摘要
目的:探讨MRI扩散加权成像表观扩散系数(ADC)的变化在预测乳腺癌新辅助化疗疗效中的价值。方法:回顾性分析2017年1月-2018年12月间收治的80例局部晚期乳腺癌患者临床资料。所有患者均行空芯针穿刺证实为乳腺癌并行新辅助化疗,在新辅助化疗第1周期前、手术前常规行乳腺MRI检查,记录新辅助治疗前与手术前肿瘤组织ADC值。分析肿瘤组织ADC值的变化(△ADC)与病理反应(MP分级)的关系,并通过ROC观察△ADC值判断新辅助化疗的效能。结果:全组患者中,新辅助化疗后病灶ADC值较化疗前增高(1.27×10^-3 mm^2/s vs.0.98×10^-3 mm^2/s,P=0.000);按类型分组分析显示,除三阴性乳腺癌ADC值化疗前后无统计学差异外(P>0.05),其余类型的乳腺癌新辅助化疗后ADC值均较化疗前明显升高(均P<0.05)。组织学显著反应患者△ADC值明显大于组织学非显著反应患者(0.448×10^-3 mm^2/s vs.0.209×10^-3mm^2/s,P=0.004)。△ADC评价乳腺癌新辅助疗效的ROC曲线下面积为0.72,敏感度73.1%,特异度66.7%,当△ADC的截断值为0.239×10^-3 mm^2/s时,阳性预测值51.4%,阴性预测值83.7%,准确度68.8%。结论:在大多数乳腺癌中,ADC的变化对早期预测和评估新辅助化疗疗效有一定的价值。
Objective:To investigate the value of changes in apparent diffusion coefficient(ADC)of diffusion-weighted MRI imaging for predicting the efficacy of neoadjuvant chemotherapy in breast cancer.Methods:The clinical data of 80 patients with locally advanced breast cancer treated from January 2017 to December 2018 were retrospectively analyzed.The breast cancer in all patients was confirmed by hollow needle aspiration.All patients underwent neoadjuvant chemotherapy,and routinely underwent MRI examination before neoadjuvant chemotherapy and before surgery.The relationship between the changes in tumor ADC values(ΔADC)and pathological response(MP grade)were analyzed.The effectiveness ofΔADC in estimating the efficacy of neoadjuvant chemotherapy was determined by the ROC curve.Results:In the entire group of patients,the ADC value of tumors after chemotherapy was significantly higher than that before chemotherapy(1.27×10^-3 mm^2/s vs.0.98×10^-3 mm^2/s,P=0.000).The cancer type-stratified analysis showed that except of no statistical difference between ADC values before and after neoadjuvant chemotherapy in triple negative breast cancer(P>0.05),the ADC values after chemotherapy was significantly higher than those before chemotherapy in all the remaining types of breast cancer(all P<0.05).TheΔADC value in patients with major histological response was significantly higher than that in those without significant histological response(0.448×10^-3 mm^2/s vs.0.209×10^-3 mm^2/s,P=0.004).The area under ROC curve ofΔADC in estimating the efficacy of breast cancer neoadjuvant chemotherapy was 0.72,with the sensitivity of 73.1%and specificity of 66.7%.When the cutoff valueΔADC value was 0.239×10^-3 mm^2/s,the positive predictive value was 51.4%,negative predictive value was 83.7%and the accuracy was 68.8%.Conclusion:In most types of breast cancer,the changes in ADC has certain value for early predicting and evaluating the treatment response of neoadjuvant chemotherapy.
作者
张彦收
张庚
刘运江
ZHANG Yanshou;ZHANG Geng;LIU Yunjiang(Center for Breast Diseases,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2019年第11期1400-1405,共6页
China Journal of General Surgery
基金
河北省卫生厅医学科学研究重点课题资助项目(20160666)
关键词
乳腺肿瘤
放化疗
辅助
弥散磁共振成像
表观扩散系数
Breast Neoplasms
Chemoradiotherapy,Adjuvant
Diffusion Magnetic Resonance Imaging
Apparent Diffusion Coefficient
