MRI对新辅助化疗后乳腺原发肿瘤退缩模式预测的准确度

doi:10.3969/j.issn.1007-3969.2016.02.009

中国癌症杂志 ›› 2016, Vol. 26 ›› Issue (2): 168-176.doi: 10.3969/j.issn.1007-3969.2016.02.009

MRI对新辅助化疗后乳腺原发肿瘤退缩模式预测的准确度

杨　涛^1,2，刘雁冰¹，张朝蓬¹，刘　广¹，穆殿斌¹，王永胜¹

1. 山东省肿瘤医院乳腺病中心，山东济南 250117 ；
2. 连云港市第一人民医院放疗科，江苏连云港 222002

出版日期:2016-02-29 发布日期:2016-06-01
通信作者: 王永胜　E-mail：wangysh2008@aliyun.com
基金资助:
山东省医药卫生科技发展计划项目(2011HD012)；山东省科技发展计划项目(2013YD18030)。

Accuracy of MRI for predicting shrinkage modes of primary breast tumor following neoadjuvant chemotherapy with three-dimensional reconstruction technique

YANG Tao^1,2, LIU Yanbing¹, ZHANG Zhaopeng¹, LIU Guang¹, MU Dianbin¹, WANG Yongsheng¹

1.Breast Cancer Center, Shandong Cancer Hospital, Jinan 250117, Shandong Province, China; 2.Department of Radiotherapy, the First People's Hospital of Lianyungang, Lianyungang 222002, Jiangsu Province, China

Published:2016-02-29 Online:2016-06-01
Contact: WANG Yong-sheng E-mail: wangysh2008@aliyun.com

摘要/Abstract

摘要： 背景与目的：新辅助化疗(neoadjuvant chemotherapy，NAC)可使原发肿瘤较大的乳腺癌患者获得保乳治疗(breast-conserving therapy，BCT)机会，但NAC后原发肿瘤退缩模式影响保乳率及预后。本研究旨在观察MRI对NAC后乳腺原发肿瘤退缩模式预测的准确度。方法：61例ⅡA~ⅢC期乳腺浸润性导管癌患者，NAC后手术标本制作次连续病理大切片，显微镜下勾画残余肿瘤范围，Photoshop软件配准，3D-DOCTOR软件三维重建病理及MRI图像残余肿瘤模型，评价NAC后原发肿瘤的病理退缩模式。将其分为外科pCR(无残留灶)、孤立状、结节状、团块伴散在状和弥散状。结合病理退缩模式，将临床-病理退缩模式分为退缩明显型(distinct shrinkage mode，DSM，相比NAC前原发肿瘤最长径，NAC后残余肿瘤最长径退缩比率≥50%且≤2 cm)和非退缩明显型(non-distinct shrinkage mode，NDSM)。结果：MRI和病理的退缩模式呈外科pCR、孤立状、结节状、团块伴散在状和弥散状模式分别为23例、17例、5例、9例、7例和18例、3例、13例、20例、7例(P=0.001)。MRI预测病理退缩模式的准确度、灵敏度和特异度分别为86.2%，65.6%和91.4%。MRI和病理呈DSM比例分别为62.3%和59.0%(κ=0.863，P=0.000)。MRI预测临床-病理退缩模式的准确度、灵敏度和特异度分别为91.0%、64.0%和94.8%，其中预测DSM和NDSM差异均无统计学意义(P均>0.05)。MRI预测临床-病理退缩模式的受试者工作特征(receiver operating characteristic，ROC)曲线下面积为0.928(P=0.000)。结论：NAC后MRI三维重建图像能准确模拟并预测残余肿瘤的立体空间位置，有助于选择NAC后降期BCT患者。

关键词: 乳腺癌, 退缩模式, 新辅助化疗, 三维重建, MRI

Abstract: Background and purpose: The most clearly recognized benefit of neoadjuvant chemotherapy (NAC) is that it can increase the proportion of patients who can be treated with breast-conserving therapy (BCT). However, the shrinkage modes of the primary breast tumor after NAC have been confirmed as a predictor of BCT rate and prognosis. This study is to evaluate the accuracy of MRI predicting the shrinkage mode of the primary breast tumor after NAC with three-dimensional reconstruction technique. Methods: Sixty-one women with pathologically proven solitary invasive ductal carcinoma (ⅡA-ⅢC) were recruited. Breast specimens were prepared with PMSS, and residual tumors were microscopically outlined, scanned and registered by PHOTOSHOP software. The 3D model of residual tumors was reconstructed with 3D-DOCTOR software based on pathology and MRI imaging characteristics to evaluate the shrinkage mode. We devided the pathological shrinkage modes into surgical pCR (no residual tumors), solitary lesions without surrounding lesions, multinodular lesions, solitary lesions with adjacent spotty lesions and diffuse lesions. Further, the clinical-pathological shrinkage modes were divided into 2 categories: distinct shrinkage mode (DSM, the longest diameter of the pathological residual tumors was less than 50% and ≤2 cm in comparison with the primary tumor before NAC) and non-distinct shrinkage mode (NDSM, the longest diameter of the pathological residual tumors was more than 50% and/or >2 cm in comparison with the primary tumor before NAC). Results: The surgical pCR, solitary lesions without surrounding lesions, multinodular lesions, solitary lesions with adjacent spotty lesions and diffuse lesions were observed in 23, 17, 5, 9, 7 and 18, 3, 13, 20, 7 patients by MRI and pathology, respectively (P=0.001). The accuracy, sensitivity and specificity of MRI for predicting pathological shrinkage modes were 86.2%, 65.6% and 91.4%, respectively. The DSM was observed in 36 (59.0%) patients by pathology, and 38 (62.3%) patients by MRI. Two methods had a high consistency in clinical-pathological shrinkage modes (κ=0.863, P=0.000). The accuracy, sensitivity and specificity of MRI for predicting clinical-pathological shrinkage modes were 91.0%, 64.0% and 94.8%, respectively. There was not a statistic difference in prediction between DSM and NDSM by MRI (P>0.05). Receiver operating characteristic (ROC) curve analysis showed an AUC of 0.928 (P=0.000) for MRI to predict the clinical-pathological shrinkage mode. Conclusion: Three-dimensional MRI reconstruction after NAC could simulate and predict spatial location of residual tumors, and can be helpful in selecting patients who received BCT after NAC with tumor downstaging.

Key words: Breast Cancer, Shrinkage mode, Neoadjuvant chemotherapy, Three-dimensional reconstruction, MRI

杨　涛,刘雁冰,张朝蓬,等. MRI对新辅助化疗后乳腺原发肿瘤退缩模式预测的准确度[J]. 中国癌症杂志, 2016, 26(2): 168-176.

YANG Tao, LIU Yanbing, ZHANG Zhaopeng, et al. Accuracy of MRI for predicting shrinkage modes of primary breast tumor following neoadjuvant chemotherapy with three-dimensional reconstruction technique[J]. China Oncology, 2016, 26(2): 168-176.

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MRI对新辅助化疗后乳腺原发肿瘤退缩模式预测的准确度

Accuracy of MRI for predicting shrinkage modes of primary breast tumor following neoadjuvant chemotherapy with three-dimensional reconstruction technique

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