动态增强磁共振成像对乳腺癌新辅助化疗后病理缓解程度预测价值分析

Predictive value of dynamic contrast-enhanced magnetic resonance imaging inpathological remission degree of breast cancer after neoadjuvant chemotherapy

目的分析动态增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)对乳腺癌新辅助化疗后病理缓解程度的预测价值。方法选择2018年6月至2019年12月重庆大学附属三峡医院收治的167例女性乳腺癌患者为研究对象,所有患者均于新辅助化疗后完成手术,并于新辅助化疗前后完成DCE-MRI检查,根据患者术后病理学检查结果,将病理学反应分级Ⅳ~Ⅴ级的40例患者纳入显著缓解组,其余127例患者病理学反应分级为Ⅰ~Ⅲ级,纳入未显著缓解组。对比两组患者的DCE-MRI影像学表现和时间-信号强度曲线(time-signal intensity curve,TIC)类型变化情况,记录新辅助化疗前后DCE-MRI检查的早期强化率(early-phase enhancement rate,E_(1))、峰值强化率(peak enhancement rate,E_(max))、达峰时间(time to peak,T_(max))等指标;同时获得容量转移常数(volume transfer constant,K_(trans))、速率常数(rate constant,K_(ep))及血管外细胞外间隙比(extravascular extracellular volume fraction,V_(e))等定量参数,计算新辅助化疗后的最大径缩小率和体积缩小率。并采用Logistic回归模型分析影响患者病理学缓解程度的独立预测因素。结果经过新辅助化疗后,显著缓解组患者的肿瘤最大径缩小率与肿瘤体积缩小率均显著高于未显著缓解组(均P<0.05);显著缓解组患者的K_(trans)、K_(ep)、V_(e)降低程度均显著高于未显著缓解组(均P<0.05);显著缓解组患者新辅助化疗前的E_(1)及E_(max)均显著高于未显著缓解组(均P<0.05),T_(max)水平显著短于未显著缓解组(P<0.05),化疗后显著缓解组患者E_(1)及E_(max)水平显著低于未显著缓解组(均P<0.05),而T_(max)显著长于未显著缓解组(P<0.05)。显著缓解组患者TIC类型降低率显著高于未显著缓解组(P<0.05)。Logistic回归分析结果显示,肿瘤最大径缩小率、ΔK_(trans)、E_(1)均是评估病理学缓解程度的独立预测因素。结论DCE-MRI能够通过肿瘤形态学、血流动力学及信号强度参数等指标,准确有效地评估预测乳腺癌患者新辅助化疗后的病理缓解程度,具有较高的应用价值。

Objective To explore the predictive value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in pathological remission degree of breast cancer after neoadjuvant chemotherapy.Method A total of 167 breast cancer patients admitted to Chongqing University Three Gorges Hospital from June 2018 to December 2019 were selected.All patients were operated after neoadjuvant chemotherapy,and DCE-MRI was performed before and after neoadjuvant chemotherapy.According to the results of postoperative pathological examination,40 patients with pathological reaction gradeⅣ~Ⅴwere included in significant remission group,and 127 patients with pathological reaction gradeⅠ~Ⅲwere included in non-significant remission group.The DCE-MRI imaging manifestations and the changes of time-signal intensity curve(TIC)were compared between the two groups.The earlyphase enhancement rate(E_(1)),peak enhancement rate(E_(max)),time to peak(T_(max))and other indexes of DCE-MRI before and after neoadjuvant chemotherapy were recorded.Meanwhile,quantitative parameters such as volume transfer constant(K_(trans)),rate constant(K_(ep))and extravascular extracellular volume fraction(V_(e))were obtained to calculate the maximum diameter reduction rate and the volume reduction rate after neoadjuvant chemotherapy.Logistic regression model was used to analyze the independent predictors of pathological remission.Result After neoadjuvant chemotherapy,the maximum diameter reduction rate and tumor volume reduction rate of patients in significant remission group were significantly higher than those in non-significant remission group(all P<0.05);the reduction of K_(trans),K_(ep)and Ve in the patients with significant remission group were significantly higher than those in the patients with non-significant remission group(all P<0.05);the E_(1)and E_(max)in the patients with significant remission group before chemotherapy were significantly higher than those in the patients with non-significant remission group(all P<0.05),the level of T_(max)in significant remission group was significantly shorter than that in non-significant remission group(all P<0.05),but the level of E_(1)and E_(max)in significant remission group after chemotherapy were significantly lower than that in non-significant remission group(all P<0.05),while T_(max)was significantly longer than that in non-remission group(P<0.05).The decrease rate of TIC type in patients with significant remission group was significantly higher than that in patients with non-significant remission group(P<0.05).Through Logistic regression model,we found that the reduction of tumor maximum diameter,ΔK_(trans)and E_(1)were independent predictors of pathological remission.Conclusion DCE-MRI can accurately and effectively evaluate and predict the degree of pathological remission of breast cancer patients after neoadjuvant chemotherapy through tumor morphology,hemodynamics and signal intensity parameters,which has high application value.