The use of contrast-enhanced computed tomography before neoadjuvant chemotherapy to identify patients likely to be treated safely with breast-conserving surgery
The use of contrast-enhanced computed tomography before neoadjuvant chemotherapy to identify patients likely to be treated safely with breast-conserving surgery
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DOI：
10.1097/01.sla.0000109157.15687.d9
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发表时间：
2004-02-01
影响因子：
9
通讯作者：
Hasegawa, T
中科院分区：
文献类型：
--
作者：
Akashi-Tanaka, S;Fukutomi, T;Hasegawa, T
目的：根据对比增强计算机断层扫描(CE-CT)将肿瘤分为局限型或弥漫型，为新辅助化疗(NAC)后的保乳治疗(BCT)选择合适的候选者。在NAC开始之前，准确评估BCT的适宜性和对NAC的反应，将有助于选择合适的治疗方案。方法：我们对1998年5月至2001年11月在东京国立癌症中心医院接受NAC治疗的110例直径3 cm或以上的可手术乳腺癌患者进行了CE-CT检查。结果：钼靶X线、超声和CE-CT将病变分为局限性和弥漫性两种类型。结果：乳腺钼靶、超声和CE-CT确定为局限型的肿瘤缩小为同心圆内小于3 cm的肿瘤(P<；0.0001)。对于CE-CT定位的肿瘤，BCT治疗切缘阴性的肿瘤是安全的(P=0.01)。相反，弥漫型肿瘤缩小为由大于3.1厘米的肿瘤组成的马赛克图案。CE-CT定位肿瘤的病理反应优于弥漫性肿瘤(P=0.0365)。多因素分析显示，CE-CT的形态类型和组织学类型是安全BCT的重要预测因素。结论：NAC治疗前CE-CT将肿瘤分为局限型或弥漫型，可准确预测NAC治疗后哪些肿瘤适合行BCT。
Objective: To select suitable candidates for breast-conserving treatment (BCT) after neoadjuvant chemotherapy (NAC), based on the classification of tumors into localized or diffuse types using contrast-enhanced computed tomography (CE-CT).Summary Background Data: A relatively high rate of loco-regional failure after BCT has been reported with breast cancer downstaged by NAC. Accurate assessment of the suitability of BCT and the response to NAC, before the initiation of NAC, will allow the optimal selection of an appropriate therapeutic course.Methods: We evaluated 110 consecutive patients with operable breast carcinomas measuring 3-cm or more in diameter by CE-CT after NAC treatment with doxorubicin and docetaxel at National Cancer Center Hospital, Tokyo, from May 1998 to November 2001. Lesions were classified as either localized or diffuse types by mammography (MMG), ultrasonography (US), and CE-CT.Results: Tumors designated as localized type by MMG, US, and CE-CT were reduced to tumors less than 3.0 cm (P < 0.0001) in a concentric circle (P < 0.0001). Localized tumors by CE-CT were treated safely with BCT maintaining a negative margin status (P = 0.01). In contrast, diffuse type tumors shrunk into a mosaic pattern consisting of tumors larger than 3.1 cm. Tumors classified as localized by CE-CT responded better pathologically than diffuse tumors (P = 0.0365). Multivariate analysis demonstrated that morphologic type by CE-CT and histologic type were significant predictors of candidates for safe BCT.Conclusions: The classification of tumors into either localized or diffuse types, using CE-CT before NAC administration, accurately predicts which tumors will be suitable candidates for BCT after NAC.