磁共振扩散加权成像对乳腺癌新辅助化疗后病理反应的评价

Evaluation of Pathologic Response of Breast Cancer To Neoadjuvant Chemotherapy with Magnetic Resonance Diffusion Weighted Imaging

本研究旨在探讨采用扩散加权成像（DWI）的不同表观扩散系数（ADC）测量方法,在评价和预测乳腺癌新辅助化疗（NAC）疗效中的价值。2010年3月~2012年12月收集在我院经核芯针穿刺活检病理证实为乳腺浸润性导管癌并术前行NAC的患者71例,在NAC前后各阶段行DWI磁共振检查,分别采用平均ADC值法及低ADC值法测量组织ADC值。NAC后按Miller＆Payne病理反应性分级标准分为组织学显著反应（MHR）组与非组织学显著反应（NMHR）组。结果显示,NAC前、第2周期后、全程结束后,两种ADC测量方法的结果具有高度的相关性,Pearson相关系数分别为0.699、0.749和0.895。自NAC第2周期结束后,两种方法测量的MHR组及NMHR组ADC值的组间差异均具有统计学意义（P值均〈0.05）。采用平均ADC值法,MHR组与NMHR组间ADC值变化率于第2周期结束时未见明显差异（P〉0.05）,而低ADC值法显示第2周期结束时MHR组ADC变化率明显高于NMHR组（P〈0.05）。DWI可对NAC后乳腺癌组织的病理改变情况进行评估,而低ADC值法比平均ADC值法能更早地通过ADC值及其变化率对化疗疗效进行评估。

This paper aims to investigate the value of diffusiion weighted imaging （DWI） and different apparent diffu- sion coefficient （ADC） methods to predict the curative effects of neoadjuvant chempotherapy （NAC） for breast canc- er. From March 2010 to December 2012, seventy-one patients were pathologically confirmed invasive breast cancer by needle puncture biopsy received before surgery, and underwent magnetic resonance before and after NAC, the ADC were measured by mean ADC method and lower ADC method. The pathologic response after NAC was divided to major histological response （MHR） group and non-major histological response （NMHR） group according to Mill- er ＆. Payne system. Results displayed that ADC values obtained before NAC, at the end of the second cycle of NAC, and after whole course of treatment, had good correlations between mean and lower ADC methods （the Pear- son＇s correlation=0. 699, 0. 749 and 0. 895, respectively）. Significant difference in ADC obtained both with mean and lower ADC methods could be found between MHR and NMHR groups after the second cycle of NAC （P〈0.05）. After the second cycle of NAC, significant difference in the change rate of ADC could be found between MHR and NMHR groups by using lower ADC method （P〈0.05）, but not be found by using mean ADC method （P〉0.05）. In conclusion, DWI could monitor the pathologic changes of breast cancer after NAC, and the lower ADC method might be used to evaluate the curative effect of NAC with the change rate of ADC.