Tsunoda-Shimizu Hiroko, Hayashi Naoki, Hamaoka Tsuyoshi, Kawasaki Tomonori, Tsugawa Koichiro, Yagata Hiroshi, Kikuchi Mari, Suzuki Koyu, Nakamura Seigo
Department of Radiology, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
Breast Cancer. 2008;15(2):133-40. doi: 10.1007/s12282-008-0030-7.
Neoadjuvant chemotherapy has recently become common therapy for breast cancer. This work studied whether or not the effects of neoadjuvant chemotherapy can be predicted from morphological features of breast cancer in initial diagnostic imaging.
A total of 186 cases who underwent neoadjuvant chemotherapy at this hospital in 2006 were studied. Morphological features were classified into four categories. One is a type of invasive carcinoma that tends to grow along the mammary ducts (type A1), another is a type of expansively growing invasive carcinoma that is relatively well-defined (type A2), a third is a type of irregularly shaped mass that retracts surrounding tissue (type A3), and the fourth is a mixed type. Thus, the effects of neoadjuvant chemotherapy on carcinomas of the four types were compared on the basis of image and pathological findings. Effects of neoadjuvant chemotherapy were classified into three categories of enlarged mass, pCR, and other, with the latter indicating no change or shrinkage.
Of the 186 total cases, 72 were classified as type A1, 31 as type A2, 52 as type A3, and 31 as a mixed type. Seven of 31 cases of type A2 (22.6%) were cases of an enlarged mass, revealing a high percentage of such cases. Dividing cases into type A2 and other types and looking at the proportion of cases of an enlarged mass thus indicated a significantly higher tendency. pCR was achieved in 6 of 31 cases with type A2 (19.4%). Here, also, the proportion of type A2 cases was significantly higher.
Morphological features prior to neoadjuvant chemotherapy can contribute to determining the effects of the therapy. Expansively growing well-defined masses contain lesions at both extremes, tending to enlarge in some instances or instead allowing pCR, so the course of therapy must be carefully followed when performing neoadjuvant chemotherapy.
新辅助化疗最近已成为乳腺癌的常见治疗方法。本研究旨在探讨能否根据乳腺癌初始诊断影像的形态学特征预测新辅助化疗的效果。
对2006年在本院接受新辅助化疗的186例患者进行研究。形态学特征分为四类。一类是倾向于沿乳腺导管生长的浸润性癌（A1型），另一类是边界相对清晰的膨胀性生长浸润性癌（A2型），第三类是使周围组织回缩的不规则形肿块（A3型），第四类是混合型。因此，根据影像和病理结果比较新辅助化疗对这四种类型癌的疗效。新辅助化疗的疗效分为肿块增大、病理完全缓解（pCR）和其他三类，后者表示无变化或缩小。
186例患者中，72例为A1型，31例为A2型，52例为A3型，31例为混合型。A2型的31例中有7例（22.6%）肿块增大，该类病例比例较高。将病例分为A2型和其他类型，观察肿块增大病例的比例，显示出明显更高的趋势。A2型的31例中有6例（19.4%）达到pCR。此处，A2型病例的比例也显著更高。
新辅助化疗前的形态学特征有助于确定治疗效果。边界清晰的膨胀性生长肿块包含两端的病变，在某些情况下倾向于增大，或者反而实现pCR，因此在进行新辅助化疗时必须密切关注治疗过程。
