Pintican Roxana, Fechete Radu, Boca Bianca, Cambrea Madalina, Leonte Tiberiu, Camuescu Oana, Gherman Diana, Bene Ioana, Ciule Larisa Dorina, Ciortea Cristiana Augusta, Dudea Sorin Marian, Ciurea Anca Ileana
Department of Radiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
Department of Radiology, Emergency County Hospital, 400347 Cluj-Napoca, Romania.
Cancers (Basel). 2022 Nov 28;14(23):5866. doi: 10.3390/cancers14235866.
Aim: To evaluate the role of MR relaxometry and derived proton density analysis in the prediction of early treatment response after two cycles of neoadjuvant therapy (NAT), in patients with breast cancer. Methods: This was a prospective study that included 59 patients with breast cancer, who underwent breast MRI prior (MRI1) and after two cycles of NAT (MRI2). The MRI1 included a sequential acquisition with five different TE’s (50, 100, 150, 200 and 250 ms) and a TR of 5000 ms. Post-processing was used to obtain the T2 relaxometry map from the MR acquisition. The tumor was delineated and seven relaxometry and proton density parameters were extracted. Additional histopathology data, T2 features and ADC were included. The response to NAT was reported based on the MRI2 as responders: partial response (>30% decreased size) and complete response (no visible tumor stable disease (SD); and non-responders: stable disease or progression (>20% increased size). Statistics was done using Medcalc software. Results: There were 50 (79.3%) patients with response and 13 (20.7%) non-responders to NAT. Age, histologic type, “in situ” component, tumor grade, estrogen and progesterone receptors, ki67% proliferation index and HER2 status were not associated with NAT response (all p > 0.05). The nodal status (N) 0 was associated with early response, while N2 was associated with non-response (p = 0.005). The tumor (T) and metastatic (M) stage were not statistically significant associated with response (p > 0.05). The margins, size and ADC values were not associated with NAT response (p-value > 0.05). The T2 min relaxometry value was associated with response (p = 0.017); a cut-off value of 53.58 obtained 86% sensitivity (95% CI 73.3−94.2), 69.23 specificity (95% CI 38.6−90.9), with an AUC = 0.715 (p = 0.038). The combined model (T2 min and N stage) achieved an AUC of 0.826 [95% CI: 0.66−0.90, p-value < 0.001]. Conclusions: MR relaxometry may be a useful tool in predicting early treatment response to NAT in breast cancer patients.
评估磁共振弛豫测量法及衍生质子密度分析在预测乳腺癌患者接受两个周期新辅助治疗（NAT）后早期治疗反应中的作用。方法：这是一项前瞻性研究，纳入59例乳腺癌患者，这些患者在接受两个周期NAT之前（MRI1）和之后（MRI2）均接受了乳腺MRI检查。MRI1采用序列采集，有五个不同的回波时间（TE，分别为50、100、150、200和250毫秒）以及5000毫秒的重复时间（TR）。通过后处理从MR采集中获得T2弛豫测量图。勾勒出肿瘤轮廓并提取七个弛豫测量和质子密度参数。还纳入了额外的组织病理学数据、T2特征和表观扩散系数（ADC）。根据MRI2报告NAT反应情况，反应者包括：部分反应（肿瘤大小缩小>30%）和完全反应（无可见肿瘤，疾病稳定（SD））；无反应者包括：疾病稳定或进展（肿瘤大小增加>20%）。使用Medcalc软件进行统计分析。结果：50例（79.3%）患者对NAT有反应，13例（20.7%）无反应。年龄、组织学类型、“原位”成分、肿瘤分级、雌激素和孕激素受体、ki67%增殖指数以及人表皮生长因子受体2（HER2）状态与NAT反应无关（所有p>0.05）。淋巴结状态（N）为0与早期反应相关，而N2与无反应相关（p = 0.005）。肿瘤（T）和转移（M）分期与反应无统计学显著相关性（p>0.05）。边缘、大小和ADC值与NAT反应无关（p值>0.05）。T2最小弛豫测量值与反应相关（p = 0.017）；截断值为53.58时，灵敏度为86%（95%置信区间73.3−94.2），特异性为69.23%（95%置信区间38.6−90.9），曲线下面积（AUC）= 0.715（p = 0.038）。联合模型（T2最小弛豫测量值和N分期）的AUC为0.826 [95%置信区间：0.66−0.90，p值<0.001]。结论：磁共振弛豫测量法可能是预测乳腺癌患者对NAT早期治疗反应的有用工具。
