Bufi Enida, Belli Paolo, Di Matteo Marialuisa, Terribile Daniela, Franceschini Gianluca, Nardone Luigia, Petrone Gianluigi, Bonomo Lorenzo
Department of Bioimaging and Radiological Sciences, Catholic University, Rome, Italy.
Department of Bioimaging and Radiological Sciences, Catholic University, Rome, Italy.
Eur J Radiol. 2014 Sep;83(9):1631-8. doi: 10.1016/j.ejrad.2014.05.002. Epub 2014 May 16.
The estimation of response to neoadjuvant chemotherapy (NAC) is useful in the surgical decision in breast cancer. We addressed the diagnostic reliability of conventional MRI, of diffusion weighted imaging (DWI) and of a merged criterion coupling morphological MRI and DWI. Diagnostic performance was analysed separately in different tumor subtypes, including HER2+ (human epidermal growth factor receptor 2)/HR+ (hormone receptor) (hybrid phenotype).
Two-hundred and twenty-five patients underwent MRI before and after NAC. The response to treatment was defined according to the RECIST classification and the evaluation of DWI with apparent diffusion coefficient (ADC). The complete pathological response - pCR was assessed (Mandard classification).
Tumor phenotypes were Luminal (63.6%), Triple Negative (16.4%), HER2+ (7.6%) or Hybrid (12.4%). After NAC, pCR was observed in 17.3% of cases. Average ADC was statistically higher after NAC (p<0.001) among patients showing pCR vs. those who had not pCR. The RECIST classification showed adequate performance in predicting the pCR in Triple Negative (area under the receiver operating characteristic curve, ROC AUC=0.9) and in the HER2+ subgroup (AUC=0.826). Lower performance was found in the Luminal and Hybrid subgroups (AUC 0.693 and 0.611, respectively), where the ADC criterion yielded an improved performance (AUC=0.787 and 0.722). The coupling of morphological and DWI criteria yielded maximally improved performance in the Luminal and Hybrid subgroups (AUC=0.797 and 0.761).
The diagnostic reliability of MRI in predicting the pCR to NAC depends on the tumor phenotype, particularly in the Luminal and Hybrid subgroups. In these cases, the coupling of morphological MRI evaluation and DWI assessment may facilitate the diagnosis.
评估新辅助化疗（NAC）的反应对于乳腺癌手术决策很有用。我们探讨了传统MRI、扩散加权成像（DWI）以及结合形态学MRI和DWI的综合标准的诊断可靠性。在不同肿瘤亚型中分别分析诊断性能，包括HER2+（人表皮生长因子受体2）/HR+（激素受体）（混合表型）。
225例患者在NAC前后接受了MRI检查。根据RECIST分类和用表观扩散系数（ADC）评估DWI来定义治疗反应。评估完全病理缓解——pCR（Mandard分类）。
肿瘤表型为管腔型（63.6%）、三阴性（16.4%）、HER2+（7.6%）或混合型（12.4%）。NAC后，17.3%的病例观察到pCR。在显示pCR的患者与未显示pCR的患者中，NAC后平均ADC在统计学上更高（p<0.001）。RECIST分类在预测三阴性乳腺癌的pCR方面表现良好（受试者操作特征曲线下面积，ROC AUC = 0.9）以及在HER2+亚组中（AUC = 0.826）。在管腔型和混合型亚组中表现较低（AUC分别为0.693和0.611），其中ADC标准产生了更好的性能（AUC = 0.787和0.722）。形态学和DWI标准的结合在管腔型和混合型亚组中产生了最大程度改善的性能（AUC = 0.797和0.761）。
MRI预测NAC的pCR的诊断可靠性取决于肿瘤表型，特别是在管腔型和混合型亚组中。在这些情况下，形态学MRI评估和DWI评估的结合可能有助于诊断。
