MR多参数联合评估局部进展期乳腺癌新辅助化疗疗效的应用价值

The Application Value of MR Multi-Parameter Combination Evaluation of the Curative Effect of Neoadjuvant Chemotherapy for Local Advanced Breast Cancer

目的探讨MRI多参数联合评价局部进展期乳腺癌新辅助化疗（NAC）疗效的效能。方法回顾性分析127例经术前穿刺、术后病理确诊的局部进展期乳腺癌。分别于NAC前、NAC 2周期后、4周期后行动态MRI增强扫描及DWI成像。按照Miller＆Payne改良病理反应性分级,将所有病例分为组织学反应显著（MHR）与组织学非显著反应组（NMHR）。以病理反应性为应变量,分别对NAC 2、4周期后获得的MRI半定量参数进行分析。建立Logistic回归模型并构建新的参数,研究各新构建参数评价乳腺癌NAC反应性的效能。结果 NAC 2周期后新构建参数ROC曲线下面积（Az）为0.80（95%CI：0.72-0.87）,大于单独使用癌灶最大径变化率作为评价指标（Az=0.66,95%CI：0.57-0.76）（P〈0.05）,最佳截断点1.81,敏感性及特异性分别为76.81%和72.41%;NAC 4周期后,新构建参数ROC曲线下面积（Az）为0.86（95%CI：0.79-0.93）,大于单独使用第4周期后癌灶最小ADC（Az=0.75,95%CI：0.67-0.84）及癌灶最大径变化率（Az=0.73,95%CI：0.62-0.80）（P〈0.05）作为评价指标,最佳截断点-1.19,敏感性及特异性分别为84.06%和81.03%。结论 MRI多参数联合评价局部进展期乳腺癌NAC疗效具有较高诊断效能,能充分利用各指标信息。

Objective To discuss the clinical value of MR multi-parameter combination evaluation of the curative effect of neoadjuvant chemotherapy（ NAC） for local advanced breast cancer Methods A total of 127 females patients with pathologically-proved local advanced breast cancer were enrolled in this study. Dynamic enhanced MRI and diffusion weighted imaging（ DWI） were performed before NAC as well as after 2 and 4 cycles of NAC in all patients. According to Miller Payne modified pathologic reaction grading,the patients were divided into major histological response group（ MHR） and non-major histological response group（ NMHR）. Taking the pathological response as the dependent variable,the semiquantitative MRI parameters obtained after 2 and 4 cycles of NAC were analyzed. The step-wise logistic regression model was established and the new parameters were constructed,and the value of the newly-constructed parameters in assessing the pathologic response to NAC was analyzed. Results After the second cycle of NAC,the area under curve（ Az） of the new parameter was 0. 80（ 95% CI： 0. 72- 0. 87）,which was significantly higher than that obtained by using the variance rate of the maximum diameter alone（ Az = 0. 66,95% CI： 0. 57- 0. 76）. The optimal diagnostic cut-off point was 1. 81,and the diagnostic sensitivity and specificity were 76. 81% and 72. 41% respectively. After 4 cycle S of NAC,the area under curve（ Az） of the new parameter was 0. 86（ 95% CI： 0. 79- 0. 93）,which was significantly higher than that obtained by using the minimum ADC of tumor（ Az = 0. 75,95% CI： 0. 67- 0. 84） or by using the variance rate of the maximum diameter alone（ Az = 0. 73,95% CI： 0. 62- 0. 80）（ P〈0. 05）. The optimal diagnostic cut-off point was- 1. 19,and the diagnostic sensitivity and specificity were 84. 06% and 81. 03% respectively. Conclusion MRI multi-parameter combination evaluation of the curative effect of neoadjuvant chemotherapy for local advanced breast cancer is highly effective,and this method can make full use of MRI information.