Che Shunan, Zhao Xinming, Ou Yanghan, Li Jing, Wang Meng, Wu Bing, Zhou Chunwu
From the Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College(SN C, XM Z, YH O, J L, CW Z); Department of Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College(M W); and GE MR Research China(B W), Beijing, PR China.
Medicine (Baltimore). 2016 Jan;95(4):e2420. doi: 10.1097/MD.0000000000002420.
The aim of this study was to explore whether intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) can probe pre-treatment differences or monitor early response in patients with locally advanced breast cancer receiving neoadjuvant chemotherapy (NAC). Thirty-six patients with locally advanced breast cancer were imaged using multiple-b DWI with 12 b values ranging from 0 to 1000 s/mm(2) at the baseline, and 28 patients were repeatedly scanned after the second cycle of NAC. Subjects were divided into pathologic complete response (pCR) and nonpathologic complete response (non-pCR) groups according to the surgical pathologic specimen. Parameters (D, D*, f, maximum diameter [MD] and volume [V]) before and after 2 cycles of NAC and their corresponding change (Δparameter) between pCR and non-pCR groups were compared using the Student t test or nonparametric test. The diagnostic performance of different parameters was judged by the receiver-operating characteristic curve analysis. Before NAC, the f value of pCR group was significantly higher than that of non-pCR (32.40% vs 24.40%, P = 0.048). At the end of the second cycle of NAC, the D value was significantly higher and the f value was significantly lower in pCR than that in non-pCR (P = 0.001; P = 0.015, respectively), whereas the D* value and V of the pCR group was slightly lower than that of the non-pCR group (P = 0.507; P = 0.676, respectively). ΔD was higher in pCR (-0.45 × 10(-3) mm(2)/s) than that in non-pCR (-0.07 × 10(-3) mm(2)/s) after 2 cycles of NAC (P < 0.001). Δf value in the pCR group was significantly higher than that in the non-pCR group (17.30% vs 5.30%, P = 0.001). There was no significant difference in ΔD* between the pCR and non-pCR group (P = 0.456). The prediction performance of ΔD value was the highest (AUC [area under the curve] = 0.924, 95% CI [95% confidence interval] = 0.759-0.990). When the optimal cut-off was set at -0.163 × 10(-3) mm(2)/s, the values for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were up to 100% (95% CI = 66.4-100), 73.7% (95% CI = 48.8-90.9), 64.3% (95% CI = 35.6-86.0), and 100% (95% CI = 73.2-99.3), respectively. IVIM-derived parameters, especially the D and f value, showed potential value in the pre-treatment prediction and early response monitoring to NAC in locally advanced breast cancer. ΔD value had the best prediction performance for pathologic response after NAC.
本研究的目的是探讨体素内不相干运动（IVIM）扩散加权成像（DWI）能否探测局部晚期乳腺癌患者接受新辅助化疗（NAC）前的差异或监测早期反应。36例局部晚期乳腺癌患者在基线时采用具有12个b值（范围为0至1000 s/mm²）的多b值DWI进行成像，28例患者在NAC第二个周期后进行重复扫描。根据手术病理标本将受试者分为病理完全缓解（pCR）组和非病理完全缓解（非pCR）组。使用Student t检验或非参数检验比较NAC两个周期前后的参数（D、D*、f、最大直径[MD]和体积[V]）以及pCR组和非pCR组之间相应的变化（Δ参数）。通过受试者工作特征曲线分析判断不同参数的诊断性能。NAC前，pCR组的f值显著高于非pCR组（32.40%对24.40%，P = 0.048）。在NAC第二个周期结束时，pCR组的D值显著高于非pCR组，f值显著低于非pCR组（分别为P = 0.001；P = 0.015），而pCR组的D值和V略低于非pCR组（分别为P = 0.507；P = 0.676）。NAC两个周期后，pCR组的ΔD（-0.45×10⁻³ mm²/s）高于非pCR组（-0.07×10⁻³ mm²/s）（P < 0.001）。pCR组的Δf值显著高于非pCR组（17.30%对5.30%，P = 0.001）。pCR组和非pCR组之间的ΔD无显著差异（P = 0.456）。ΔD值的预测性能最高（曲线下面积[AUC]=0.924，95%置信区间[95%CI]=0.759 - 0.990）。当最佳截断值设定为-0.163×10⁻³ mm²/s时，灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别高达100%（95%CI = 66.4 - 100）、73.7%（95%CI = 48.8 - 90.9）、64.3%（95%CI = 35.6 - 86.0）和100%（95%CI = 73.2 - 99.3）。IVIM衍生参数，尤其是D和f值，在局部晚期乳腺癌NAC的治疗前预测和早期反应监测中显示出潜在价值。ΔD值对NAC后的病理反应具有最佳预测性能。
