Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy
Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy
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DOI：
10.1007/s00330-004-2246-z
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发表时间：
2004-08-01
影响因子：
5.9
通讯作者：
Zuiani, C
中科院分区：
文献类型：
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作者：
Londero, V;Bazzocchi, M;Zuiani, C
评估钼靶摄影、超声和磁共振成像(MRI)在确定新辅助化疗后残留病变方面的准确性，并将影像结果与病理结果相关联。15例参加新辅助化疗实验方案的患者在新辅助化疗前、后分别进行了临床检查、钼靶X线片、超声和动态MRI检查。四名放射科医生，两名乳房X光检查，一名超声波检查，一名MR检查，对其他检查的结果视而不见，检查了图像。所有患者均接受根治性或保守性手术，并将其影像表现与病理结果进行对照。临床完全缓解(CR)2例(13.3%)，部分缓解(PR)9例(60%)，稳定(SD)3例(20%)，进展1例(6.7%)。钼靶X线片显示临床CR 1/15(6.7%)，PR 8/15(53.3%)，SD 4/15(27%)，2/15(13%)不能评价病情。超声显示的结果与MRT相同。因此，与钼靶摄影相比，MRI和超声对残留病变的诊断正确率分别为100%和86%。由于原位导管癌(DCIS)和浸润性小叶癌(LCI)存在微灶，MRI有两个假阴性结果。在多灶性或多中心性疾病中，MRI优于钼靶摄影(83%比33%)。MRI后行超声检查，可提高MRI对多灶性病变不确定病灶的诊断准确率，诊断准确率由73%提高到84.5%。MRI对新辅助化疗疗效的评估优于传统的体检和乳房X光检查方法。
The accuracy of mammography, sonography and magnetic resonance imaging (MRI) in identifying residual disease after neoadjuvant chemotherapy is evaluated and imaging findings are correlated with pathologic findings. Fifteen patients enrolled in an experimental protocol of preoperative neoadjuvant chemotherapy underwent clinical examination, mammography, sonography and dynamic MRI, performed in this order, before and respectively after 2 and 4 cycles of neoadjuvant chemotherapy. Four radiologists, two for mammography, one for sonography and one for MR, examined the images, blinded to the results of the other examinations. All patients underwent radical or conservative surgery, and imaging findings were compared with pathologic findings. MRI identified 2/15 (13.3.%) clinically complete response (CR), 9/15 (60%) partial response (PR), 3/15 (20%) stable disease (SD) and 1/15 (6.7%) progressive disease. Mammography identified 1/15 (6.7%) clinically CR, 8/15 (53.3%) PR and 4/15 (27%) SD, and was not able to evaluate the disease in 2/15 (13%) cases. Sonography presented the same results as MRT. Therefore, MRI and sonography compared to mammography correctly identified residual disease in 100 vs. 86%. MRI resulted in two false-negative results because of the presence of microfoci of in situ ductal carcinoma (DCIS) and invasive lobular carcinoma (LCI). MRI was superior to mammography in cases of multifocal or multicentric disease (83 vs. 33%). Sonography performed after MRI improves the accuracy in evaluation of uncertain foci of multifocal disease seen on MR images with an increase of diagnostic accuracy from 73 to 84.5%. MRI assesses response to neoadjuvant chemotherapy better than traditional methods of physical examination and mammography.