Analysis of Factors that Influence the Accuracy of Magnetic Resonance Imaging for Predicting Response after Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer
Analysis of Factors that Influence the Accuracy of Magnetic Resonance Imaging for Predicting Response after Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer
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DOI：
10.1245/s10434-013-2925-6
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发表时间：
2013-08-01
影响因子：
3.7
通讯作者：
Park, Yeon Hee
中科院分区：
文献类型：
--
作者：
Ko, Eun Sook;Han, Boo-Kyung;Park, Yeon Hee
本研究的目的是评估乳腺磁共振成像（MRI）预测新辅助化疗（NAC）后残留病灶大小的准确性，并确定影响反应预测准确性的因素。使用MRI测量残留癌的最长直径，并与病理结果相关联。根据各种放射学和组织病理学因素，患者进一步分为亚组。病理学完全缓解（pCR）定义为不存在残留的浸润性癌细胞。Pearson相关性用于将MRI和病理学确定的肿瘤大小相关联，Mann-Whitney U检验和Kruskal-Wallis检验用于根据各种临床、组织病理学因素和MRI结果比较MRI-病理学大小差异。使用MRI诊断浸润性残留病变的总体敏感性、特异性和准确性分别为96%、65%和89%。MRI测量的肿瘤大小与病理结果的Pearson相关系数为0.749（P < 0.001）。在雌激素受体阳性的癌症患者中，（P = 0.037），在低核分级的癌症中（P = 0.007），在MRI上显示为弥漫性非肿块样增强的癌症中（P = 0.001）。在雌激素受体阳性乳腺癌、低核分级、初次MRI显示弥漫性非肿块样增强。
The purpose of this study was to evaluate the accuracy of breast magnetic resonance imaging (MRI) to predict residual lesion size after neoadjuvant chemotherapy (NAC) and to determine the factors that influence the accuracy of response prediction.This study comprised 166 patients who underwent MRI before and after NAC, but before surgery. The longest diameter of the residual cancer was measured using MRI and correlated with pathologic findings. Patients were further divided into subgroups according to various radiologic and histopathologic factors. Pathologic complete response (pCR) was defined as the absence of residual invasive cancer cells. The Pearson correlation was used to correlate tumor size as determined by MRI and pathology, and the Mann-Whitney U test and Kruskal-Wallis test were used to compare MRI-pathologic size discrepancies according to various clinical, histopathologic factors, and MRI findings.Of the 166 women, 40 achieved pCR. The overall sensitivity, specificity, and accuracy for diagnosing invasive residual disease by using MRI were 96, 65, and 89 %, respectively. The Pearson's correlation coefficient between the tumor sizes measured using MRI and pathology was 0.749 (P < 0.001). The size discrepancy was significantly greater in patients with estrogen receptor-positive cancer (P = 0.037), in cancers with low nuclear grade (P = 0.007), and in cancers shown as diffuse non-mass-like enhancement on MRI (P = 0.001).Size prediction is less accurate in cases with estrogen receptor-positive breast cancer, low nuclear grade, and diffuse non-mass-like enhancement on initial MRI.