Ah-See Mei-Lin W, Makris Andreas, Taylor N Jane, Harrison Mark, Richman Paul I, Burcombe Russell J, Stirling J James, d'Arcy James A, Collins David J, Pittam Michael R, Ravichandran Duraisamy, Padhani Anwar R
Mount Vernon Hospital, Northwood, Middlesex, UK.
Clin Cancer Res. 2008 Oct 15;14(20):6580-9. doi: 10.1158/1078-0432.CCR-07-4310.
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) allows noninvasive, in vivo measurements of tissue microvessel perfusion and permeability. We examined whether DCE-MRI done after two cycles of neoadjuvant chemotherapy could predict final clinical and pathologic response in primary breast cancers.
Thirty-seven patients with primary breast cancer, due to receive six cycles of neoadjuvant 5-fluorouracil, epirubicin and cyclophosphamide chemotherapy, were examined using DCE-MRI before neoadjuvant chemotherapy and after two cycles of treatment. Changes in DCE-MRI kinetic parameters (K(trans), k(ep), v(e), MaxGd, rBV, rBF, MTT) were correlated with the final clinical and pathologic response to neoadjuvant chemotherapy. Test-retest variability was used to determine individual patient response.
Twenty-eight patients were evaluable for response (19 clinical responders and 9 nonresponders; 11 pathologic responders and 17 nonresponders). Changes in the DCE-MRI kinetic parameters K(trans), k(ep), MaxGd, rBV, and rBF were significantly correlated with both final clinical and pathologic response (P < 0.01). Change in K(trans) was the best predictor of pathologic nonresponse (area under the receiver operating characteristic curve, 0.93; sensitivity, 94%; specificity, 82%), correctly identifying 94% of nonresponders and 73% of responders. Change in MRI-derived tumor size did not predict for pathologic response.
Changes in breast tumor microvessel functionality as depicted by DCE-MRI early on after starting anthracycline-based neoadjuvant chemotherapy can predict final clinical and pathologic response. The ability to identify nonresponders early may allow the selection of patients who may benefit from a therapy change.
动态对比增强磁共振成像（DCE-MRI）可对组织微血管灌注和通透性进行无创性活体测量。我们研究了在新辅助化疗两个周期后进行的DCE-MRI是否能预测原发性乳腺癌的最终临床和病理反应。
37例原发性乳腺癌患者，计划接受六个周期的新辅助5-氟尿嘧啶、表柔比星和环磷酰胺化疗，在新辅助化疗前和两个周期治疗后使用DCE-MRI进行检查。DCE-MRI动力学参数（Ktrans、 kep、 ve、 MaxGd、 rBV、 rBF、 MTT）的变化与新辅助化疗的最终临床和病理反应相关。采用重测变异性来确定个体患者的反应。
28例患者可评估反应（19例临床反应者和9例无反应者；11例病理反应者和17例无反应者）。DCE-MRI动力学参数Ktrans、 kep、 MaxGd、 rBV和rBF的变化与最终临床和病理反应均显著相关（P < 0.01）。Ktrans的变化是病理无反应的最佳预测指标（受试者操作特征曲线下面积，0.93；敏感性，94%；特异性，82%），正确识别了94%的无反应者和73%的反应者。MRI衍生肿瘤大小的变化不能预测病理反应。
在基于蒽环类药物的新辅助化疗开始后早期，DCE-MRI所描绘的乳腺肿瘤微血管功能变化可预测最终临床和病理反应。早期识别无反应者的能力可能有助于选择可能从治疗改变中获益的患者。
