Tozaki Mitsuhiro, Kobayashi Tadashi, Uno Shinji, Aiba Keisuke, Takeyama Hiroshi, Shioya Hisashi, Tabei Isao, Toriumi Yasuo, Suzuki Masafumi, Fukuda Kunihiko
Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan.
AJR Am J Roentgenol. 2006 Feb;186(2):431-9. doi: 10.2214/ajr.04.1520.
For this study, we investigated the usefulness of MDCT in assessing the extent of residual breast cancer after neoadjuvant chemotherapy. To ensure the success of breast-conserving surgery, we evaluated the usefulness of determining the tumor distribution before neoadjuvant chemotherapy and the shrinkage pattern after neoadjuvant chemotherapy.
MDCT before and after neoadjuvant chemotherapy was performed in 46 consecutive patients with 47 locally advanced breast cancers. The distribution pattern of contrast enhancement on MDCT before neoadjuvant chemotherapy was classified into five categories: solitary lesion, grouped lesion (localized lesion with linear, spotty, or linear and spotty enhancement), separated lesion (multiple foci of contrast enhancement), mixed lesion (grouped lesion with multiple foci), and replaced lesion (diffuse contrast enhancement in whole quadrants).
There was agreement between the MDCT assessment and pathologic findings in 44 (94%) of the 47 tumors. In the partial response group with nonreplaced lesions, MDCT revealed three shrinkage patterns: pattern 1a, concentric shrinkage without surrounding lesions; pattern 1b, concentric shrinkage with surrounding lesions; and pattern 2, shrinkage with residual multinodular lesions. Breast-conserving surgery was performed successfully in 14 patients including complete response cases that were detected on the basis of MDCT findings and partial response cases that were detected on the basis of observation of pattern 1 shrinkage. In all five patients with pattern 2 shrinkage, CT underestimated the residual tumor extent by more than 2 cm.
MDCT classification of tumor distribution before neoadjuvant chemotherapy and of shrinkage patterns after neoadjuvant chemotherapy is important in the preoperative evaluation of patients undergoing breast-conserving surgery.
在本研究中，我们调查了多层螺旋CT（MDCT）在评估新辅助化疗后残余乳腺癌范围方面的效用。为确保保乳手术成功，我们评估了在新辅助化疗前确定肿瘤分布以及新辅助化疗后缩小模式的效用。
对46例连续患有47处局部晚期乳腺癌的患者在新辅助化疗前后进行了MDCT检查。新辅助化疗前MDCT上对比增强的分布模式分为五类：孤立性病变、成组病变（具有线性、斑点状或线性和斑点状增强的局限性病变）、分离性病变（对比增强的多个病灶）、混合性病变（有成组病变及多个病灶）和替代病变（整个象限弥漫性对比增强）。
47个肿瘤中有44个（94%）的MDCT评估与病理结果一致。在非替代病变的部分缓解组中，MDCT显示出三种缩小模式：模式1a，无周围病变的同心缩小；模式1b，有周围病变的同心缩小；模式2，有残余多结节病变的缩小。14例患者成功进行了保乳手术，包括基于MDCT结果检测出的完全缓解病例以及基于模式1缩小观察检测出的部分缓解病例。在所有5例模式2缩小的患者中，CT对残余肿瘤范围的低估超过2厘米。
新辅助化疗前肿瘤分布及新辅助化疗后缩小模式的MDCT分类在接受保乳手术患者的术前评估中很重要。
