摘要
目的:探索新辅助化疗(neoadjuvant chemotherapy,NAC)1个周期后动态增强磁共振成像(dynamic contrastenhanced magnetic resonance imaging,DCE-MRI)定量分析在预测局部进展期乳腺癌(locally advanced breast cancer,LABC)化疗效果中的价值。方法:收集NAC的LABC患者28例,NAC前及化疗1个周期后均进行多期DCE-MRI扫描,采用38期,每期10 s。测量DCE-MRI的定量参数:容量转移常数(Ktrans)、速率常数(Kep)和血管外细胞外间隙容积比(Ve)。患者根据治疗后手术病理学检查结果分为组织学显著反应组和组织学非显著反应组两组,利用t检验或非参数检验的方法,比较NAC前和化疗1个周期后两组间DCE-MRI定量参数的差异。通过绘制受试者工作特征(receiver operating characteristic curve,ROC)曲线分析NAC前及化疗1个周期后DCE-MRI定量参数预测NAC疗效的诊断效能。结果:28例患者中,9例(32.1%)为组织学显著反应,19例(67.9%)为组织学非显著反应。化疗前定量DCE-MRI的Ktrans、Kep、Ve值在两组间差异并无统计学意义(P>0.05);NAC 1个周期后Ktrans、Kep值较化疗前明显减低,化疗前后差异有统计学意义(P<0.05);Ve值化疗前后变化不显著(P>0.05)。化疗1个周期后的Ktrans值能够区分组织学显著反应组和组织学非显著反应组,ROC曲线分析显示Ktrans值的曲线下面积(area under curve,AUC)为0.749,阈值为0.202/min,灵敏度为100.00%,特异度为63.16%。而Kep及Ve值的预测效能降低,AUC分别为0.667、0.632。结论:NAC前所有DCE-MRI的Ktrans、Kep、Ve值均不能够预测疗效;化疗1个周期后Ktrans是预测组织学显著反应的最佳指标,Kep、Ve值可作为辅助预测指标。
Objecctive:To determine whether quantitative analysis of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)after the first cycle of neoadjuvant chemotherapy(NAC)in locally advanced breast cancer(LABC)could predict final pathologic response.Methods:Twenty-eight patients with LABC who had undergone NAC were enrolled.All of them were imaged using DCE-MRI with 38 phases(10 s per phase)at the baseline and were repeatedly scanned after the first cycle of treatment.DCEMRI kinetic parameters(Ktrans,Kep,Ve)were calculated.Subjects were divided into major histological response group and nonmajor histological response group according to the surgical pathologic specimen.All parameters were compared by Student t test or nonparametric test.The diagnostic performance of different parameters(including Ktrans,Kep and Ve)was judged by the receiver operating characteristic(ROC)curve analysis.Results:Nine(32.1%)of 28 patients showed major histological response and 19(67.9%)showed non-major histological response.No difference in all pre-treatment parameters(including Ktrans,Kep and Ve)was found between groups(P>0.05).At the end of the first cycle of treatment,the Ktrans value and Kep value were significantly lower than that of the baseline(P<0.05),while the changes of Ve value during the treatment was not significant(P>0.05).Ktrans was significantly different between major histological responders from non-major histological responders(P<0.05)after a single cycle of chemotherapy.ROC curve analysis showed that the area under curve(AUC)of Ktrans was 0.749.When the optimal cut-off was set at 0.202,the values for sensitivity and specificity were up to 100.00%and 63.16%.The AUCs of Kep and Ve were 0.667 and 0.632,respectively.Conclusion:Before treatment,all DCE-MRI kinetic parameters(Ktrans,Kep,Ve)can not predict treatment response.At the end of the first cycle of treatment,Ktrans was the best predictor of major histologic response,and Kep and Ve were supplementary predictors.
作者
孙海馨
张仁知
周纯武
蒋涛
SUN Haixin;ZHANG Renzhi;ZHOU Chunwu;JIANG Tao(Department of Radiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Radiology,Cancer Hospital Chinese Academy of Medical Sciences,Beijing 100021,China)
出处
《肿瘤影像学》
2020年第2期127-133,共7页
Oncoradiology
关键词
乳腺癌
动态增强
磁共振成像
新辅助化疗
Breast cancer
Dynamic contrast-enhanced
Magnetic resonance imaging
Neoadjuvant chemotherapy
