Monitoring response to primary chemotherapy in breast cancer using dynamic contrast-enhanced magnetic resonance imaging
Monitoring response to primary chemotherapy in breast cancer using dynamic contrast-enhanced magnetic resonance imaging
复制标题
DOI：
10.1023/b:brea.0000010700.11092.f4
复制
发表时间：
2004-01-01
影响因子：
3.8
通讯作者：
Aglietta, M
中科院分区：
文献类型：
--
作者：
Martincich, L;Montemurro, F;Aglietta, M
目的。动态增强磁共振成像(DCE-MRI)允许使用单一工具分析肿瘤体积和增强模式。我们试图研究DCE-MRI是否可以用来预测乳腺癌患者接受初级化疗(PCT)后的组织学反应。30例临床直径<3 cm或ⅢA/B期乳腺癌患者接受了以蒽环类和紫杉烷为基础的PCT。分别于术前、术前、术后2个周期和术后4个周期行DCE-MRI检查。组织学反应采用五点法进行评估。4级(分散的残留癌细胞小团)和5级(没有残留的活癌细胞)被定义为主要的组织病理学反应(MHR)。单变量分析显示，两个周期PCT后肿瘤体积缩小65%和早期增强率(ECU)降低与MHR相关。多变量分析显示，两个周期后肿瘤体积缩小与MHR独立相关(优势比[OR]39.968，95%可信区间[CI]3.438-464.962，p<；0.01)。ECU减少仍然与MHR相关(OR2.5，95%CI 0.263-23.775)，但没有统计学意义(p=0.42)。两个周期PCT后结合肿瘤体积和ECU缩小，对病理完全应答(PCR5级)的肿瘤诊断准确率为93%。DCE-MRI可以预测乳腺癌新辅助化疗的效果。虽然在我们的研究中，两个周期后肿瘤体积缩小具有最强的预测价值，但DCE-MRI具有提供功能参数的潜力，可以整合这些参数来优化新辅助化疗策略。
Purpose. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) allows analysis of both tumor volume and contrast enhancement pattern using a single tool. We sought to investigate whether DCE-MRI could be used to predict histological response in patients undergoing primary chemotherapy (PCT) for breast cancer.Patients and methods. Thirty patients with breast cancer, clinical diameter > 3 cm or stage III A/B, received anthracycline and taxane based PCT. DCE-MRI was performed at the baseline, after two cycles and after four cycles of PCT, before surgery. Histological response was assessed using a five-point scheme. Grade 4 ( small cluster of dispersed residual cancer cells) and grade 5 ( no residual viable cancer cell) were defined as a major histopathological response (MHR).Results. Univariate analysis showed that a > 65% reduction in the tumor volume and a reduction in the early enhancement ratio (ECU) after two cycles of PCT were associated with a MHR. Multivariate analysis revealed that tumor volume reduction after two cycles of PCT was independently associated with a MHR ( odds ratio [ OR] 39.968, 95% confidence interval [CI] 3.438 - 464.962, p < 0.01). ECU reduction was still associated with a MHR (OR 2.50, 95% CI 0.263 - 23.775), but it did not retain statistical significance ( p = 0.42). Combining tumor volume and ECU reduction after two cycles of PCT yielded a 93% diagnostic accuracy in identifying tumors achieving a pathological complete response (pCR) ( histopathological grade 5).Conclusions. DCE-MRI allows prediction of the effect of neoadjuvant chemotherapy in breast cancer. Although in our study tumor volume reduction after two cycles had the strongest predictive value, DCE-MRI has the potential to provide functional parameters that could be integrated to optimize neoadjuvant chemotherapy strategies.