磁共振扩散加权成像ADC值在评估肝郁痰凝型三阴乳腺癌新辅助化疗早期疗效中的应用

Application of ADC Value of Diffusion-Weighted Magnetic Resonance Imaging in Evaluating the Early Curative Effect of Neoadjuvant Chemotherapy for Triple-Negative Breast Cancer of Liver Depression and Congealing Phlegm Type

目的:观察磁共振(MR)扩散加权成像(DWI)参数表观扩散系数(ADC)值在评估肝郁痰凝型三阴乳腺癌新辅助化疗(NAC)早期疗效中的应用价值。方法:选取局部进展期肝郁痰凝型三阴乳腺癌患者32例,在NAC前、2个周期后行磁共振成像(MRI)检查,记录病灶最小ADC值,并计算ADC变化率(ΔADC),根据临床疗效结果分为完全缓解(CR)+部分缓解(PR)组、疾病稳定(SD)+疾病进展(PD)组;根据病理疗效结果分为病理完全缓解(pCR)组、非病理完全缓解(nonpCR)组。分别比较2组间ADC值、ΔADC的变化及疗效评估结果的相关性。结果:32例患者中,NAC临床疗效评估CR+PR组共20例,SD+PD组共12例。其中28例行改良根治术,4例行保乳手术;手术后病理反应分级pCR组共18例,non-pCR组共14例。NAC前,病灶最小ADC值2组间比较,差异均无统计学意义(P>0.05);NAC治疗2个周期后,CR+PR组ADC值、ΔADC较SD+PD组升高,2组间比较,差异有统计学意义(P<0.05);pCR组ADC值、ΔADC较non-pCR组升高,2组间比较,差异有统计学意义(P<0.05)。结论:肝郁痰凝型三阴乳腺癌NAC治疗2个周期后,病灶最小ADC值对其早期疗效有较好的评估价值。

Objective:To observe the application effect of apparent diffusion coefficient(ADC)value of diffusion-weighted imaging(DWI)of magnetic resonance(MR)in evaluating the early curative effect of neoadjuvant chemotherapy(NAC)for triplenegative breast cancer of the liver depression and congealing phlegm type.Methods:A total of 32 cases of patients with locally advanced triple-negative breast cancer of the liver depression and congealing phlegm type were selected.Magentic resonance imaging(MRI)was performed before NAC and after two-cycle chemotherapy.The minimum ADC value of the lesion was recorded and the ADC change rate(ΔADC)was calculated.According to the clinical effect all patients were divided into the complete remission(CR)+partial remission(PR)group,the disease stability(SD)+disease progression(PD)group.Accordin to the pathological effect,all patients were divided into the pathological complete remission(pCR)group and nonpathological complete remission(non-pCR)group.The correlations between changes in ADC values andΔADC and the evaluating results of curative effect were compared between the two groups respectively.Results:According to the evaluation of NAC clinical effect,among 32 patients,there were 20 cases in the CR+PR group and 12 cases in the SD+PD group.A total of 28 patients underwent modified radical mastectomy and four cases underwent breast-conserving surgery.According to the grading of postoperative pathological reactions,there were 18 cases in the p CR group and 14 cases in the non-pCR group.Before NAC,there was no significance in differences being found in the comparison of minimum ADC value of the lesion between the two groups(P>0.05).After two-cycle NAC,ADC value andΔADC in the CR+PR group were increased when compared with those in the SD+PD group,the difference being significant(P<0.05);ADC value andΔADC in the pCR group were increased when compared with those in the non-pCR group,the difference being significant(P<0.05).Conclusion:After two cycles of NAC treatment for triple-negative breast cancer of the liver depression and congealing phlegm type,the minimum ADC value of the lesion has a good evaluation value for its early curative effect.