比较临时超声、剪切波弹性成像和 MRI 对原发性乳腺癌新辅助化疗病理完全缓解的预测。
Prediction of Pathological Complete Response to Neoadjuvant Chemotherapy for Primary Breast Cancer Comparing Interim Ultrasound, Shear Wave Elastography and MRI.
机构信息
Imaging and Technology, Dundee University, Dundee, United Kingdom of Great Britain and Northern Ireland.
Breast Imaging, Ninewells Hospital, Dundee, United Kingdom of Great Britain and Northern Ireland.
出版信息
Ultraschall Med. 2018 Aug;39(4):422-431. doi: 10.1055/s-0043-111589. Epub 2017 Sep 21.
BACKGROUND
Prediction of pathological complete response (pCR) of primary breast cancer to neoadjuvant chemotherapy (NACT) may influence planned surgical approaches in the breast and axilla. The aim of this project is to assess the value of interim shear wave elastography (SWE), ultrasound (US) and magnetic resonance imaging (MRI) after 3 cycles in predicting pCR.
METHODS
64 patients receiving NACT had baseline and interim US, SWE and MRI examinations. The mean lesion stiffness at SWE, US and MRI diameter was measured at both time points. We compared four parameters with pCR status: a) Interim mean stiffness ≤ or > 50 kPa; b) Percentage stiffness reduction; c) Percentage US diameter reduction and d) Interim MRI response using RECIST criteria. The Chi square test was used to assess significance.
RESULTS
Interim stiffness of ≤ or > 50 kPa gave the best prediction of pCR with pCR seen in 10 of 14 (71 %) cancers with an interim stiffness of ≤ 50 kPa, compared to 7 of 50 (14 %) of cancers with an interim stiffness of > 50 kPa, (p < 0.0001) (sensitivity 59 %, specificity 91 %, PPV 71 %, NPV 86 % and diagnostic accuracy 83 %). Percentage reduction in stiffness was the next best parameter (sensitivity 59 %, specificity 85 %, p < 0.0004) followed by reduction in MRI diameter of > 30 % (sensitivity 50 % and specificity 79 %, p = 0.03) and % reduction in US diameter (sensitivity 47 %, specificity 81 %, p = 0.03). Similar results were obtained from ROC analysis.
CONCLUSION
SWE stiffness of breast cancers after 3 cycles of NACT and changes in stiffness from baseline are strongly associated with pCR after 6 cycles.
背景
预测原发性乳腺癌新辅助化疗（NACT）的病理完全缓解（pCR）可能会影响乳房和腋窝的计划手术方法。本项目的目的是评估在 3 个周期后，间隔性剪切波弹性成像（SWE）、超声（US）和磁共振成像（MRI）在预测 pCR 方面的价值。
方法
64 例接受 NACT 的患者进行了基线和间隔性 US、SWE 和 MRI 检查。在这两个时间点测量了 SWE、US 和 MRI 直径的平均病变硬度。我们比较了四个参数与 pCR 状态的关系：a）间隔期平均硬度≤或>50kPa；b）硬度降低百分比；c）US 直径降低百分比和 d）使用 RECIST 标准的间隔期 MRI 反应。采用卡方检验评估差异的统计学意义。
结果
间隔期硬度≤或>50kPa 对 pCR 的预测最佳，14 例（71%）间隔期硬度≤50kPa 的肿瘤中均可见 pCR，而 50 例（14%）间隔期硬度>50kPa 的肿瘤中仅 7 例可见 pCR（p<0.0001）（敏感性 59%，特异性 91%，PPV 71%，NPV 86%和诊断准确性 83%）。硬度降低百分比是下一个最佳参数（敏感性 59%，特异性 85%，p<0.0004），其次是 MRI 直径减少>30%（敏感性 50%和特异性 79%，p=0.03）和 US 直径减少百分比（敏感性 47%，特异性 81%，p=0.03）。ROC 分析也得到了类似的结果。
结论
NACT 后 3 个周期的乳腺癌 SWE 硬度及其与基线相比的变化与 6 个周期后的 pCR 密切相关。
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