MRI参数在进展期乳腺癌患者新辅助化疗效果、病理反应性评估中的应用

Application of MRI Parameters in Evaluation of Neoadjuvant Chemotherapy Effect and Pathological Reactivity in Patients with Advanced Breast Cancer

目的探讨磁共振(MRI)参数对进展期乳腺癌患者新辅助化疗(NAC)效果与病理反应性的评估价值。方法选取2021年6月至2022年5月清丰第一医院收治的进展期乳腺癌患者84例,均实施NAC,根据化疗效果分为有效组与无效组,根据不同肿瘤病理反应性分级分为病理完全缓解(pCR)组与非pCR组,比较治疗前后肿瘤体积(GTV)、弥散系数(ADC)值,分析GTV与ADC值的相关性。结果84例进展期乳腺癌患者经过NAC后有效46例,占54.76%;无效38例,占45.24%。pCR 34例,占40.48%;非pCR 50例,占59.52%。有效组治疗后GTV小于无效组,肿瘤体积减少值(△GTV)高于无效组,pCR组治疗后GTV小于无效组,△GTV高于非pCR组;有效组治疗后ADC值、ADC增加值(△ADC)高于无效组,pCR组治疗后ADC值、△ADC高于非pCR组;进展期乳腺癌患者GTV与ADC值呈负相关(r=-0.484,P=0.017),△GTV与△ADC呈正相关,差异有统计学意义(r=0.487,P=0.015)。治疗后GTV、△GTV、治疗后ADC、△ADC对pCR的曲线下面积分别为0.861、0.910、0.753、0.876。结论MRI参数与进展期乳腺癌患者GTV有着密切关系,其中ADC值能够有效评估NAC效果及病理反应性。

Objective To explore the value of magnetic resonance(MRI)parameters in evaluating the efficacy and pathological reactivity of neoadjuvant chemotherapy(NAC)in patients with advanced breast cancer.Methods A total of 84 patients with advanced breast cancer who were admitted in Qingfeng First Hospital in Chongqing from June 2021 to May 2022 were selected,all of whom were treated with NAC.They were divided into effective group and ineffective group by the effect of chemotherapy.They were divided into pathological complete remission(pCR)group and non pCR group by the grading of tumor pathological reactivity.The tumor volume(GTV)and diffusion coefficient(ADC)values before and after treatment were compared,and the correlation between GTV and ADC values was analyzed.Results Among 84 patients with advanced breast cancer,46 cases were effective(54.76%)and 38 cases were ineffective(45.24%)after NAC.34 cases were pCR(40.48%),50 cases were non pCR(59.52%).After treatment,GTV in the effective group was smaller than that in the ineffective group(P<0.05),tumor volume reduction value(△GTV)was higher than that in the ineffective group(P<0.05),GTV in the pCR group was smaller than that in the ineffective group(P<0.05),and△GTV was higher than that in the non pCR group(P<0.05).The ADC value and ADC increment value(△ADC)in the effective group were higher than those in the ineffective group(P<0.05),and those in the pCR group were higher than those in the non pCR group(P<0.05).In patients with advanced breast cancer,GTV was negatively correlated with ADC(r=-0.484,P=0.017),and△GTV was positively correlated with△ADC(r=0.487,P=0.015).The area under the curve of GTV,△GTV,ADC and△ADC to pCR after treatment were 0.861,0.910,0.753 and 0.876 respectively.Conclusion MRI parameters are closely related to GTV in patients with advanced breast cancer,and ADC value can effectively evaluate the effect of NAC and pathological reactivity.