扩散加权成像在局部进展期乳腺癌新辅助化疗疗效评估的价值

Assessment of Locally Advanced Breast Cancer Response to Neoadjuvant Chemotherapy with Diffusion weighted MRI

目的探讨扩散加权成像在评估局部进展期乳腺癌接受新辅助化疗后的疗效的价值.方法前瞻性对需进行新辅助化疗的局部进展期乳腺癌患者24例共26个病灶,于化疗前、第1周期化疗后及全程化疗后共行3次磁共振检查.每次检查包括常规磁共振检查、扩散加权成像及动态增强扫描,所有病例均经治疗前细针穿刺活检及术后病理证实.对照治疗前穿刺及术后病理结果,将入组病例分为病理完全缓解及非完全缓解组.评估各个检测点的ADC_(mean)和ADC_(min)及其变化率在病理完全缓解组和非完全缓解组之间的差异.结果病理完全缓解组及非完全缓解组之间ADC_(mean)和ADC_(min)在化疗前、第1周期化疗后二者的差异无统计学意义(P>0.05);全程化疗结束后两者有统计学意义(P<0.05);病理完全缓解组和病理非完全缓解组早期ADC_(min)值变化率分别为(16.78±22.70)%和(12.37±10.09)%,差异无统计学意义(P=0.53);术前ADC_(min)值变化率分别为(91.41±45.83)%和(29.74±22.96)%,差异有统计学意义(P=0.00).结论磁共振扩散加权成像可以用于监测乳腺癌病灶在新辅助化疗后的反应,但在第1疗程后不能预测其在全程化疗后能否获得病理完全缓解.

Objective To assess the value of diffusion weighted imaging（DWI） in monitoring therapy effect of neoadjuvant chemotherapy（NAC） in patients with locally advanced breast cancer. Me thods The prospective study included 26 lesions in 24 patients with LABC undergoing NAC.MRI was conducted before chemotherapy,after the first cycle of chemotherapyand after all cycles, including conventional MRI and DWI.All patients were confirmed by pre- treatment fine needle aspiration biopsy（FNAB）, and postoperative histopathological prout. All lesions were divided into two groups of pathological complete response（p CR） and non- p CR. We evaluated ADC value and its changes in pathological complete response difference between the groups and complete remission in each testing point.Re s ults Before chemotherapy and after the first cycle of chemotherapy, the ADCmeanand ADCminhad no statistically significant difference hetween pathologic complete response group and non- complete remission.After the whole chemotherapy,both of them had statistically significant difference;pathological complete response（p CR） and non- p CR early ADCmin value rate were（16.78 ±22.70） % and（12.37 ±10.09） %respectively.No statistically significant difference was seen（P = 0.53）. Preoperative ADCminvalue rates were（91.41 ±45.83） % and（29.74 ±22.96） % respectively, which were statistically significant（P = 0.00）.Conclus ion ADC which is measured from DWI can be used to assess early response to NAC in breast cancer lesion, but cannat predict p CR or non- p CR for all cycles of chemotherapy on the first cycle.