磁共振成像联合超声检查对乳腺癌新辅助化疗疗效的评估

Assessing curative effect of neoadjuvant chemotherapy in breast cancer by magnetic resonance imaging combined with ultrasound

目的探讨磁共振成像(MRI)联合超声(US)检查在评估乳腺癌新辅助化疗(NAC)后完全病理缓解(pCR)中的临床价值。方法回顾性收集2016年12月至2019年12月期间在青岛大学附属医院乳腺病诊疗中心完成了NAC后手术切除且符合纳入标准的原发性浸润性乳腺癌患者的MRI和MRI联合US检查评估NAC疗效的影像学资料。将单独使用MRI评估和MRI联合US评估结果分为影像学完全缓解(rCR)和影像学非完全缓解(non-rCR)。以术后病理学结果为金标准,比较rCR和non-rCR患者的pCR率并计算单独MRI和MRI联合US预测pCR的敏感度、特异度和阳性预测值(PPV),并进一步分析其对4种亚型乳腺癌pCR的评估价值。结果①按照纳入和排除标准,共纳入146例符合标准的原发性浸润性乳腺癌患者,其中HR^+/HER2^+亚型34例、HR^+/HER2^–亚型63例、HR^–/HER2^+亚型23例、HR^–/HER2^–亚型26例。②NAC后经术后病理检测结果显示pCR者共36例,其中在HR^+/HER2^+亚型中9例(26.5%)、在HR^+/HER2^–亚型中10例(15.9%)、在HR^–/HER2^+亚型中8例(34.8%)、在HR^–/HER2^–亚型中9例(34.6%)。③NAC后,单独MRI评估rCR 28例中有22例(78.6%)术后达到pCR,MRI联合US评估rCR 21例患者中有17例(81.0%)术后达到pCR,单独MRI和MRI联合US评估pCR的PPV值分别为78.6%和81.0%。④无论是单独MRI还是MRI联合US预测NAC后pCR的PPV值在HR^–/HER2^–亚型乳腺癌患者均为最大(分别为85.7%和100%),在HR^+/HER2^–中均为最小(分别为71.4%和60.0%)。结论对于整体原发性浸润性乳腺癌患者而言,NAC后疗效评估采用MRI联合US优于单独MRI,且在不同亚型乳腺癌患者中除了HR^+/HER2^–亚型,仍是MRI联合US较单独MRI能更有效地预测NAC后疗效。

Objective To investigate the clinical value of magnetic resonance imaging(MRI)combined with ultrasound(US)contrasting with MRI in evaluating the pathological complete response(pCR)of breast cancer after neoadjuvant chemotherapy(NAC).Methods The imaging data of patients with primary invasive breast cancer who completed the surgical resection after NAC and met the inclusion criteria in the Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qingdao University from December 2016 to December 2019 were collected retrospectively.These patients were evaluated by MRI and MRI combined with US examination respectively.The results of MRI alone and MRI combined with US were designed into imaging of complete remission(rCR)and imaging of noncomplete remission(non-rCR).With results of postoperative pathology as the gold standard,the sensitivity,specificity,and positive predictive value(PPV)of MRI alone and MRI combined with US in predicting pCR of patients with rCR or non-rCR were calculated and which were further analyzed in the 4 subtypes of breast cancer(HR^+/HER2^+,HR^+/HER2^–,HR^–/HER2^+,and HR^–/HER2^–subtype).Results①According to the inclusion and exclusion criteria,a total of 146 patients with primary invasive breast cancer were included,including 34 cases of HR^+/HER2^+subtype,63 cases of HR^+/HER2^–subtype,23 cases of HR^–/HER2^+subtype,and 26 cases of HR^–/HER2^–subtype.②After NAC,36 cases had a pCR,among which 9 cases(26.5%)were in HR^+/HER2^+subtype,10 cases(15.9%)were in HR^+/HER2^–subtype,8 cases(34.8%)were in HR^–/HER2^+subtype,and 9 cases(34.6%)were in HR^–/HER2^–subtype.③After NAC,22(78.6%)of the 28 patients evaluated by MRI alone achieved pCR,17(81.0%)of the 21 patients evaluated by MRI combined with US achieved pCR,and the PPV value of pCR evaluated by MRI alone and MRI combined with US was 78.6%and 81.0%,respectively.④Both MRI alone and MRI combined with US predicted NAC showed the highest PPV values in patients with HR^–/HER2^–subtype breast cancer(85.7%and 100%,respectively),and the lowest values in HR^+/HER2^–subtype breast cancer(71.4%and 60.0%,respectively).Conclusion For the overall patients with primary invasive breast cancer,MRI combined with US is superior to MRI alone in the evaluation of efficacy after NAC,and among the patients with different subtypes of breast cancer,except HR^+/HER2^–subtype,MRI combined with US is still more effective in predicting efficacy after NAC than MRI alone.