MR多参数联合评估局部进展期乳腺癌新辅助化疗疗效的应用价值

发布时间：2019-05-10 00:17

【摘要】：目的探讨MRI多参数联合评价局部进展期乳腺癌新辅助化疗(NAC)疗效的效能。方法回顾性分析127例经术前穿刺、术后病理确诊的局部进展期乳腺癌。分别于NAC前、NAC 2周期后、4周期后行动态MRI增强扫描及DWI成像。按照MillerPayne改良病理反应性分级,将所有病例分为组织学反应显著(MHR)与组织学非显著反应组(NMHR)。以病理反应性为应变量,分别对NAC 2、4周期后获得的MRI半定量参数进行分析。建立Logistic回归模型并构建新的参数,研究各新构建参数评价乳腺癌NAC反应性的效能。结果 NAC 2周期后新构建参数ROC曲线下面积(Az)为0.80(95%CI:0.72~0.87),大于单独使用癌灶最大径变化率作为评价指标(Az=0.66,95%CI:0.57~0.76)(P0.05),最佳截断点1.81,敏感性及特异性分别为76.81%和72.41%;NAC 4周期后,新构建参数ROC曲线下面积(Az)为0.86(95%CI:0.79~0.93),大于单独使用第4周期后癌灶最小ADC(Az=0.75,95%CI:0.67~0.84)及癌灶最大径变化率(Az=0.73,95%CI:0.62~0.80)(P0.05)作为评价指标,最佳截断点-1.19,敏感性及特异性分别为84.06%和81.03%。结论 MRI多参数联合评价局部进展期乳腺癌NAC疗效具有较高诊断效能,能充分利用各指标信息。
[Abstract]:Objective to evaluate the efficacy of MRI in evaluating the efficacy of neoadjuvant chemotherapy (NAC) in locally advanced breast cancer. Methods 127 cases of locally advanced breast cancer diagnosed by preoperative puncture and postoperative pathology were analyzed retrospectively. Before NAC, after NAC 2 cycles, 4 cycles later, active MRI enhanced scanning and DWI imaging were performed. According to the improved pathological responsiveness grade of MillerPayne, all cases were divided into two groups: histologic response significant (MHR) and histologically non-significant response group (NMHR). The semi-quantitative parameters of MRI obtained after 4 cycles of NAC 2 and 4 cycles were analyzed with pathological responsiveness as dependent variable. The Logistic regression model was established and new parameters were constructed to study the effectiveness of the newly constructed parameters in evaluating NAC responsiveness in breast cancer. Results after NAC 2 cycle, the area (Az) under the newly constructed parameter ROC curve was 0.80 (95%CI:0.72~0.87), which was larger than that of using the maximum diameter change rate of cancer focus alone as the evaluation index (Az=0.66,95%CI:0.57~0.76) (P 0.05). The best cut-off point was 1.81, the sensitivity and specificity were 76.81% and 72.41%, respectively. After NAC 4 cycle, the area (Az) under the new construction parameter ROC curve is 0.86 (95%CI:0.79~0.93). The minimum ADC (Az=0.75,95%CI:0.67~0.84) and the maximum diameter change rate (Az=0.73,95%CI:0.62~0.80) (P 0.05) were used as the evaluation index, and the best cut-off point was-1.19. The sensitivity and specificity were 84. 06% and 81. 03%, respectively. the sensitivity and specificity were 84. 06% and 81. 03%, respectively. Conclusion MRI multi-parameter combined evaluation of NAC in locally advanced breast cancer has high diagnostic efficacy and can make full use of the information of each index.
【作者单位】：北京大学深圳医院医学影像科;北京大学第一医院医学影像科北京大学前沿交叉学科研究院功能成像研究中心;
【基金】：医学物理和工程北京市重点实验室开放课题:乳腺MR诊断(编号:2008P03)
【分类号】：R737.9;R445.2

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