乳腺癌表型影响新辅助化疗后MRI反应评估的准确性

Breast cancer phenotype affects accuracy of MRI responseevaluation after neoadjuvant chemotherapy

目的 探讨磁共振成像(MRI)评估乳腺癌新辅助化疗(neoadjuvant chemotherapy, NAC)后病理完全缓解(pathologic complete response, pCR)准确性的影响因素。方法 回顾性分析2019年7月至2021年12月于西安交通大学第二附属医院接受NAC的89例乳腺癌患者,在NAC前及全程结束后分别行乳腺MRI检查。根据NAC全程结束后手术所获得的病理结果,以Miller-Payne分级为评估标准,分为pCR与非病理完全缓解(npCR)2个亚组。应用卡方检验比较两组间NAC前病变MRI特征。应用受试者工作特征(ROC)曲线分析MRI评估NAC后pCR的准确性、敏感度、特异度、阳性预测值、阴性预测值,并分析MRI预测不同肿瘤亚型pCR的诊断效能。单变量和多变量分析影响放射学完全缓解(radiographic complete response, rCR)和pCR一致性的因素。结果 NAC后MRI分析显示rCR 20例(22.5%),pCR 28例(31.5%),将rCR视为MRI分析的“阳性”结果,MRI评估正确79例,其中真阳性19例,真阴性60例,评估错误10例,其中假阴性9例,假阳性1例,MRI评估pCR的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为67.86%、98.36%、88.76%、95.00%、86.96%;MRI评估ERBB2+型乳腺癌NAC后pCR的诊断效能最低。单因素分析显示,雌激素受体(ER)、临床分期、背景实质强化及肿瘤最大径均影响rCR和pCR一致性(P<0.05);多因素Logistic回归分析显示,临床分期是影响rCR和pCR一致性的独立影响因素。结论 MRI评估乳腺癌NAC后pCR整体准确性良好,治疗前MRI特征和肿瘤亚型可能与乳腺癌患者NAC治疗后MRI的诊断准确性相关。

Objective To evaluate which factors may affect magnetic resonance imaging(MRI)performance in the detection of pathologic complete response(pCR)after neoadjuvant chemotherapy(NAC).Methods This retrospective study involved 89 patients diagnosed with invasive breast carcinoma who received NAC at The Second Affiliated Hospital of Xi’an Jiaotong University from July 2019 to December 2021.Breast MRI was performed before and after NAC.Based on the pathological results obtained surgery after the completion NAC and using Miller-Payne classification as the evaluation standard,the patients were divided into two subgroups:pCR and non-pathological complete response(npCR).Chi-square test was used to compare the MRI characteristics of pre-NAC lesions between the two groups.ROC curve analysis was made to analyze the accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of MRI after NAC;the diagnostic performance of MRI in predicting pCR in different tumor subtypes was analyzed.We made univariate and multivariate analyses of factors affecting radiographic complete response(rCR)and pCR concordance.Results MRI analysis after NAC showed rCR in 20 cases(22.5%)and pCR in 28 cases(31.5%).Considering rCR as a“positive”result of MRI analysis,MRI assessment was accurate in 79 cases,including 19 true positive cases and 60 true negative cases.MRI assessment was inaccurate in 10 cases,including 9 false negative cases and 1 false positive case.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of MRI assessment of pCR were 67.86%,98.36%,88.76%,95.00%,and 86.96%.MRI had the lowest diagnostic efficiency in evaluating pCR of ERBB2+breast cancer after NAC.Single factor analysis showed that estrogen receptor(ER),clinical stage,background parenchymal enhancement,and maximum tumor diameter all affected the consistency of rCR and pCR(P<0.05).Multivariate Logistic regression analysis showed that the independent influencing factor affecting the consistency of rCR and pCR was clinical stage.Conclusion MRI demonstrated good accuracy in predicting pCR after NAC in the breast cancer patients examined.Pre-treatment MRI characteristics and tumor subtypes may be related to the diagnostic accuracy of post-NAC MRI in breast cancer patients.