新辅助化疗后MRI和PET/CT在乳腺癌患者中的应用：与基于肿瘤细胞密度的病理反应分级系统的相关性

Utility of MRI and PET/CT after neoadjuvant chemotherapy in breast cancer patients: correlation with pathological response grading system based on tumor cellularity.

作者信息

Kim Taehee, Kang Doo Kyoung, An Young-Sil, Yim Hyunee, Jung Yong Sik, Kim Ku Sang, Kang Seok Yun, Kim Tae Hee

机构信息

Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea.

出版信息

Acta Radiol. 2014 May;55(4):399-408. doi: 10.1177/0284185113498720. Epub 2013 Aug 20.

DOI:10.1177/0284185113498720

PMID:23963151

Abstract

BACKGROUND

MRI and PET/CT are useful for assessing breast cancer patients after neoadjuvant chemotherapy (NAC).

PURPOSE

To investigate the utility of MRI and PET/CT in the prediction of pathologic response to neoadjuvant chemotherapy using Miller-Payne grading system in patients with breast cancer.

MATERIAL AND METHODS

From January 2008 to December 2010, 59 consecutive patients with pathologically proven breast cancer, who underwent neoadjuvant chemotherapy followed by surgery were retrospectively enrolled. The maximal diameter decrease rate and volume reduction rate by three-dimensional (3D) MRI and standardized uptake value (SUV) reduction rate by PET/CT were calculated and correlated with the Miller-Payne grading system using the Spearman rank correlation test. Patients with Miller-Payne grades 1 or 2 were classified into the non-responder group and patients with grades 3, 4, and 5 were in the responder group. To differentiate between responders and non-responders, receiver-operating characteristic (ROC) analysis was performed.

RESULTS

The volume reduction rate was 64.87 ± 46.95, diameter decrease rate was 48.09 ± 35.02, and SUV decrease rate was 62.10 ± 32.17. Among three parameters, the volume reduction rate was most correlated with histopathologic grades of regression (ρ = 0.755, P < .0001) followed by diameter decrease rate (ρ = 0.660, P < 0.0001), and SUV decrease rate of primary breast mass (ρ = 0.561, P = 0.0002). The area under the ROC curve (Az) value was largest in the volume reduction rate (Az = 0.9), followed by SUV decrease rate (Az = 0.875), and diameter decrease rate (Az = 0.849). The best cut-offs for differentiating responders from non-responders in the ROC curve analysis were a 50% decrease in diameter, 68.9% decrease in volume, and 60.1% decrease in SUV after NAC.

CONCLUSION

Volumetric measurement using 3D MRI combined with conventional diameter measurement may be more accurate to evaluate pathologic response after NAC.

摘要

背景

磁共振成像（MRI）和正电子发射断层显像/X线计算机体层成像（PET/CT）对评估新辅助化疗（NAC）后的乳腺癌患者很有用。

目的

利用米勒-佩恩分级系统研究MRI和PET/CT在预测乳腺癌患者新辅助化疗病理反应中的作用。

材料与方法

回顾性纳入2008年1月至2010年12月期间59例经病理证实的乳腺癌患者，这些患者接受了新辅助化疗后行手术治疗。计算三维（3D）MRI的最大直径缩小率和体积缩小率以及PET/CT的标准化摄取值（SUV）降低率，并使用Spearman等级相关检验将其与米勒-佩恩分级系统进行关联。米勒-佩恩分级为1或2级的患者被归类为无反应组，3、4和5级的患者为反应组。为区分反应者和无反应者，进行了受试者操作特征（ROC）分析。

结果

体积缩小率为64.87±46.95，直径缩小率为48.09±35.02，SUV降低率为62.10±32.17。在这三个参数中，体积缩小率与组织病理学消退分级的相关性最高（ρ=0.755，P<.0001），其次是直径缩小率（ρ=0.660，P<0.0001），以及原发乳腺肿块的SUV降低率（ρ=0.561，P=0.0002）。ROC曲线下面积（Az）值在体积缩小率中最大（Az=0.9），其次是SUV降低率（Az=0.875），以及直径缩小率（Az=0.849）。ROC曲线分析中区分反应者和无反应者的最佳截断值为新辅助化疗后直径降低50%、体积降低68.9%和SUV降低60.1%。