Department of Radiology, Università Cattolica del Sacro Cuore, Fondazione Agostino Gemelli, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy.
Department of Gynecology and Obstetrics, Università Cattolica del Sacro Cuore, Fondazione Agostino Gemelli, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy.
Eur Radiol. 2018 Jun;28(6):2425-2435. doi: 10.1007/s00330-017-5233-x. Epub 2018 Jan 9.
To analyse the role of DW-MRI in early prediction of pathologically-assessed residual disease in locally-advanced cervical cancer (LACC) treated with neoadjuvant chemoradiotherapy followed by radical surgery.
Between October 2010-June 2014, 108 women with histologically-proven cervical cancer were screened; 88 were included in this study. Tumour volume (TV) and ADC were measured before (baseline-MRI) and after 2 weeks of chemoradiotherapy (early-MRI). According to histopathology, treatment response was classified as complete (CR) or partial (PR). Comparisons were made with Mann-Whitney, Wilcoxon and χ2 tests. ROC curves were generated for statistically significant parameters on univariate analysis.
CR and PR were documented in 40 and 48 patients. At baseline-MRI, TV did not differ between groups. At early-MRI, TV was higher in PR than in CR (p=0.001). ΔTV reduction after treatment was lower in PR than in CR (63.6% vs. 81.1%; p=0.001). At baseline-MRI and early-MRI, ADC did not differ between PR and CR. ROC curve showed best cut-off for predicting pathological PR was ΔTV reduction of 73% with sensitivity, specificity, accuracy, NPV, PPV of 73%, 72.5%, 72.7%, 76%, 69%.
TV evaluated before and early after treatment could predict pathological response in LACC. ADC did not correlate with treatment outcome.
• Early-MRI tumour volume assessment could predict pathological response to nCRT in LACC. • Best cut-off for predicting pathological PR was ΔTV reduction of 73 %. • Early-MRI ADC measurements did not correlate with treatment outcome.
分析扩散加权磁共振成像（DW-MRI）在新辅助放化疗后行根治性手术治疗的局部晚期宫颈癌（LACC）患者中，对预测病理评估残留疾病的作用。
2010 年 10 月至 2014 年 6 月，对 108 例经组织学证实的宫颈癌患者进行筛查，其中 88 例纳入本研究。在新辅助放化疗前（基线 MRI）和治疗后 2 周（早期 MRI）测量肿瘤体积（TV）和 ADC。根据组织病理学，将治疗反应分为完全缓解（CR）和部分缓解（PR）。采用 Mann-Whitney、Wilcoxon 和 χ2 检验进行比较。对单因素分析中具有统计学意义的参数进行 ROC 曲线分析。
40 例患者为 CR，48 例患者为 PR。在基线 MRI 时，两组的 TV 无差异。在早期 MRI 时，PR 组的 TV 高于 CR 组（p=0.001）。PR 组治疗后 TV 降低程度低于 CR 组（63.6% vs. 81.1%；p=0.001）。在基线 MRI 和早期 MRI 时，PR 组和 CR 组的 ADC 无差异。ROC 曲线显示，预测病理 PR 的最佳截断值为 TV 降低 73%，其灵敏度、特异性、准确性、阴性预测值、阳性预测值分别为 73%、72.5%、72.7%、76%、69%。
治疗前后的 MRI 肿瘤体积评估可预测 LACC 的病理反应。ADC 与治疗结果无关。
•早期 MRI 肿瘤体积评估可预测 LACC 患者对 nCRT 的病理反应。•预测病理 PR 的最佳截断值为 TV 降低 73%。•早期 MRI ADC 测量与治疗结果无关。
