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

杨　涛; 刘雁冰; 张朝蓬

doi:10.3969/j.issn.1007-3969.2016.02.009

您当前的位置：

首页 >

文章列表页 >

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

更新时间：2025-12-31

- Accuracy of MRI for predicting shrinkage modes of primary breast tumor following neoadjuvant chemotherapy with three-dimensional reconstruction technique
- China Oncology Vol. 26, Issue 2, Pages: 168-176(2016)
- 作者机构：
  
  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
- 作者简介：
- 基金信息：
- DOI：10.3969/j.issn.1007-3969.2016.02.009
  CLC：
- Published Online：01 June 2016，
  
  Published：01 June 2016
- 稿件说明：
移动端阅览
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.

杨　涛, 刘雁冰, 张朝蓬. 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.
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. DOI： 10.3969/j.issn.1007-3969.2016.02.009.

杨　涛, 刘雁冰, 张朝蓬. 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. DOI： 10.3969/j.issn.1007-3969.2016.02.009.

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。

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

7 and 18

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 (P0.05). 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.

关键词

Keywords

references

Views

1656

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Selective elimination of axillary surgery staging after neoadjuvant chemotherapy for HER2 positive and triple-negative breast cancer

Validation and modification study of axillary node pathologic complete response predictive model after neoadjuvant chemotherapy for breast cancer

The value of serum HER2-ECD level in neoadjuvant chemotherapy for breast cancer

Progress in selective elimination of breast surgery after neoadjuvant chemotherapy for breast cancer

Anylasis of risk factors for arm lymphedema in breast cancer patients treated with neoadjuvant chemotherapy

Related Author

石志强

邱鹏飞

刘雁冰

赵　桐

孙　晓

陈　鹏

王春建

张朝蓬

Related Institution

山东省肿瘤防治研究院（山东省肿瘤医院）乳腺病中心

山东第一医科大学（山东省医学科学院）

济南大学山东省医学科学院医学与生命科学学院

山东大学附属山东省肿瘤医院乳腺病中心外科三病区

山东大学附属山东省肿瘤医院病理科

AI问答

⁰