Hu Qilan, Hu Yiqi, Ai Huiyang, Xia Liming, Liu Rong, Ai Tao
Department of Radiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Oncol. 2024 May 17;14:1366613. doi: 10.3389/fonc.2024.1366613. eCollection 2024.
To investigate what pre-treatment clinical-pathological features and MRI characteristics influence the performance of breast MRI in assessing the pathologic complete response (pCR) of breast cancer patients to Neoadjuvant Chemotherapy (NAC).
A total of 225 patients with pathologically-confirmed breast cancer who underwent pre- and post-NAC breast MRI between January 2020 and April 2023 were retrospectively analyzed. All patients were categorized into radiologic complete response (rCR) and non-rCR groups based on pre-operative MRI. Univariable and multivariable logistic regression were used to identify independent clinicopathological and imaging features associated with imaging-pathological discordance. The performance of pre-operative MRI for predicting pCR to NAC was assessed according to the baseline characteristics of the clinicopathological data and pre-NAC MRI. In addition, the discrepancy between the pre-operative MRI and post-operative pathological findings was further analyzed by a case-control approach.
Among 225 patients, 99 (44.0%) achieved pCR after NAC. MRI showed the overall sensitivity of 97.6%, specificity of 58.6%, accuracy of 80.4%, a positive predictive value (PPV) of 75.0%, and a negative predictive value (NPV) of 95.1% in identifying pCR. Of baseline features, presence of ductal carcinoma (DCIS) (OR, 3.975 [95% CI: 1.448-10.908], = 0.007), luminal B (OR, 5.076 [95% CI: 1.401-18.391], p = 0.013), HER2-enriched subtype (OR, 10.949 [95% CI: 3.262-36.747], < 0.001), multifocal or multicentric lesions (OR, 2.467 [95% CI: 1.067-5.706], = 0.035), segmental or regional distribution of NME (OR, 8.514 [95% CI: 1.049-69.098], = 0.045) and rim enhancement of mass (OR, 4.261 [95% CI: 1.347-13.477], = 0.014) were significantly associated with the discrepancy between MRI and pathology.
Presence of DCIS, luminal B or HER2-enriched subtype, multicentric or multifocal lesions, segmental or regional distribution of NME and rim enhancement of mass may lead to a decrease in diagnostic accuracy of MRI in patients of breast cancer treated with NAC.
探讨哪些治疗前临床病理特征和MRI特征会影响乳腺MRI评估乳腺癌患者对新辅助化疗（NAC）的病理完全缓解（pCR）的性能。
回顾性分析2020年1月至2023年4月期间225例经病理确诊的乳腺癌患者，这些患者在NAC治疗前后均接受了乳腺MRI检查。所有患者根据术前MRI分为放射学完全缓解（rCR）组和非rCR组。采用单变量和多变量逻辑回归分析来确定与影像病理不一致相关的独立临床病理和影像特征。根据临床病理数据和NAC治疗前MRI的基线特征，评估术前MRI预测NAC治疗pCR的性能。此外，采用病例对照方法进一步分析术前MRI与术后病理结果之间的差异。
225例患者中，99例（44.0%）在NAC治疗后达到pCR。MRI在识别pCR方面的总体敏感性为97.6%，特异性为58.6%，准确性为80.4%，阳性预测值（PPV）为75.0%，阴性预测值（NPV）为95.1%。在基线特征中，导管原位癌（DCIS）的存在（OR，3.975 [95% CI：1.448 - 10.908]，P = 0.007）、管腔B型（OR，5.076 [95% CI：1.401 - 18.391]，p = 0.013）、HER2富集亚型（OR，10.949 [95% CI：3.262 - 36.747]，P < 0.001）、多灶性或多中心性病变（OR，2.467 [95% CI：1.067 - 5.706]，P = 0.035）、非肿块强化（NME）的节段性或区域性分布（OR，8.514 [95% CI：1.049 - 69.098]，P = 0.045）以及肿块的边缘强化（OR，4.261 [95% CI：1.347 - 13.477]，P = 0.014）与MRI和病理之间的差异显著相关。
DCIS、管腔B型或HER2富集亚型的存在、多中心或多灶性病变、NME的节段性或区域性分布以及肿块的边缘强化可能导致MRI对接受NAC治疗的乳腺癌患者的诊断准确性降低。
