Department of Radiology, Institution of Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
Department of Radiology, Institution of Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
Eur J Radiol. 2019 Aug;117:132-139. doi: 10.1016/j.ejrad.2019.06.009. Epub 2019 Jun 12.
To validate the performance of multiparametric magnetic resonance (MR) imaging to assess pathologic response to neoadjuvant systemic therapy (NST) in various breast cancer subtypes considering two definitions of pCR: absence of any residual invasive cancer or DCIS (ypT0) and absence of invasive tumour cells (ypT0/is).
Institutional review board-approved retrospective study, with waiver of the need to obtain informed consent. From January 2015 to June 2017, 81 women with 82 breast cancers undergoing NST were included. Eighteen lesions (22%) were immunohistochemically HER2-positive, 12 (15%) triple negative (TN), 42 (51%) luminal B-like and 10 (12%) luminal B-like/HER2-positive. Breast MR imaging was performed before and after NST. A comparative analysis considering pCR as ypT0 and ypT0/is was carried out. Performance of univariate and multivariate models to potentially predict pathologic response were evaluated.
ypT0 was attained in 23% (19/82) of cases and ypT0/is in 33% (27/82) of cases. In both scenarios, HER2-positive subtype achieved the best response, 53% and 48%, respectively. A significant relationship was found between late enhancement and pathologic response (p < 0.001) regardless of pCR definition. In the ypT0 scenario, mean ADC ratio in the pCR subgroup was significantly higher than that in the non-pCR subgroup (p = 0.021) but no significant relationship was noted in ypT0/is. A multivariate model including MR late enhancement, ADC ratio and tumor subtype identified pathologic response with 86% and 84% accuracy when ypT0 and ypT0/is were considered, respectively.
MR imaging late enhancement and ADC ratio along with breast cancer IHC subtype identify pathologic response following NST with high accuracy, achieving the highest NPV in TN and HER2-positive tumors and the highest PPV in luminal B-like subtypes, regardless of the definition of pCR as ypT0 or ypT0/is. In light of these findings and given that residual DCIS does not have an impact on survival rates, ypT0/is seems to be the preferable definition of pCR.
评估多参数磁共振成像（MR 成像）在不同乳腺癌亚型中评估新辅助全身治疗（NST）病理反应的性能，同时考虑两种 pCR 定义：无任何残留浸润性癌或 DCIS（ypT0）和无浸润性肿瘤细胞（ypT0/is）。
这是一项经机构审查委员会批准的回顾性研究，豁免了获得知情同意的要求。2015 年 1 月至 2017 年 6 月，纳入 81 例 82 个乳腺癌症患者，这些患者接受 NST。18 个病灶（22%）免疫组织化学 HER2 阳性，12 个（15%）三阴性（TN），42 个（51%）管腔 B 样，10 个（12%）管腔 B 样/HER2 阳性。NST 前后进行乳腺 MR 成像。进行了考虑 pCR 为 ypT0 和 ypT0/is 的对比分析。评估了用于预测病理反应的单变量和多变量模型的性能。
ypT0 达到 23%（19/82），ypT0/is 达到 33%（27/82）。在这两种情况下，HER2 阳性亚型的反应最好，分别为 53%和 48%。无论 pCR 定义如何，晚期增强与病理反应之间均存在显著关系（p<0.001）。在 ypT0 情况下，pCR 亚组的平均 ADC 比值明显高于非 pCR 亚组（p=0.021），但在 ypT0/is 中未见明显关系。包括 MR 晚期增强、ADC 比值和肿瘤亚型的多变量模型在考虑 ypT0 和 ypT0/is 时分别以 86%和 84%的准确率识别病理反应。
MR 成像晚期增强和 ADC 比值以及乳腺癌免疫组织化学亚型可准确识别 NST 后的病理反应，在 TN 和 HER2 阳性肿瘤中具有最高的阴性预测值（NPV），在管腔 B 样亚型中具有最高的阳性预测值（PPV），无论 pCR 定义为 ypT0 还是 ypT0/is。基于这些发现，并且由于残留的 DCIS 对生存率没有影响，因此 ypT0/is 似乎是 pCR 的首选定义。
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