Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074 Aachen, Germany; Department of Surgery II, School of Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, 162-8666 Tokyo, Japan.
Department of Radiology, Nihon University School of Medicine, 30-1, Oyaguchi Kami-Cho, Itabashi-ku, 173-8610 Tokyo, Japan.
Magn Reson Imaging. 2019 Oct;62:242-248. doi: 10.1016/j.mri.2019.07.008. Epub 2019 Jul 25.
To evaluate whether multiparametric breast-MRI, obtained before the initiation of neoadjuvant systemic therapy (NST) for operable breast cancer, predicts which cancer will achieve a pathological complete response (pCR) after the completion of NST.
This was an IRB-approved retrospective study on 31 consecutive patients (median age, 56 years) with operable invasive breast cancer (median size: 22 mm; triple-negative: 11/31 [35%], HER2-positive: 7/31 [23%], triple-positive: 13/31 [42%]) who underwent multiparametric DCE-MRI before the initiation of NST. The MRI protocol consisted of high-resolution dynamic contrast-enhanced MRI (DCE-MRI), T2-TSE, and DWI (b-values 0, 100, 800 s/mm). The results of surgical pathology after the completion of NST served as a standard of reference. Patient characteristics (age and menopausal status), pathological tumor characteristics (type, stage, nuclear grade, ER/PR and HER2 receptor status, and Ki-67 staining), and MRI characteristics (size, morphology, T2 signal intensity, enhancement kinetics, and ADC values) before NST were evaluated and compared between patients achieving pCR vs. non-pCR.
Among 31 patients, 17 achieved pCR (55%) and 14 non-pCR (45%). No correlation was observed between patient- or tumor pathology-derived characteristics and pCR vs. non-pCR. Among MRI-derived tumor characteristics, tumor growth orientation parallel to Cooper's ligaments (p = 0.002) and wash-out rates (p = 0.019) correlated with pCR. Pre-NST ADC values were lower in patients achieving pCR (P = 0.086).
A tumor growth pattern parallel with Cooper's ligaments and a fast wash-out rate on pre-treatment multiparametric MRI are predictive of pCR and more closely associated with pCR than ADC values.
评估在接受新辅助全身治疗（NST）之前获得的多参数乳腺 MRI 是否可预测可手术乳腺癌患者在完成 NST 后能否达到病理完全缓解（pCR）。
这是一项经机构审查委员会批准的回顾性研究，共纳入 31 例连续可手术浸润性乳腺癌患者（中位年龄 56 岁），这些患者在接受 NST 之前均接受了多参数 DCE-MRI 检查（中位肿瘤大小：22mm；三阴性：31 例中的 11 例[35%]，HER2 阳性：31 例中的 7 例[23%]，三阳性：31 例中的 13 例[42%]）。MRI 方案包括高分辨率动态对比增强 MRI（DCE-MRI）、T2-TSE 和 DWI（b 值为 0、100、800s/mm）。NST 完成后的手术病理结果作为参考标准。评估并比较了 NST 前患者特征（年龄和绝经状态）、病理肿瘤特征（类型、分期、核分级、ER/PR 和 HER2 受体状态以及 Ki-67 染色）和 MRI 特征（大小、形态、T2 信号强度、强化动力学和 ADC 值），并比较了达到 pCR 与未达到 pCR 的患者之间的差异。
31 例患者中，17 例达到 pCR（55%），14 例未达到 pCR（45%）。患者或肿瘤病理特征与 pCR 与非 pCR 之间未观察到相关性。在 MRI 衍生的肿瘤特征中，与 Cooper 韧带平行的肿瘤生长方向（p=0.002）和洗脱率（p=0.019）与 pCR 相关。达到 pCR 的患者的 NST 前 ADC 值较低（P=0.086）。
在接受新辅助全身治疗之前，肿瘤与 Cooper 韧带平行生长且洗脱速度较快的模式是 pCR 的预测因素，与 ADC 值相比，与 pCR 更密切相关。
