乳腺癌新辅助化疗后残余肿瘤瘤床的磁共振成像研究

发布时间：2018-05-20 04:25

本文选题：乳腺癌 + 新辅助化疗　；参考：《第三军医大学》2016年博士论文

【摘要】：乳腺癌是女性发病率最高的肿瘤,严重影响妇女的健康与生命。新辅助化疗已经成为乳腺癌的标准治疗方案,它能使肿块缩小,降低肿瘤的分期,提高保乳手术率。保乳手术与乳房切除术有相同的总生存率和无瘤生存率,并能保持乳房的美容外观,提高患者的生活质量。然而,并不是所有进行了新辅助化疗的乳腺癌患者都能进行保乳手术。新辅助化疗后残余肿瘤的收缩模式可呈散在的多中心模式,在残留癌灶旁可能仍有小卫星灶,若此类患者选择保乳手术,则可能会导致切缘阳性和肿瘤残留,因而临床迫切需要能在术前评价残余肿瘤收缩模式的检查方法。针对目前尚不明确MRI评价乳腺癌新辅助化疗后残余肿瘤收缩模式的能力,本课题拟通过乳腺磁共振成像并与全乳腺大切片对比,研究MRI在评价乳腺癌新辅助化疗后残余肿瘤中的作用,旨在为临床手术方案的制定提供重要的参考依据。一、新辅助化疗后残余肿瘤MRI表现与全乳腺大切片对比研究目的:探讨MRI评价乳腺癌新辅助化疗后残余肿瘤收缩模式的能力。方法:收集35例Ⅱ、Ⅲ期浸润性导管癌患者的MRI检查资料并与全乳腺大切片对比。35例患者均采用TE方案进行了4个周期的新辅助化疗,并均在新辅助化疗前、后进行了MRI检查,对比化疗前后MRI图像分析肿瘤的收缩模式。35例乳腺癌患者在化疗结束后均进行了乳腺癌改良根治术,术后乳腺标本取一半制成全乳腺大切片,显微镜观察残余肿瘤瘤床表现。结果:新辅助化疗后残余肿瘤表现为向心型收缩、树枝型收缩。35例新辅助化疗后的残余肿瘤在MRI上表现为向心型收缩的有28例,占80%;表现为树枝型收缩的有7例,占20%。全乳腺大切片显示为向心型收缩的有29例(82.86%),树枝型收缩的有6例(17.14%),MRI与全乳腺大切片评价残余肿瘤收缩模式的相关系数为0.906(P=7.37×10-8)。结论:新辅助化疗后残余肿瘤表现为向心型收缩和树枝型收缩,MRI能正确评价残余肿瘤的收缩模式。二、乳腺癌新辅助化疗后的磁共振成像研究目的:探讨乳腺癌新辅助化疗后的MRI表现与残余肿瘤收缩模式的相关性方法:分析35例乳腺癌患者新辅助化疗前和化疗结束后的MRI资料,包括MRI平扫、动态增强检查和弥散加权成像检查,研究肿瘤最大径、动态增强参数及ADC值与残余肿瘤收缩模式的关系。结果:新辅助化疗前原发肿瘤的最大径与肿瘤收缩模式有相关性,原发肿瘤越大,越易出现树枝型收缩(P0.001)。新辅助化疗前、后的肿瘤时间-信号强度曲线与肿瘤收缩模式无相关性(P0.05),新辅助化疗前、后MRI动态增强参数SIpeak、Tpeak、ECU与肿瘤收缩模式无相关性(P0.05)。化疗前ADC值与肿瘤收缩率的相关系数R=-0.775,P0.001,与肿瘤的收缩模式无相关性(P0.05)。结论:MRI显示的残余肿瘤的收缩模式与原发肿瘤的大小密切相关,原发肿瘤越大,残余肿瘤越容易出现树枝型收缩;原发肿瘤的ADC值越大,残余肿瘤的收缩程度越大。
[Abstract]:Breast cancer is the highest incidence of women's cancer, which seriously affects the health and life of women. Neoadjuvant chemotherapy has become a standard treatment for breast cancer. It can reduce the lump, reduce the stage of the tumor and improve the rate of breast conserving surgery. The breast conserving surgery and mastectomy have the same total and no tumor survival rates, and keep the breast. Cosmetic appearance can improve the quality of life of the patient. However, not all breast cancer patients undergoing neoadjuvant chemotherapy have been able to perform breast conserving surgery. After neoadjuvant chemotherapy, the contractile pattern of the residual tumor can be scattered in a multi center mode, and there may still be small satellite foci beside the residual cancer. If such patients choose breast conserving surgery, it may lead to the operation. There is an urgent need for the evaluation of residual tumor contraction patterns before operation. In view of the ability of MRI to evaluate the residual tumor contraction pattern after neoadjuvant chemotherapy for breast cancer, this subject is to compare the breast MRI with large breast slices to evaluate the evaluation of MRI in breast cancer. The role of neoadjuvant chemotherapy after neoadjuvant chemotherapy in adenocarcinoma was designed to provide important reference for the formulation of clinical surgical procedures. (1) the comparison of the MRI manifestations of residual tumor after neoadjuvant chemotherapy and the large slice of the whole breast: To explore the ability of MRI to evaluate the residual tumor contraction pattern after neoadjuvant chemotherapy of breast cancer. Methods: 35 cases of II, III were