动态对比增强磁共振成像在评估乳腺癌新辅助化疗临床反应中的有效性。

Effectiveness of dynamic contrast-enhanced magnetic resonance imaging in evaluating clinical responses to neoadjuvant chemotherapy in breast cancer.

机构信息

Department of General Surgery, Breast Disease Center, Peking University First Hospital, Beijing 100034, China.

出版信息

Chin Med J (Engl). 2011 Jan;124(2):194-8.

Abstract

BACKGROUND

Use of neoadjuvant chemotherapy necessitates assessment of response to cytotoxic drugs. The aim of this research was to investigate the effectiveness of dynamic contrast-enhanced magnetic resonance imaging (MRI) for evaluating clinical responses to neoadjuvant chemotherapy in breast cancer patients.

METHODS

We examined patients receiving neoadjuvant chemotherapy for primary breast cancer between October 2007 and September 2008. Dynamic contrast-enhanced MRI was used to examine breast tumors prior to and after neoadjuvant chemotherapy. The MRI examination assessed tumors using Response Evaluation Criteria in Solid Tumors (RECIST). The Miller-Payne grading system was used as a histopathological examination to assess the effect of the treatment. We examined the relationship between the results of RECIST and histopathological criteria. In addition, we used time-signal intensity curves (MRI T-SI) to further evaluate the effects of neoadjuvant chemotherapy on tumor response.

RESULTS

MRI examination of patients completing four three-week anthracycline-taxanes chemotherapy treatment revealed that no patients had complete responses (CR), 58 patients had partial responses (PR), 29 patients had stable disease (SD), and four with progressive disease (PD). The effectiveness of neoadjuvant chemotherapy (CR + PR) was 63.7% (58/91). The postoperative histopathological evaluations revealed the following: seven G5 (pCR) cases (7.7%), 39 G4 cases (42.9%), 16 G3 cases (17.6%), 23 G2 cases (25.3%), and six G1 cases (6.6%). The effectiveness (G5 + G4 + G3) was 68.1% (62/91). MRI T-SI standards classified 53 responding cases, 29 stable cases, and nine progressing cases. These results indicated that the treatment was 58.2% effective (53/91) overall.

CONCLUSIONS

Dynamic contrast-enhanced MRI and histopathological standards were highly correlated. Importantly, MRI T-SI evaluation was found to be useful in assessing the clinical effectiveness of neoadjuvant chemotherapy.

摘要

背景

新辅助化疗的应用需要评估细胞毒药物的反应。本研究旨在探讨动态对比增强磁共振成像（MRI）在评估乳腺癌患者新辅助化疗临床反应中的有效性。

方法

我们检查了 2007 年 10 月至 2008 年 9 月期间接受新辅助化疗的原发性乳腺癌患者。在新辅助化疗前后，使用动态对比增强 MRI 检查乳腺肿瘤。MRI 检查使用实体瘤反应评估标准（RECIST）评估肿瘤。Miller-Payne 分级系统作为组织病理学检查评估治疗效果。我们检查了 RECIST 结果与组织病理学标准之间的关系。此外，我们使用时间信号强度曲线（MRI T-SI）进一步评估新辅助化疗对肿瘤反应的影响。

结果

完成 4 个三周蒽环类药物-紫杉烷化疗疗程的患者 MRI 检查显示，无完全缓解（CR）患者，58 例部分缓解（PR），29 例稳定疾病（SD），4 例进展疾病（PD）。新辅助化疗的有效性（CR+PR）为 63.7%（58/91）。术后组织病理学评估显示以下结果：7 例 G5（pCR）病例（7.7%），39 例 G4 病例（42.9%），16 例 G3 病例（17.6%），23 例 G2 病例（25.3%）和 6 例 G1 病例（6.6%）。有效性（G5+G4+G3）为 68.1%（62/91）。MRI T-SI 标准分类为 53 例反应病例、29 例稳定病例和 9 例进展病例。这些结果表明治疗总体有效率为 58.2%（53/91）。