磁共振动态增强检查及生物学因子对乳腺浸润性导管癌新辅助化疗疗效的分析研究

Effect of dynamic enhanced magnetic resonance imaging and biological factors in neoadjuvant chemotherapy for invasive ductal carcinoma of breast

目的探讨3.0T磁共振动态增强(dynamic enhanced magnetic resonance imaging,DCE-MRI)检查对乳腺浸润性导管癌新辅助化疗(neoadjuvant chemotherapy,NAC)疗效的评估以及分析生物学因子的变化能否预测化疗疗效。方法对33例乳腺浸润性导管癌的患者NAC前后均行DCE-MRI检查,病灶NAC前后均进行病理学检测。分析化疗前后病灶的形态、边缘、是否肿块型、增强特征及最大直径缩小率;NAC后根据实体肿瘤的反应评价标准,将病例分为有效组和无效组,并通过独立样本t检验比较两组之间最大直径缩小率的差异。分析NAC前后雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人表皮生长因子受体2(human epidermal growth factor receptor 2,Her-2)、细胞增殖核抗原Ki67(cell valueadded nuclear antigen,Ki67)等标记物的表达水平变化。结果 NAC前后乳腺癌病变的形态、增强特征无明显差异(P>0.05);NAC前后TIC类型比较差异有统计学意义(P<0.05)。33例NAC患者,有效组23例,无效组10例,有效组病灶最大直径缩小率(61.31±20.13)%,无效组(17.06±10.21)%,两组最大直径缩小率比较,差异有统计学意义(P=0.000)。NAC前后ER、PR、Her-2的变化差异无统计学意义(P>0.05),Ki67的变化差异有统计学意义(P=0.028)。结论 3.0 T DCE-MRI可以监测乳腺癌NAC治疗过程中肿瘤大小、形态和增强特征的变化,可用于术前评估NAC后病变的残留情况,并结合生物学因子的变化,预测NAC的疗效。

Objective To evaluate the effect of neoadjuvant chemotherapy （NAC） with 3.0 T dynamic enhanced magnetic resonance imaging （DCE-MRI） in breast invasive ductal carcinoma and analyze whether the change of biological factors can predict the effect of NAC. Methods Thirty-three patients of breast invasive ductal carcinoma underwent DCE-MRI examination before and after NAC;lesions were performed pathological examination before and after NAC. Lesion morphology, margin, lumpy or not, enhanced features and largest diameter reduction rate were analyzed before and after NAC. After NAC, according to the response evaluation criteria of solid tumors （RECIST） , the patients were divided into effective and invalid groups, and the difference of the maximum diameter reduction rate of the two groups was tested by independent sample t test. The changes of expression levels of estrogen receptor （ER） ,progesterone receptor （ PR）, human epidermal growth factor receptor 2 （ Her-2 ） and cell value-added nuclear antigen （ Ki67 ） before and after NAC were analyzed. Results There was no significant difference in the shape and intensifying characteristics of breast cancer before and after NAC （ P 〉 0. 05 ）. There was a statistically significant difference in TIC type before and after NAC （ P 〈 0. 05 ）. In 33 patients, effective group of 23 eases, 10 eases of invalid group. The largest diameter reduction rate of effective group was （61.31 ± 20. 13 ） % ,invalid group was （ 17. 06± 10. 21 ） % , the largest diameter reduction rate of the two group was compared, there was significant difference （P = 0. 000）. Compared the expression levels of ER,PR, Her-2, Ki67 before and after NAC, there were no significant differences in ER, PR, Her-2 （ P 〉 0. 05 ）, there were statistically significant differences in the changes of Ki67 （ P = 0. 028 ）. Conclusion 3.0T DCE-MRI can monitor the size, shape and enhancement characteristics of breast cancer during NAC. It can be used for preoperative evaluation of residual lesions after NAC, and combined with changes in biological factors, to predict the effect of NAC.