Accuracy of magnetic resonance imaging for predicting pathological complete response of breast cancer after neoadjuvant chemotherapy: association with breast cancer subtype.
Accuracy of magnetic resonance imaging for predicting pathological complete response of breast cancer after neoadjuvant chemotherapy: association with breast cancer subtype.
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DOI：
10.1186/s40064-016-1800-x
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Iwase T
中科院分区：
文献类型：
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作者：
Fukuda T;Horii R;Gomi N;Miyagi Y;Takahashi S;Ito Y;Akiyama F;Ohno S;Iwase T
对新辅助化疗(NAC)的病理完全应答(PCR)是乳腺癌预后良好的标志。本研究的目的是评估磁共振成像(MRI)预测NAC后PCR值的准确性。对265例NAC后接受手术的II或III期乳腺癌患者在NAC治疗前后的MRI表现进行了回顾性调查。对于每一种肿瘤亚型，评估了聚合酶链式反应与“成像完全反应”(ICR)的相关性，“成像完全反应”定义为动态增强T1加权成像在所有序列图像上均未发现肿瘤。265例中，44例(16.6%)诊断为ICR，24例(9.1%)诊断为聚合酶链式反应。44例ICR患者中19例(43.2%)为聚合酶链式反应，221例非ICR患者中216例(97.7%)为非聚合酶链式反应。其准确性(ACC)、聚合酶链式反应预测值(PPV)和非聚合酶链式反应预测值(NPV)分别为88.7、43.2和97.7%。每种肿瘤亚型的ACC、PPV和NPV分别为93.2%、21.4%和100%，70.8%、0%和89.5%，HER2富集型为75%、57.1%和88.8%，三阴性亚型为90.9%、72.7%和97%。MRI是预测乳腺癌NAC治疗后PCR值的一种有价值的方法。然而，它的准确性在不同的乳腺癌亚型中差别很大。尽管MRI能很好地预测三阴性亚型的PCR值，但管腔亚型的ICR往往被高估了。另一方面，MRI确定的残留病变是管腔亚型非聚合酶链式反应的可靠标志。
A pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) is a signature of favorable prognosis in breast cancer. The aim of this study was to assess the accuracy of magnetic resonance imaging (MRI) in predicting the pCR after NAC. 265 women with stage II or III breast cancer who underwent surgery after NAC were retrospectively investigated for MRI findings before and after the NAC. Correlation of pCR with an “imaging complete response” (iCR), defined as no detectable tumor on all serial images with dynamic contrast-enhanced T1-weighted imaging, was evaluated with respect to each tumor subtype. Of 265 cases, 44 (16.6 %) and 24 (9.1 %) were diagnosed as iCR and pCR, respectively. Nineteen of the 44 iCR cases (43.2 %) were assessed as pCR, and 216 (97.7 %) of the 221 non-iCR cases were assessed as non-pCR. The accuracy (ACC), the pCR predictive value (PPV) and the non-pCR predictive value (NPV) were 88.7, 43.2, and 97.7 %, respectively. When assessed according to each tumor subtype, the ACC, PPV and NPV were 93.2, 21.4 and 100 % for luminal subtype, 70.8, 0 and 89.5 % for luminal/HER2 subtype, 75, 57.1 and 88.8 % for HER2-enriched subtype, and 90.9, 72.7 and 97 % for triple-negative subtype, respectively. MRI is a valuable modality for predicting pCR of breast cancer after NAC treatment. However, its accuracy varies greatly in different breast cancer subtypes. Whereas MRI closely predicts pCR in the triple-negative subtype, iCR in the luminal subtype is often an over-estimation. On the other hand, residual lesions identified by MRI are reliable markers of non-pCR for the luminal subtype.