Department of Radiology, National Cancer Center, Goyang 10408, Korea.
Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, Korea.
Korean J Radiol. 2018 Jul-Aug;19(4):682-691. doi: 10.3348/kjr.2018.19.4.682. Epub 2018 Jun 14.
To determine the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and DCE ultrasound (DCE-US) for predicting response to neoadjuvant chemotherapy (NAC) in breast cancer patients.
This Institutional Review Board-approved prospective study was performed between 2014 and 2016. Thirty-nine women with breast cancer underwent DCE-US and DCE-MRI before the NAC, follow-up DCE-US after the first cycle of NAC, and follow-up DCE-MRI after the second cycle of NAC. DCE-MRI parameters (transfer constant [K], reverse constant [k], and leakage space [V]) were assessed with histograms. From DCE-US, peak-enhancement, the area under the curve, wash-in rate, wash-out rate, time to peak, and rise time (RT) were obtained. After surgery, all the imaging parameters and their changes were compared with histopathologic response using the Miller-Payne Grading (MPG) system. Data from minor and good responders were compared using Wilcoxon rank sum test, chi-square test, or Fisher's exact test. Receiver operating characteristic curve analysis was used for assessing diagnostic performance to predict good response.
Twelve patients (30.8%) showed a good response (MPG 4 or 5) and 27 (69.2%) showed a minor response (MPG 1-3). The mean, 25th, 50th, and 75th percentiles of K and K of post-NAC DCE-MRI differed between the two groups. These parameters showed fair to good diagnostic performance for the prediction of response to NAC (AUC 0.76-0.81, ≤ 0.007). Among DCE-US parameters, the percentage change in RT showed fair prediction (AUC 0.71, = 0.023).
Quantitative analysis of DCE-MRI and DCE-US was helpful for early prediction of response to NAC.
确定动态对比增强磁共振成像（DCE-MRI）和动态对比增强超声（DCE-US）在预测乳腺癌患者新辅助化疗（NAC）反应中的诊断性能。
本研究为机构审查委员会批准的前瞻性研究，于 2014 年至 2016 年进行。39 例乳腺癌患者在 NAC 前接受 DCE-US 和 DCE-MRI 检查，NAC 后第 1 周期后行随访 DCE-US，第 2 周期后行随访 DCE-MRI。使用直方图评估 DCE-MRI 参数（转移常数 [K]、反转常数 [k]和泄漏空间 [V]）。从 DCE-US 中获得峰值增强、曲线下面积、流入率、流出率、达峰时间和上升时间（RT）。手术后，所有成像参数及其变化均与组织病理学反应（采用 Miller-Payne 分级（MPG）系统）进行比较。使用 Wilcoxon 秩和检验、卡方检验或 Fisher 精确检验比较轻微反应和良好反应者的数据。采用受试者工作特征曲线分析评估预测良好反应的诊断性能。
12 例患者（30.8%）表现为良好反应（MPG 4 或 5），27 例患者（69.2%）表现为轻微反应（MPG 1-3）。两组间 NAC 后 DCE-MRI 的 K 和 K 的平均值、25%、50%和 75%位数均有差异。这些参数对预测 NAC 反应具有良好至极好的诊断性能（AUC 0.76-0.81， ≤ 0.007）。DCE-US 参数中，RT 变化百分比具有较好的预测性（AUC 0.71， = 0.023）。
DCE-MRI 和 DCE-US 的定量分析有助于早期预测 NAC 反应。
