Eom Hye Joung, Kim Hak Hee, Kim Hee Jeong, Choi Woo Jung, Chae Eun Young, Shin Hee Jung, Cha Joo Hee
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Korea.
Eur Radiol. 2025 Jun 24. doi: 10.1007/s00330-025-11640-y.
To evaluate the diagnostic performance of post-neoadjuvant therapy (NAT) diffusion-weighted magnetic resonance imaging (DW-MRI) compared to contrast-enhanced MRI (CE-MRI) in predicting tumor response in breast cancer.
Patients with breast cancer who were examined using 3.0-T MRI after NAT and underwent surgery between 2015 and 2018 were studied. Qualitative assessment of pathological complete response (pCR) and size of residual tumor following NAT were evaluated using CE-MRI and DW-MRI with b-values of 0 and 1000 s/mm. Apparent diffusion coefficient (ADC) cut-off for predicting pCR was estimated using Youden's Index in lesions with residual high signal intensity. Agreement of residual tumor size at CE-MRI, DW-MRI, and pathology was compared.
A total of 1062 patients (49.3 years ± 9.0) were evaluated. Sensitivity for predicting pCR did not show a significant difference between CE-MRI and DW-MRI (65.3% and 62.9%, p = 0.50). The HR+/HER2- subtype showed significantly lower positive predictive value and higher negative predictive value than the others. Agreement of residual tumor size between CE-MRI and pathology (intraclass correlation coefficient [ICC], 0.62; 95% confidence interval [CI]: 0.58-0.66) and between DW-MRI and pathology (ICC, 0.64; 95% CI: 0.61-0.68) did not differ significantly (p = 0.49). Residual tumor size was underestimated in the HR+/HER2- subtype and overestimated in the HR-/HER2+ subtype. The optimum ADC cut-off was 1.22 × 10 mm/s, with the area under the curve of 0.73 (95% CI: 0.68-0.78).
DW-MRI demonstrated comparable sensitivity for predicting pCR and agreement in residual invasive tumor size measurement to CE-MRI. ADC can be used as an additional tool for distinguishing residual tumors from post-treatment changes.
Question The effectiveness of diffusion-weighted MRI in predicting tumor response to NAT in breast cancer remains uncertain. Findings Diffusion-weighted MRI demonstrated similar sensitivity to CE-MRI in predicting pCR and comparable accuracy in measuring residual tumor size. Clinical relevance Diffusion-weighted MRI could potentially be used as an alternative or complementary technique to CE-MRI for evaluating tumor response to NAT in patients with breast cancer.
评估新辅助治疗（NAT）后扩散加权磁共振成像（DW-MRI）与对比增强磁共振成像（CE-MRI）在预测乳腺癌肿瘤反应方面的诊断性能。
对2015年至2018年间接受NAT后使用3.0-T MRI检查并接受手术的乳腺癌患者进行研究。使用CE-MRI和b值为0和1000 s/mm²的DW-MRI对NAT后的病理完全缓解（pCR）和残余肿瘤大小进行定性评估。使用约登指数在残余高信号强度病变中估计预测pCR的表观扩散系数（ADC）临界值。比较CE-MRI、DW-MRI和病理检查中残余肿瘤大小的一致性。
共评估了1062例患者（49.3岁±9.0岁）。CE-MRI和DW-MRI在预测pCR方面的敏感性无显著差异（分别为65.3%和62.9%，p = 0.50）。HR+/HER2-亚型的阳性预测值显著低于其他亚型，阴性预测值显著高于其他亚型。CE-MRI与病理检查之间（组内相关系数[ICC]，0.62；95%置信区间[CI]：0.58 - 0.66）以及DW-MRI与病理检查之间（ICC，0.64；95% CI：0.61 - 0.68）的残余肿瘤大小一致性无显著差异（p = 0.49）。HR+/HER2-亚型的残余肿瘤大小被低估，HR-/HER2+亚型的残余肿瘤大小被高估。最佳ADC临界值为1.22×10⁻³mm²/s，曲线下面积为0.73（95% CI：0.68 - 0.78）。
DW-MRI在预测pCR方面显示出与CE-MRI相当的敏感性，并且在测量残余浸润性肿瘤大小方面与CE-MRI具有一致性。ADC可作为区分残余肿瘤与治疗后改变的辅助工具。
问题扩散加权MRI在预测乳腺癌NAT肿瘤反应中的有效性仍不确定。发现扩散加权MRI在预测pCR方面显示出与CE-MRI相似的敏感性，在测量残余肿瘤大小方面具有相当的准确性。临床意义扩散加权MRI有可能作为CE-MRI的替代或补充技术，用于评估乳腺癌患者对NAT的肿瘤反应。
