扩散加权成像在评估乳腺癌亚型肿瘤对新辅助化疗的病理反应中的应用
Diffusion-weighted imaging in assessing pathological response of tumor in breast cancer subtype to neoadjuvant chemotherapy.
作者信息
Liu Shangang, Ren Ruimei, Chen Zhaoqiu, Wang Yongsheng, Fan Tingyong, Li Chengli, Zhang Pinliang
机构信息
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Science, Jinan, P.R. China.
Department of Radiology, Shandong Cancer Hospital and Institute, School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Science, Jinan, P.R. China.
出版信息
J Magn Reson Imaging. 2015 Sep;42(3):779-87. doi: 10.1002/jmri.24843. Epub 2015 Jan 8.
PURPOSE
To investigate the efficacy of diffusion-weighted imaging (DWI) for reflecting and predicting pathological tumor response in breast cancer subtype to neoadjuvant chemotherapy (NAC).
MATERIALS AND METHODS
The retrospective study included 176 patients with breast cancer who underwent magnetic resonance imaging (MRI) examinations before and after NAC prior to surgery. The pre- and post-NAC apparent diffusion coefficient (ADC) values of tumor were measured respectively on DWI. The pathological response was classified into either a complete response (pCR) or as a noncomplete response (pNCR) to NAC with the Miller & Payne system. The relationship between the ADC value and the pathological response was assessed according to intrinsic subtypes (Luminal A, Luminal B, HER2-enriched, and triple negative) defined by immunohistochemical features.
RESULTS
Multiple comparisons respectively showed that pre-NAC and post-NAC ADC were significantly different among four subtypes (P < 0.001). After the comparison between two different subtypes, the pre-NAC ADC value of the triple-negative and HER2-enriched subtypes were significantly higher than Luminal A (P < 0.001 and P < 0.001) and Luminal B subtype (P < 0.001 and P = 0.009), and the post-NAC ADC of triple-negative subtype was significantly higher than the others (P < 0.001). The pre-NAC ADC of pCRs was significantly lower than that of pNCRs only in the triple-negative subtype among four subtypes (P < 0.001), and the post-NAC ADC of pCRs was significantly higher than that of pNCRs in each subtype (P < 0.001).
CONCLUSION
DWI appears to be a promising tool to determine the association of pathological response to NAC in breast cancer subtypes.
目的
探讨扩散加权成像（DWI）在反映和预测乳腺癌亚型对新辅助化疗（NAC）的病理肿瘤反应方面的疗效。
材料与方法
这项回顾性研究纳入了176例乳腺癌患者，这些患者在手术前接受了NAC前后的磁共振成像（MRI）检查。分别在DWI上测量肿瘤的NAC前后表观扩散系数（ADC）值。根据Miller & Payne系统，将病理反应分为对NAC的完全缓解（pCR）或非完全缓解（pNCR）。根据免疫组化特征定义的内在亚型（Luminal A、Luminal B、HER2富集型和三阴性）评估ADC值与病理反应之间的关系。
结果
多重比较分别显示，四种亚型之间NAC前和NAC后的ADC存在显著差异（P < 0.001）。在两种不同亚型之间进行比较后，三阴性和HER2富集型亚型的NAC前ADC值显著高于Luminal A（P < 0.001和P < 0.001）和Luminal B亚型（P < 0.001和P = 0.009），三阴性亚型的NAC后ADC显著高于其他亚型（P < 0.001）。在四种亚型中，仅在三阴性亚型中，pCR的NAC前ADC显著低于pNCR（P < 0.001），并且在每个亚型中，pCR的NAC后ADC显著高于pNCR（P < 0.001）。
结论
DWI似乎是确定乳腺癌亚型对NAC病理反应相关性的一种有前景的工具。
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