超声造影与磁共振成像在评估乳腺癌新辅助化疗后肿瘤反应中的准确性比较
Accuracy of Contrast-Enhanced Ultrasound Compared With Magnetic Resonance Imaging in Assessing the Tumor Response After Neoadjuvant Chemotherapy for Breast Cancer.
作者信息
Lee Sandy C, Grant Edward, Sheth Pulin, Garcia Agustin A, Desai Bhushan, Ji Lingyun, Groshen Susan, Hwang Darryl, Yamashita Mary, Hovanessian-Larsen Linda
机构信息
Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Department of Internal Medicine, Section of Hematology/Oncology, Louisiana State University, New Orleans, Louisiana, USA.
出版信息
J Ultrasound Med. 2017 May;36(5):901-911. doi: 10.7863/ultra.16.05060. Epub 2017 Feb 2.
OBJECTIVES
This pilot study compared contrast enhanced ultrasound (US) with contrast-enhanced magnetic resonance imaging (MRI) in assessing the treatment response in patients with breast cancer receiving preoperative neoadjuvant chemotherapy (NAC).
METHODS
This prospective Institutional Review Board-approved and Health Insurance Portability and Accountability Act-compliant study included 30 patients, from January 2014 to October 2015, with invasive breast cancer detected by mammography, conventional US imaging, or both and scheduled for NAC. Informed consent was obtained. Contrast-enhanced US (perflutren lipid microspheres, 10 μL/kg) and MRI (gadopentetate dimeglumine, 0.1 mmol/kg) scans were performed at baseline before starting NAC and after completing NAC before surgery. Results of the imaging techniques were compared with each other and with histopathologic findings obtained at surgery using the Spearman correlation. Tumor size and enhancement parameters were compared for 15 patients with contrast-enhanced US, MRI, and surgical pathologic findings.
RESULTS
The median tumor size at baseline was 3.1 cm on both contrast-enhanced US and MRI scans. The Spearman correlation showed strong agreement in tumor size at baseline between contrast-enhanced US and MRI (r = 0.88; P < .001) but less agreement in tumor size after NAC (r = 0.66; P = .004). Trends suggested that contrast-enhanced US (r = 0.75; P < .001) had a better correlation than MRI (r = 0.42; P = .095) with tumor size at surgery. Contrast-enhanced US was as effective as MRI in predicting a complete pathologic response (4 patients; 75.0% accuracy for both) and a non-complete pathologic response (11 patients; 72.7% accuracy for both).
CONCLUSIONS
Contrast enhanced US is a valuable imaging modality for assessing the treatment response in patients receiving NAC and had a comparable correlation as MRI with breast cancer size at surgery.
目的
本前瞻性初步研究比较了超声造影（US）与磁共振成像造影（MRI）在评估接受术前新辅助化疗（NAC）的乳腺癌患者治疗反应中的作用。
方法
本研究经机构审查委员会前瞻性批准，并符合《健康保险流通与责任法案》要求，纳入了2014年1月至2015年10月期间的30例患者，这些患者通过乳腺X线摄影、传统超声成像或两者检查发现患有浸润性乳腺癌，并计划接受NAC治疗。已获得知情同意书。在开始NAC前的基线期以及完成NAC后手术前，分别进行了超声造影（全氟丙烷脂质微球，10 μL/kg）和MRI（钆喷酸葡胺，0.1 mmol/kg）扫描。将成像技术的结果相互比较，并与手术时获得的组织病理学结果进行Spearman相关性分析。对15例同时有超声造影、MRI及手术病理结果的患者的肿瘤大小和增强参数进行了比较。
结果
超声造影和MRI扫描在基线期的肿瘤中位大小均为3.1 cm。Spearman相关性分析显示，超声造影与MRI在基线期肿瘤大小上有很强的一致性（r = 0.88；P < 0.001），但在NAC后肿瘤大小的一致性较差（r = 0.66；P = 0.004）。趋势表明，超声造影（r = 0.75；P < 0.001）与手术时肿瘤大小的相关性优于MRI（r = 0.42；P = 0.095）。超声造影在预测完全病理缓解（4例患者；两者准确率均为75.0%）和非完全病理缓解（11例患者；两者准确率均为72.7%）方面与MRI效果相当。
结论
超声造影是评估接受NAC治疗患者治疗反应的一种有价值的成像方式，并且在与手术时乳腺癌大小的相关性方面与MRI相当。
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