新辅助化疗治疗乳腺癌时，MRI评估瘤周残余水肿的预后价值

Prognostic Value of MRI Assessment of Residual Peritumoral Edema in Breast Cancer Treated With Neoadjuvant Chemotherapy.

作者信息

Shigematsu Hideo, Fujimoto Mutsumi, Kobayashi Yoshie, Yasui Daisuke, Komoto Daisuke, Matsuura Noriaki, Kuraoka Kazuya, Yoshiyama Tomoyuki

机构信息

Department of Breast Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan.

Department of Radiology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan.

出版信息

J Magn Reson Imaging. 2025 Feb;61(2):944-955. doi: 10.1002/jmri.29456. Epub 2024 May 29.

DOI:10.1002/jmri.29456

PMID:38809133

Abstract

BACKGROUND

Peritumoral edema (PE) identified on T2-weighted breast MRI is a factor for poor prognosis in breast cancer.

PURPOSE

To assess the prognostic value of residual PE (rPE) in patients with PE positive breast cancer prior to neoadjuvant chemotherapy (NACT) who subsequently underwent curative surgery.

STUDY TYPE

Retrospective.

POPULATION

In total, 128 patients with nonmetastatic invasive breast cancer who underwent breast MRI before and after NACT.

FIELD STRENGTH/SEQUENCE: Axial precontrast 2D fast spin echo T2W fat-suppressed sequence. Axial dynamic 3D gradient echo T1W fat-suppressed sequence.

ASSESSMENT

PE was diagnosed when a signal intensity as high as water was detected surrounding the tumor on a T2-weighted breast MRI. PE was qualitatively evaluated by three readers with more than 20 years of experience in interpreting breast field imaging findings. Residual cancer burden (RCB) were assessed post-NACT. Recurrence-free survival (RFS) and overall survival (OS) were evaluated as the endpoints of this study.

STATISTICAL TESTS

Chi-square test; Kaplan-Meier method, log-rank test, and Cox proportional hazard model. A P-value <0.05 was considered statistically significant.

RESULTS

Pre-PE was observed in 64 out of 128 patients. Of these, rPE was observed in 21. In the log-rank test, breast cancer with rPE had significantly worse RFS and OS than that without rPE. Cox proportional hazard analysis identified rPE as a significant prognostic factor for recurrence (hazard ratio, 11.6; 95% confidence interval [CI], 3.05-43.8) and death (hazard ratio, 17.8; 95% CI, 3.30-96.3). Breast cancer with rPE had significant worse RFS and OS than that without rPE in RCB class II, and significant worse OS in pathological complete response, class I and class II in the log-rank test.

DATA CONCLUSION

rPE on a T2-weighted breast MRI was a significant factor for breast cancer recurrence and death in patients with pre-PE-positive breast cancer treated with NACT.

TECHNICAL EFFICACY

Stage 2.

摘要

背景

乳腺T2加权磁共振成像（MRI）上发现的瘤周水肿（PE）是乳腺癌预后不良的一个因素。

目的

评估新辅助化疗（NACT）前PE阳性且随后接受根治性手术的乳腺癌患者中残余PE（rPE）的预后价值。

研究类型

回顾性研究。

研究对象

总共128例非转移性浸润性乳腺癌患者，这些患者在NACT前后均接受了乳腺MRI检查。

场强/序列：轴位预增强二维快速自旋回波T2加权脂肪抑制序列。轴位动态三维梯度回波T1加权脂肪抑制序列。

评估

当在乳腺T2加权MRI上检测到肿瘤周围信号强度与水一样高时，诊断为PE。由三位具有20多年乳腺影像学解读经验的阅片者对PE进行定性评估。NACT后评估残余癌负担（RCB）。将无复发生存期（RFS）和总生存期（OS）作为本研究的终点进行评估。

统计检验

卡方检验；Kaplan-Meier法、对数秩检验和Cox比例风险模型。P值<0.05被认为具有统计学意义。

结果

128例患者中有64例观察到术前PE。其中，21例观察到rPE。在对数秩检验中，有rPE的乳腺癌患者的RFS和OS明显比无rPE的患者差。Cox比例风险分析确定rPE是复发（风险比，11.6；95%置信区间[CI]，3.05 - 43.8）和死亡（风险比，17.8；95%CI，3.30 - 96.3）的重要预后因素。在对数秩检验中，有rPE的乳腺癌患者在RCB II类中的RFS和OS明显比无rPE的患者差，在病理完全缓解、I类和II类中的OS明显更差。