Hsiang David J, Yamamoto Maki, Mehta Rita S, Su Min-Ying, Baick Choong H, Lane Karen T, Butler John A
Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, 101 The City Drive South, Bldg 56, Route 81, Orange, CA 92868, USA.
Arch Surg. 2007 Sep;142(9):855-61; discussion 860-1. doi: 10.1001/archsurg.142.9.855.
Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) is a reliable and accurate method for monitoring primary tumor response in the breast and can be used as a surrogate to predict final axillary nodal status.
Retrospective study (October 1, 2004, through February 28, 2006) of 46 patients with clinically staged locally advanced breast cancer.
Comprehensive cancer center.
Forty-six patients with locally advanced breast cancer.
Neoadjuvant chemotherapy (NAC), DCE-MRI, mastectomy and lumpectomy, and axillary lymph node dissection.
The DCE-MRI results and pathologic response of the breast and axillary lymph nodes.
Forty-six patients underwent NAC with doxorubicin hydrochloride and cyclophosphamide, followed by paclitaxel and carboplatin, with or without trastuzumab based on human epidermal growth factor receptor 2 (HER2/neu) status. Twenty-one patients (46%) had a complete pathologic response. For the HER2/neu-positive patients, the complete pathologic response rate was 70% (14/20). The accuracy, sensitivity, and specificity of the primary tumor response in predicting the axillary nodal status were 78%, 88%, and 72%, respectively. The accuracy, sensitivity, and specificity of the DCE-MRI-measured response in the primary tumor in predicting axillary nodal status were 74%, 62%, and 82%, respectively. For the HER2/neu-positive patients, the accuracy, sensitivity, and specificity improved to 80%, 75%, and 82%, respectively.
The results of DCE-MRI of the primary tumor can be predictive of axillary nodal status, especially in patients receiving trastuzumab who are HER2/neu positive. The HER2/neu-positive patients with a complete clinical response on DCE-MRI are highly unlikely to benefit from an axillary lymph node dissection. For HER2/neu-negative patients, sentinel lymph node sampling is warranted.
动态对比增强（DCE）磁共振成像（MRI）是监测乳腺原发性肿瘤反应的一种可靠且准确的方法，可作为预测最终腋窝淋巴结状态的替代指标。
对46例临床分期为局部晚期乳腺癌患者进行回顾性研究（2004年10月1日至2006年2月28日）。
综合癌症中心。
46例局部晚期乳腺癌患者。
新辅助化疗（NAC）、DCE-MRI、乳房切除术和肿块切除术以及腋窝淋巴结清扫术。
乳腺和腋窝淋巴结的DCE-MRI结果及病理反应。
46例患者接受了含盐酸阿霉素和环磷酰胺的NAC，随后接受紫杉醇和卡铂治疗，根据人表皮生长因子受体2（HER2/neu）状态决定是否使用曲妥珠单抗。21例患者（46%）有完全病理缓解。对于HER2/neu阳性患者，完全病理缓解率为70%（14/20）。原发性肿瘤反应预测腋窝淋巴结状态的准确性、敏感性和特异性分别为78%、88%和72%。DCE-MRI测量的原发性肿瘤反应预测腋窝淋巴结状态的准确性、敏感性和特异性分别为74%、62%和82%。对于HER2/neu阳性患者，准确性、敏感性和特异性分别提高到80%、75%和82%。
原发性肿瘤的DCE-MRI结果可预测腋窝淋巴结状态，尤其是在接受曲妥珠单抗治疗的HER2/neu阳性患者中。DCE-MRI上有完全临床反应的HER2/neu阳性患者极不可能从腋窝淋巴结清扫术中获益。对于HER2/neu阴性患者，有必要进行前哨淋巴结活检。