collected. MRI examination data of patients with invasive ductal carcinoma and compared with whole breast large section.35 patients were treated with TE regimen for 4 cycles of neoadjuvant chemotherapy, and both before and after the neoadjuvant chemotherapy, after the MRI examination, the contractile pattern of MRI images before and after the chemotherapy was compared to.35 cases of breast cancer patients were performed after chemotherapy. Modified radical mastectomy for breast cancer, half of the breast specimens were made into large section of the whole mammary gland and microscopic observation of the residual tumor bed. Results: after the neoadjuvant chemotherapy, the remnants of the tumor were contracted to the heart type, and the residual tumor of the branch type.35 after the neoadjuvant chemotherapy was shown to be 28 cases, 80%. There were 7 cases of branch type contraction, which accounted for 29 cases (82.86%) of 20%. whole breast section, 6 cases (17.14%) of branch contraction, and 0.906 (P=7.37 x 10-8) for evaluating the residual tumor contraction pattern of MRI and large section of whole breast. Conclusion: the residual tumor after neoadjuvant chemotherapy is the contraction of the heart type and the contraction of the branch type, M RI can correctly evaluate the contractile pattern of residual tumor. Two. The purpose of magnetic resonance imaging after neoadjuvant chemotherapy of breast cancer: To explore the correlation between the MRI performance and the residual tumor contraction pattern after neoadjuvant chemotherapy of breast cancer: the analysis of the MRI data of 35 cases of breast cancer patients before and after the end of chemotherapy, including MRI plain scan, and dynamic increase The relationship between the maximum diameter of the tumor, the dynamic enhancement parameters and the ADC value with the residual tumor contractile patterns. Results: the maximum diameter of the primary tumor before the neoadjuvant chemotherapy is related to the pattern of the tumor contraction. The greater the primary tumor is, the more easily the dendritic contraction (P0.001) appears. The time of the tumor before the neoadjuvant chemotherapy is - There was no correlation between signal intensity curve and tumor contraction mode (P0.05). Before neoadjuvant chemotherapy, MRI dynamic enhancement parameters SIpeak, Tpeak, ECU were not related to tumor contraction model (P0.05). The correlation coefficient of ADC value before chemotherapy and tumor contraction rate R=-0.775, P0.001, and tumor contraction pattern (P0.05). Conclusion: MRI display of residual tumor The shrinkage mode of the primary tumor is closely related to the size of the primary tumor. The greater the primary tumor, the more likely the residual tumor will appear in the branch type contraction. The greater the ADC value of the primary tumor, the greater the shrinkage of the residual tumor.
【学位授予单位】：第三军医大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R737.9;R445.2

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