Fujimoto Hiroshi, Kazama Toshiki, Nagashima Takeshi, Sakakibara Masahiro, Suzuki Tiberiu Hiroshi, Okubo Yoshiyuki, Shiina Nobumitsu, Fujisaki Kaoru, Ota Satoshi, Miyazaki Masaru
Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan,
Breast Cancer. 2014 Nov;21(6):724-31. doi: 10.1007/s12282-013-0449-3. Epub 2013 Feb 12.
Conventional imaging does not always accurately depict the pathological response to neoadjuvant chemotherapy (NAC). Diffusion-weighted imaging (DWI) may provide additional insight into the chemotherapeutic effect. This study assessed whether the apparent diffusion coefficient (ADC) correlated with pathological outcome and prognosis in breast cancer patients receiving NAC.
Fifty-six patients with locally advanced breast cancer received surgery after NAC. Dynamic contrast-enhanced (DCE) and DWI were performed before and after NAC. The pathological response was classified into five categories from no response to complete response according to amount of residual cancer. The correlation between ADC and postoperative pathologic and prognostic outcome was assessed.
The distribution of the pathological response classification was as follows: no response, 3 cases; mild response, 22 cases; moderate response, 12 cases; marked response, 11 cases; complete response, 8 cases. ADC after NAC correlated with pathological response, but ADC before NAC did not. The change in ADC after chemotherapy had better correlation coefficient (r = 0.67) than change in size (r = 0.58) and ADC after NAC (r = 0.64). Although the group with larger change of tumor size showed only marginal significance compared with the smaller change group (p = 0.089), the group with higher change of ADC showed significantly better prognosis than the lower one (p = 0.038).
Change in ADC after chemotherapy better correlated with pathological outcome and prognosis than change in tumor size. DWI has potential in evaluating the pathological outcome of NAC in breast cancer patients.
传统成像并不总是能准确描绘新辅助化疗（NAC）后的病理反应。扩散加权成像（DWI）可能会为化疗效果提供更多见解。本研究评估了表观扩散系数（ADC）与接受NAC的乳腺癌患者的病理结果及预后是否相关。
56例局部晚期乳腺癌患者在NAC后接受手术。在NAC前后进行了动态对比增强（DCE）和DWI检查。根据残留癌数量，将病理反应分为从无反应到完全反应的五类。评估了ADC与术后病理及预后结果之间的相关性。
病理反应分类分布如下：无反应3例；轻度反应22例；中度反应12例；显著反应11例；完全反应8例。NAC后的ADC与病理反应相关，但NAC前的ADC不相关。化疗后ADC的变化比大小变化（r = 0.58）和NAC后的ADC（r = 0.64）具有更好的相关系数（r = 0.67）。尽管肿瘤大小变化较大的组与变化较小的组相比仅具有边缘显著性（p = 0.089），但ADC变化较高的组的预后明显优于变化较低的组（p = 0.038）。
化疗后ADC的变化比肿瘤大小的变化与病理结果及预后的相关性更好。DWI在评估乳腺癌患者NAC的病理结果方面具有潜力。
