增强MRI用于乳腺癌新辅助化疗疗效的评价

Contrast-enhanced MRI for Evaluating Response to Neoadjuvant Chemotherapy in Patients with Breast Cancer

目的研究增强MRI用于评价乳腺癌新辅助化疗疗效的可行性和准确性。方法收集2007年3月～2011年11月乳腺癌63例,Ⅱ期45例,Ⅲ期18例。接受2～4个周期的新辅助化疗,方案为CEF或ET,分别在新辅助化疗前和新辅助化疗后即手术前接受2次增强MRI检查,全部患者经新辅助化疗后3～6周手术,术后切除组织送病理学检查评估肿瘤大小。结果新辅助化疗后经增强MRI评估完全缓解(CR)9例,部分缓解(PR)49例,疾病稳定(SD)5例,无疾病进展(PD)者,总有效率92.1%(58/63)。术后病理评估化疗有效率93.7%(59/63)。MRI评价的敏感性为93.2%(55/59),特异性为25.0%(1/4),阳性预测值94.8%(55/58),阴性预测值20.0%(1/5),准确率88.9%(56/63)。除CR 9例外,54例增强MRI测量肿瘤残存病变最大径线0.6～5.1 cm,病理镜下残余肿瘤最大径线0.5～4.8 cm,Pearson相关性检验显示呈高度相关性(r=0.834,P=0.001)。结论增强MRI可以准确反映新辅助化疗后残留肿瘤组织的变化,在评价新辅助化疗疗效方面有重要作用。

Objective To evaluate the feasibility and accuracy of contrast-enhanced MRI for preoperative assessment of response of patients with breast cancer to neoadjuvant chemotherapy（NAC）.Methods During March 2007 to November 2011,63 patients with breast cancer,including 45 cases of stage Ⅱ and 18 cases of stage Ⅲ,were enrolled into this study.All the patients received 2-4 cycles of NAC（CEF or ET）.Contrast-enhanced MRI was made before and after NAC.Surgical treatment was carried out 3 to 6 weeks after the NAC,and pathological examination was performed after the operation.Results Post-NAC MRI showed CR in 9 cases,PR in 49 cases,and SD in 5,the total effective rate was 92.1%（58/63）.Postoperative pathological examination showed an effective rate of 93.7%（59/63）.The sensitivity and specificity of contrast-enhanced MRI were 93.2%（55/59） and 25.0%（1/4）,respectively,positive and negative predictive value were 94.8%（55/58） and 20.0%（1/5）,and accuracy was 88.9%（56/63）.Except for the 9 cases of CR,contrast-enhanced MRI showed a 0.6-to 5.1-cm maximum diameter of the residual tumor,while pathological examination showed a 0.5-to 4.8-cm maximum diameter of the residual tumor.Pearson correlation coefficient between MRl and pathology was significant（r=0.834,P=0.001）.Conclusion Contrast-enhanced MRI can accurately assess the size of residual cancerous lesion after NAC,and therefore is useful for evaluating response to neoadjuvant chemotherapy in patients with breast cancer.