadjuvant chemotherapy for breast cancer.Methods Thirty-six patients with breast cancer confirmed pathologically underwent DWI before and after different courses of neoadjuvant chemotherapy（NAC）.All patients were divided into responder group（n=24） and non-responder group（n=12） according to pathologic results.The ADC values of tumor between two groups were compared before NAC.The ADC values of tumor before NAC and after different courses of NAC also were compared.Results No significant difference of the mean ADC was found between responder [（0.98±0.18）×10-3 mm2/s] and non-responder [（0.95±0.15）×10-3 mm2/s] before NAC（t=0.694,P=0.411）.The ADCs of responders significantly increased after NAC,while the ADCs of non-responder stayed invariable after therapy.The mean ADCs of contralateral disease-free breast tissue of 20 responders before therapy [（1.98±0.30）×10-3 mm2/s] and that of 12 responders after 4 courses of NAC [（1.96±0.28）×10-3 mm2/s] showed no significant difference.Conclusion The ADCs of responders increased after NAC,indicating that DWI could predict the therapeutic effect of NAC in patients with breast cancer.