新辅助化疗后乳腺癌瘤床MRI表现与病理对比研究

Comparison of MRI and whole subserial section in assessing tumor bed after neoadjuvant chemotherapy for breast cancer

目的探讨MRI评价乳腺癌新辅助化疗后残余肿瘤收缩模式的能力。方法收集48例Ⅱ、Ⅲ期浸润性导管癌患者的MRI检查资料并与全乳腺大切片对比。48例患者均采用TE方案进行4个周期的新辅助化疗,并在新辅助化疗前后进行MRI检查。48例乳腺癌患者在化疗结束后均进行乳腺癌改良根治术,术后乳腺标本取一半制成全乳腺大切片,显微镜观察残余肿瘤瘤床表现。结果新辅助化疗后残余肿瘤表现为向心型收缩、树枝型收缩。48例新辅助化疗后的残余肿瘤在MRI上表现为向心型收缩的有39例,占81.25%;表现为树枝型收缩的有9例,占18.75%。全乳腺大切片显示为向心型收缩的有40例(83.33%),树枝型收缩的有8例(16.67%),MRI与全乳腺大切片评价残余肿瘤收缩模式的相关系数为0.906(P=7.37×10^-8)。结论MRI能正确评价残余肿瘤的收缩模式,能为临床手术方式的制定提供重要的依据。

Objective To evaluate the ability of residual tumor shrinkage pattern by MRI after neoadjuvant chemotherapy(NCT) for breast cancer. MethodsMRI and whole subserial section(WSS) of 48 patients with clinical TNM stage Ⅱ and stage Ⅲ infiltrating duct carcinoma were compared.All of 48 patients achieved four courses of neoadjuvant chemotherapy with Taxol and Epirubicin(TE),and then examined by MRI.All of 48 patients received modified radical mastectomy after NCT,and the samples were subjected to perform WSS.Pathological changes of tumor bed and pericancerous tissues were examined with optical microscope. Results The shrinkage patterns were divided into two types,concentric shrinkage(CS) and dendritic shrinkage(DS).According to shrinkage pattern assessed by MRI,a total of 39(81.25%) patients showed CS after NCT,while,9(18.75%) patients showed DS.The WSS shrinkage pattern was CS in 40(83.33%) patients after NCT,and DS in 8(16.67%) patients.The correlation coefficient between the tumor shrinkage patterns assessed by MRI and that determined by pathological WSS after NCT was 0.906( P =7.37×10^-8 ). Conclusion MRI can correctly evaluate the shrinkage pattern of residual tumor and provide important basis for clinical operation.