磁共振动态增强扫描在乳腺癌新辅助化疗疗效评价中的应用

Application of dynamic-enhanced MR scan for evaluating the efficacy of neoadjuvant chemotherapy in patients with breast carcinoma

目的探讨磁共振动态增强扫描在评价乳腺癌新辅助化疗(NAC)疗效的应用价值。方法 31例经活检病理证实的乳腺癌女性患者起先均接受NAC,每4周重复治疗,共6个疗程,化疗后1～2周又经手术病检。依据病理切片上观察的肿瘤细胞密度(TCD)减小程度进行病理反应性分级:1级无变化;2级减小30%以下;3级减小30%～90%;4级减小90%以上;5级肿瘤完全消失。1～3级称组织学非显著反应(NMHR)组,4～5级称组织学显著反应(MNHR)组。所有患者于化疗前及3个疗程后均经磁共振平扫与增强扫描,以获得剪影图和在MIP像上测量治疗前与3个疗程后乳腺癌灶最大径线的变化情况,并与术后病理反应级别进行统计学分析与比较。结果 MRI与病理反应级相关性分析表明,MHR组乳腺癌灶最大径线减小程度及其变化率均显著高于NMHR组(P<0.05)。结论磁共振动态增强扫描与术后病理相结合,是评价乳腺癌NAC疗效较敏感的方法之一,值得临床推广应用。

Objective To study the usefulness of dynamic-enhanced MR scanning（DEMRS） for evaluating the efficacy of neoadjuvant chemotheraphy（NAC） in patients with breast carcinoma.Methods Thirty-one female patients with breast carcinoma confirmed by biopsy pathology initially received NAC which was repeated every 4 weeks with a maximum of six cycles and then received surgical resection and pathologic examination at 1-2 weeks after NAC.The pathologic reaction of cancerous lesion was classified into following five grades according to the reduction of tumor cell density seen on pathologic sections： grade 1-nonchanged,grade 2-reducted by less than 30%,grade 3-reducted by 30%-90%,grade 4-reducted by more than 90%,and grade 5-complete tumor disappearance.The grade 1-3 was called non-major histological response（NMHR）,while grade 4-5 was called major histological response（MHR）.All patients underwent plain and DEMRS before and after NAC for three cycles to acquire the cucoloris and to measure the changes of cancerous lesion maximum diameters on MR MIP images.The correlation between pathologic reaction grades and MR measurements was statistically analyzed and compared.Results The correlative analysis between MR and pathology demonstrated that the reduced degree and changed rate of cancerous lesion maximum diameters in MHR group were significantly higher than those in NMHR group（P 0.05）.Conclusion The combination of DEMRS with postoperative pathology is a more sensitive modality to assess the efficacy of NAC,which is worth clinically wide application.