Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
Department of Medical Oncology, Mayo Clinic, Rochester, MN.
AJR Am J Roentgenol. 2019 Oct;213(4):932-943. doi: 10.2214/AJR.18.20628. Epub 2019 Jun 5.
The purpose of this study is to prospectively compare the size of invasive breast cancer before and after neoadjuvant chemotherapy (NAC) at breast MRI and molecular breast imaging (MBI) and to assess the accuracy of post-NAC MBI and MRI relative to pathologic analysis. Women with invasive breast cancer greater than or equal to 1.5 cm were enrolled to compare the longest dimension before and after NAC at MRI and MBI. MBI was performed on a dual-detector cadmium zinc telluride system after administration of 6.5 mCi (240 MBq) Tc-sestamibi. The accuracy of MRI and MBI in assessing residual disease (invasive disease or ductal carcinoma in situ) was determined relative to pathologic examination. The longest dimension at MRI was within 1.0 cm of that at MBI in 72.3% of cases before NAC and 70.1% of cases after NAC. The difference between the longest dimension at imaging after NAC and pathologic tumor size was within 1 cm for 58.7% of breast MRI cases and 59.6% of MBI cases. Ninety patients underwent both MRI and MBI after NAC. In the 56 patients with invasive residual disease, 10 (17.9%) cases were negative at MRI and 23 (41.1%) cases were negative at MBI. In the 34 patients with breast pathologic complete response, there was enhancement in 10 cases (29.4%) at MRI and uptake in six cases (17.6%) at MBI. Sensitivity, specificity, positive predictive value, and negative predictive value after NAC were 82.8%, 69.4%, 81.4%, and 71.4%, respectively, for MRI and 58.9%, 82.4%, 84.6%, and 54.9%, respectively, for MBI. Breast MRI and MBI showed similar disease extent before NAC. MBI may be an alternative to breast MRI in patients with a contraindication to breast MRI. Neither modality showed sufficient accuracy after NAC in predicting breast pathologic complete response to obviate tissue diagnosis to assess for residual invasive disease. Defining the extent of residual disease compared with pathologic evaluation was also limited after NAC for both breast MRI and MBI.
本研究旨在前瞻性比较新辅助化疗（NAC）前后乳腺 MRI 和分子乳腺成像（MBI）中浸润性乳腺癌的大小，并评估 NAC 后 MBI 和 MRI 相对于病理分析的准确性。纳入了浸润性乳腺癌大于或等于 1.5cm 的女性，以比较 NAC 前后 MRI 和 MBI 中的最长径。MBI 在给予 6.5mCi（240MBq）Tc- sestamibi 后，在双探测器碲化镉锌系统上进行。MRI 和 MBI 评估残留疾病（浸润性疾病或导管原位癌）的准确性相对于病理检查确定。NAC 前，72.3%的病例 MRI 最长径与 MBI 相差 1.0cm 以内，NAC 后，70.1%的病例 MRI 最长径与 MBI 相差 1.0cm 以内。NAC 后影像学上最长径与肿瘤大小的差值在 1cm 以内的乳腺 MRI 病例为 58.7%，MBI 病例为 59.6%。90 例患者在 NAC 后均行 MRI 和 MBI。在 56 例有浸润性残留疾病的患者中，10 例（17.9%）MRI 阴性，23 例（41.1%）MBI 阴性。在 34 例乳腺病理完全缓解的患者中，10 例（29.4%）MRI 增强，6 例（17.6%）MBI 摄取。NAC 后 MRI 的敏感性、特异性、阳性预测值和阴性预测值分别为 82.8%、69.4%、81.4%和 71.4%，MBI 分别为 58.9%、82.4%、84.6%和 54.9%。NAC 前后，乳腺 MRI 和 MBI 显示出相似的疾病程度。对于有乳腺 MRI 禁忌证的患者，MBI 可能是乳腺 MRI 的替代方法。NAC 后两种方法均未能准确预测乳腺病理完全缓解，以避免组织诊断来评估残留的浸润性疾病。与病理评估相比，NAC 后，两种方法对残留疾病的范围进行定义也受到限制。
