增强能谱乳腺X线摄影与MRI评估乳腺癌新辅助化疗后残留病灶大小的价值

The value of contrast-enhanced spectral mammography and MRI for detecting residual disease after neoadjuvant chemotherapy in breast cancer

目的比较增强能谱乳腺X线摄影(contrast-enhanced spectral mammography,CESM)与MRI评估乳腺癌新辅助化疗(neoadjuvant chemotherapy,NAC)后残留病灶大小的应用价值。方法选取2019年3月至2021年12月于青岛大学附属泰安市中心医院经病理确诊为乳腺癌且接受NAC的31例患者作为研究对象。所有患者在NAC前后均进行CESM和MRI检查,分别测量NAC后残留病灶的大小,并与病理检查结果进行比较。分析两种检查方法测量肿瘤大小的相关性,与病理检查结果的一致性及两者的灵敏度、特异度、准确度、阳性预测值、阴性预测值。结果CESM与MRI都倾向于低估NAC后残留病灶的大小,其中CESM平均低估6.2 mm,MRI平均低估2.9 mm。NAC前后CESM与MRI测量的肿瘤大小呈正相关性(r>0,P<0.05)。CESM与病理学检查结果的一致性为0.665,MRI为0.815。CESM、MRI评估完全缓解的灵敏度、特异度、阳性预测值、阴性预测值比较差异无统计学意义。结论在评估NAC后肿瘤残留病灶大小方面,CESM的检查性能与MRI相当,可作为一种替代方法。

Objective To compare the performance of contrast-enhanced spectral mammography(CESM)and MRI for detecting residual disease after neoadjuvant chemotherapy(NAC)in breast cancer.Methods 31 patients who were pathologically diagnosed with breast cancer and received neoadjuvant chemotherapy in the Affiliated Taian City Centeral Hospital of Qingdao University from March 2019 to December 2021 were selected as the research subjects.All patients underwent both CESM and MRI before and after NAC,the size of the residual lesion after NAC measured on CESM and MRI was compared with the pathological results.Correlations between measurements,concordances with pathology,sensitivity,specificity,positive predictive value and negative predictive value were evaluated.Results Both methods tend to underestimate the residual tumor size afer NAC,CESM underestimated tumor size by 6.2 mm,whereas MRI underestimated tumor size by 2.9 mm.Before and after NAC,the tumor size measured by CESM were positively correlated with MRI(r>0,P<0.05).There were no significant differences in sensitivity,specificity,positive predictive value and negative predictive value between CESM and MRI in evaluating complete remission.Conclusion CESM was comparable to MRI in assessing residual tumor size afer NAC,and can be regarded as an alternative method.