Faculty of Medicine, McGill University, Montréal, QC, H4A3T2, Canada.
Department of Oncology, McGill University, Montréal, QC, H4A3T2, Canada.
World J Surg. 2019 Sep;43(9):2254-2261. doi: 10.1007/s00268-019-05032-9.
MRI performance in detecting pathologic complete response (pCR) post-neoadjuvant chemotherapy (NAC) in breast cancer has been previously explored. However, since tumor response varies by molecular subtype, it is plausible that imaging performance also varies. Therefore, we performed a literature review on subtype-specific MRI performance in detecting pCR post-NAC.
Two reviewers searched Cochrane, PubMed, and EMBASE for articles published between 2013 and 2018 that examined MRI performance in detecting pCR post-NAC. After filtering, ten primary research articles were included. Statistical metrics, such as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were extracted per study for triple negative, HR+/HER2-, and HER2+ patients.
Ten studies involving 2310 patients were included. In triple negative breast cancer, MRI showed NPV (58-100%) and PPV (72.7-94.7%) across 446 patients and sensitivity (45.5-100%) and specificity (49-94.4%) in 375 patients. In HR+/HER2- breast cancer patients, MRI showed NPV (29.4-100%) and PPV (21.4-95.1%) across 851 patients and sensitivity (43-100%) and specificity (45-93%) across 780 patients. In HER2+-enriched subtype, MRI showed NPV (62-94.6%) and PPV (34.9-72%) in 243 patients and sensitivity (36.2-83%) and specificity (47-90%) in 255 patients.
MRI accuracy in detecting pCR post-NAC by subtype is not as consistent, nor as high, as individual studies suggest. Larger studies using standardized pCR definition with appropriate timing of surgery and MRI need to be conducted. This study has shown that MRI is in fact not an accurate prediction of pCR, and thus, clinicians may need to rely on other approaches such as biopsies of the tumor bed.
MRI 在检测新辅助化疗（NAC）后乳腺癌病理完全缓解（pCR）方面的性能已被前人探索过。然而，由于肿瘤反应因分子亚型而异，因此可以推测成像性能也会有所不同。因此，我们对 NAC 后基于亚型的 MRI 检测 pCR 的性能进行了文献综述。
两名审查员在 Cochrane、PubMed 和 EMBASE 中搜索了 2013 年至 2018 年间发表的检查 NAC 后 MRI 检测 pCR 性能的文章。经过筛选，纳入了 10 篇原始研究文章。针对三阴性、HR+/HER2-和 HER2+患者，分别从每项研究中提取了统计指标，如敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
纳入了 10 项涉及 2310 例患者的研究。在三阴性乳腺癌中，MRI 在 446 例患者中显示出 NPV（58-100%）和 PPV（72.7-94.7%），在 375 例患者中显示出敏感性（45.5-100%）和特异性（49-94.4%）。在 HR+/HER2-乳腺癌患者中，MRI 在 851 例患者中显示出 NPV（29.4-100%）和 PPV（21.4-95.1%），在 780 例患者中显示出敏感性（43-100%）和特异性（45-93%）。在 HER2+富集亚型中，MRI 在 243 例患者中显示出 NPV（62-94.6%）和 PPV（34.9-72%），在 255 例患者中显示出敏感性（36.2-83%）和特异性（47-90%）。
按亚型划分，MRI 检测 NAC 后 pCR 的准确性并非如个别研究所述那样一致和高。需要开展使用标准化 pCR 定义、适当手术和 MRI 时间点的更大规模研究。本研究表明，MRI 实际上并不能准确预测 pCR，因此临床医生可能需要依赖于肿瘤床活检等其他方法。
