MRI动态增强定量分析早期预测乳腺癌患者NAC疗效的可行性

Quantitative dynamic contrast enhanced MRI in the response prediction of breast cancer patients undergoing neoadjuvant chemotherapy

目的探讨动态对比增强MRI(DCE-MRI)定量分析早期预测乳腺癌患者NAC疗效的可行性。方法收集经穿刺证实的女性浸润性导管癌患者55例,均予4～6个周期的新辅助化疗。化疗前后分别行DCE-MRI检查。根据化疗后同一病灶穿刺病理结果有无癌灶浸润将所有患者分为缓解组和非缓解组。比较化疗前后两组患者细胞外血管外间隙容积比(Ve)、容量转移常数(Ktrans)、速率常数(Kep)的差异。分析DCE-MRI对乳腺癌患者化疗后疗效判定的敏感度、特异度、阳性预测值、阴性预测值。结果化疗前两组患者的DCE-MRI参数无统计学差异(P>0.05)。化疗4个周期后DCE-MRI缓解组的Ktrans及Kep变化值大于非缓解组〔(1.60±0.25)vs(1.80±0.20)/min;(3.01±0.96)vs(2.87±0.88)/min〕,而Ve变化值小于非缓解组〔(0.62±0.14)vs(0.67±0.10)/min〕(P<0.05)。DCE-MRI对乳腺癌患者化疗后疗效判定的敏感度、特异度、阳性预测值、阴性预测值分别为60.0%、85.7%、70.6%、78.9%。结论 DCE-MRI定量分析对早期预测乳腺癌患者NAC疗效有一定的可行性。

Objective To investigate whether quantitative dynamic contrast enhanced MRI could predict final pathologic response in primary breast cancer patients undergoing neoadjuvant chemotherapy ( NAC) .Methods Fifty five female patients who were pathologically proved infiltrating ductal carcinoma with core needle puncture biopsy were examined by DCE -MRI before NAC and after four to six cycles of treatment.Patients were divided into two groups by the results of the pathological presence of cancer invasion :the group of pathological com-plete response ( after chemotherapy cancer with no invasion ) and incomplete response ( after chemotherapy cancer with invasion ) .Two groups of patients with extracellular blood vessels outside the clearance volume ratio ( Ve) ,transfer constant capacity ( volume transfer constant , Ktrans) ,rate constant (rate constant, Kep) and the changes in values of the three parameters were compared before and after chemothera -py.The sensitivity, specificity, positive predictive value , negative predictive value of DCE -MRI after chemotherapy in patients with breast cancer were analyzed .Results The DCE-MRI parameters before chemotherapy of patients between two groups had no significant difference (P>0.05).After four cycles of treatment, the changes of Ktrans, Kep in complete response group were greater than those in imcomplete re-sponse group〔(1.60±0.25) vs (1.80±0.20)/min;(3.01±0.96) vs (2.87±0.88)/min〕, but the changes of vein pathological complete response group was less than that in pathological imcomplete response group〔(0.62±0.14) vs( 0.67±0.10)/min〕.The difference was sta-tistically significant between the two groups (P<0.05).The sensitivity, specificity, positive predictive value, negative predictive value of DCE-MRI after chemotherapy in patients with breast cancer were 60.0%,85.7%,70.6%,78.9%respectively.Conclusions Quantitative dynamic contrast enhanced MRI predicting final pathologic response in primary breast cancer patients undergoing neoadjuvant chemotherapy ( NAC) has certain feasibility .