动态增强MRI预测乳腺癌新辅助化疗后病理完全缓解的准确性

Accuracy of Dynamic Contrast-enhanced MRI in Predicting Pathological Complete Response After Neoadjuvant Chemotherapy for Breast Cancer

目的探讨动态增强MRI预测乳腺癌新辅助化疗后病理完全缓解的准确性。方法选取2018年12月-2021年12月在我院接受治疗的316例乳腺癌患者为研究对象,比较新辅助化疗以及手术治疗之后的放射完全缓解(rCR)与病理完全缓解(pCR)判定结果,对比真阳性和假阳性患者、真阴性和假阴性患者新辅助化疗后的MRI参数。结果以术后病理学检查pCR的结果作为金标准,MRI检查的rCR预测的灵敏度为81.82%,特异度为32.43%,准确度为70.25%,阳性预测值为79.84%,阴性预测值为35.29%,与pCR的Kappa值为0.15。新辅助化疗后,真阳性和假阳性患者的肿瘤直径、背景实质强化、肿瘤周围水肿比例比较,差异有统计学意义(P<0.05);真阴性和假阴性患者的乳腺组织密度、肿瘤边缘强化比较,差异有统计学意义(P<0.05)。结论动态增强MRI检查能够作为预测乳腺癌新辅助化疗后pCR预测的重要手段,对于预测准确性有影响的指标,需要在工作中给予足够的关注,进一步提升预测的准确性。

Objective To investigate the accuracy of dynamic contrast-enhanced MRI in predicting the pathological complete remission of breast cancer after neoadjuvant chemotherapy.Methods A total of 316 patients with breast cancer who were treated in our hospital from December 2018 to December 2021 were selected as the research objects.The results of radiation complete remission(rCR)and pathological complete remission(pCR)after neoadjuvant chemotherapy and surgical treatment were compared.The MRI parameters of true positive and false positive patients,true negative and false negative patients after neoadjuvant chemotherapy were compared.Results With the results of postoperative pathological examination of pCR as the gold standard,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of rCR in MRI were 81.82%,32.43%,70.25%,79.84%and 35.29%,respectively,the Kappa value with pCR was 0.15.After neoadjuvant chemotherapy,there were significant differences in tumor diameter,background parenchymal enhancement and peritumoral edema between true positive and false positive patients(P<0.05).There were significant differences in breast tissue density and tumor edge enhancement between true negative and false negative patients(P<0.05).Conclusion Dynamic contrast-enhanced MRI can be used as an important means to predict pCR after neoadjuvant chemotherapy for breast cancer.For indicators that affect the accuracy of prediction,sufficient attention needs to be paid in the work to further improve the accuracy of prediction.