动态增强MRI扫描对乳腺癌新辅助化疗疗效的评估

Evaluation value of dynamic enhanced MRI scan for neoadjuvant chemotherapy in breast cancer

目的探讨动态增强MRI扫描评估乳腺癌新辅助化疗(NAC)疗效的价值。方法回顾性分析绍兴第二医院医共体总院2019年1月-2021年3月行乳腺癌新辅助化疗后肿瘤切除术的46例乳腺癌患者的临床资料。化疗前后患者均行统一动态增强扫描方案的乳腺MRI检查和病理学检查,且新辅助化疗全程结束后行化疗病理效果评价。根据化疗前后组织病理学变化行疗效评价,将患者分为病理完全缓解组(pCR组)和病理非完全缓解组(NpCR组)。比较化疗前后两组动态增强MRI检查参数变化的差异,以病理反应性标准为金标准,对其中有统计学意义的参数行ROC曲线分析,并计算ROC曲线下面积(AUC),评价各参数对NAC疗效的评价效能。结果pCR组15例,NpCR组31例。两组治疗前后定量参数容量转移常变化值(ΔK^(trans)%)、细胞外血管外间隙容积比变化值(ΔV_(e)%)、速率常数变化值(ΔK_(ep)%)、肿瘤最大径线变化率(ΔD%)、早期强化程度变化(ΔS%)、时间信号强度曲线最大线性斜率变化率(ΔS_(max)%)、时间信号强度曲线类型的变化值(ΔTIC),差异均有统计学意义(P<0.05)。ΔV_(e)%评估肿瘤疗效灵敏度最高,而ΔS_(max)%特异度最高;除ΔTIC外,其余参数AUC均大于0.7,其中,ΔK^(trans)%、ΔV_(e)%及ΔK_(ep)%的AUC均大于0.9。结论动态增强MRI扫描参数中,ΔK^(trans)%、ΔV_(e)%及ΔK_(ep)%三个参数对乳腺癌NAC疗效具有较好的评估价值,可用于乳腺癌新辅助化疗后的疗效评估。

Objective To investigate the value of dynamic enhanced MRI scan in evaluating the efficacy of neoadjuvant chemotherapy(NAC)for breast cancer.Methods The clinical data of 46 patients with breast cancer who underwent tumor resection after neoadjuvant chemotherapy for breast cancer from January 2019 to March 2021 were retrospectively analyzed.Before and after chemotherapy,patients underwent breast MRI examination and pathological examination with a unified dynamic enhanced scan protocol,and the pathological effect of chemotherapy was evaluated after the end of neoadjuvant chemotherapy.According to the histopathological changes before and after chemotherapy,the patients were divided into pathological complete remission group(group pCR)and pathological non-complete remission group(group NpCR).The differences in the numerical changes of dynamic enhanced MRI parameters between the two groups before and after chemotherapy were compared.The pathological reactivity standard group was used as the gold standard.ROC curve analysis was performed on the statistically significant parameters,and the area under the ROC curve(AUC)was calculated to evaluate the efficacy of each parameter on NAC efficacy.Results There were 15 cases in pCR group and 31 cases in NpCR group.2.Before and after treatment,the quantitative parameters of volume transfer constant change value(ΔK^(trans)%),extracellular extravascular space volume ratio change value(ΔV_(e)%),rate constant change value(ΔK_(ep)%),tumor maximum meridian change rate(ΔD%),early enhancement value change(ΔS%),time signal intensity curve maximum linear slope change rate(ΔS_(max)%),time signal intensity curve type change(ΔTIC)between the two groups were statistically significant(P<0.05).ΔV_(e)%had the highest sensitivity andΔS_(max)%had the highest specificity in evaluating tumor response.Among them,Except forΔTIC,the AUC of other parameters were all>0.7 and the AUC ofΔK^(trans)%,ΔV_(e)%andΔK_(ep)%were all>0.9,indicating that these three dynamic enhanced MRI scanning parameters had a very good evaluation effect on the NAC efficacy of breast cancer,and the remaining parameters had a certain evaluation ability exceptΔTIC.Conclusion Dynamic enhanced MRI scan parameters can be used to evaluate the efficacy of neoadjuvant chemotherapy for breast cancer.