Los Angeles County+University of Southern California (LAC+USC) Medical Center, Los Angeles, California.
Department of Surgery and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California.
J Surg Oncol. 2019 Nov;120(6):903-910. doi: 10.1002/jso.25663. Epub 2019 Aug 9.
This study assessed whether magnetic resonance imaging (MRI) could accurately predict pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) for patients receiving standardized treatment, pre- and post-NAC MRI on the same instrumentation using a consistent imaging protocol, interpreted by a single breast fellowship-trained radiologist.
A single-institution retrospective analysis was performed including clinical, radiographic, and pathologic parameters for all patients with breast cancer treated with NAC from 2015 to 2018. Radiographic complete response (rCR) was defined as absence of suspicious MRI findings in the ipsilateral breast or lymph nodes. pCR was defined as the absence of invasive cancer or ductal carcinoma in-situ in breast or lymph nodes after operation (ypT0N0M0).
Data for 102 consecutive patients demonstrated that 44 (43.1%) had rCR and 41 (40.1%) had pCR. pCR occurred in 12 (25.0%) of 48 estrogen receptor positive (ER+) patients, 29 (53.7%) of 54 ER- patients, and 25 (52.1%) of 48 human epidermal growth factor receptor 2 positive patients. The positive predictive value for MRI after NAC was 84.5% and the negative predictive value was 72.7%. The accuracy rate for MRI was 78.6%. Of the 44 patients with rCR, 12 (27.3%) had residual cancer on the pathologic specimen after surgical excision.
rCR is not accurate enough to serve as a surrogate marker for pCR on MRI after NAC.
本研究评估了在相同仪器设备上使用一致的成像方案进行新辅助化疗（NAC）前后 MRI 是否可以准确预测接受标准化治疗的患者的病理完全缓解（pCR），并由一位经过乳腺专科培训的放射科医生进行单一解读。
对 2015 年至 2018 年接受 NAC 治疗的所有乳腺癌患者的临床、影像学和病理学参数进行了单中心回顾性分析。放射学完全缓解（rCR）定义为同侧乳房或淋巴结中无可疑 MRI 发现。pCR 定义为手术后乳房或淋巴结中无浸润性癌或导管原位癌（ypT0N0M0）。
102 例连续患者的数据显示，44 例（43.1%）有 rCR，41 例（40.1%）有 pCR。48 例雌激素受体阳性（ER+）患者中有 12 例（25.0%）发生 pCR，54 例 ER-患者中有 29 例（53.7%）发生 pCR，48 例人表皮生长因子受体 2 阳性患者中有 25 例（52.1%）发生 pCR。NAC 后 MRI 的阳性预测值为 84.5%，阴性预测值为 72.7%。MRI 的准确率为 78.6%。在 44 例 rCR 患者中，12 例（27.3%）在手术切除后的病理标本中仍有肿瘤残留。
rCR 不足以作为 NAC 后 MRI 上 pCR 的替代标志物。
