Diffusion-weighted MRI Findings Predict Pathologic Response in Neoadjuvant Treatment of Breast Cancer: The ACRIN 6698 Multicenter Trial
Diffusion-weighted MRI Findings Predict Pathologic Response in Neoadjuvant Treatment of Breast Cancer: The ACRIN 6698 Multicenter Trial
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DOI：
10.1148/radiol.2018180273
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发表时间：
2018-12-01
期刊：
影响因子：
19.7
通讯作者：
Hylton, Nola M.
中科院分区：
文献类型：
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作者：
Partridge, Savannah C.;Zhang, Zheng;Hylton, Nola M.
目的探讨肿瘤表观扩散系数(ADC)在磁共振弥散加权成像(DW)上的变化是否可以预测乳腺癌新辅助化疗的病理完全缓解(PCR)。材料与方法在这项前瞻性多中心研究中，272例乳腺癌患者从2012年8月至2015年1月在10个机构随机接受每周12剂紫杉醇(含或不含实验药物)治疗，然后用4个周期的蒽环类药物治疗12周。每名妇女在治疗前、治疗早期(3周)、治疗中期(12周)和治疗后进行乳房DW MRI检查。在每个时间点测量肿瘤ADC与治疗前相比的百分比变化(Delta ADC)。根据肿瘤激素受体(HR)/人表皮生长因子受体2(HER2)疾病亚型，利用受试者工作特征曲线下面积(AUC)对预测PCR值的效果进行评估。结果最终的分析包括242例有可评价的系列影像资料的患者，平均年龄为48岁+/-10(标准差)，99例HR阳性(以下简称HR+)/HER2阴性(以下简称HER2-)，77例HR-/HER2-疾病，42例HR+/HER2+疾病，24例HR-/HER2+疾病。242例患者中有80例(33%)接受了聚合酶链式反应。总体而言，Delta ADC在治疗中期/12周(AUC=0.60；95%可信区间[CI]：0.52，0.68；P=.017)和治疗后(AUC=0.61；95%CI：0.52，0.69；P=.013)对PCR值有中等预测作用。在四种疾病亚型中，中期治疗Delta ADC仅对HR+/HER2-肿瘤有预测作用(AUC=0.76；95%CI：0.62，0.89；P<；.001)。在测试子集中，结合肿瘤亚型和中期治疗的Delta ADC的预测性能(AUC=0.72；95%CI：0.61，0.83)优于单独使用Delta ADC(AUC=0.57；95%CI：0.44，0.70；P=.032)。结论治疗12周后，MRI上乳腺肿瘤表观扩散系数的变化预示着新辅助化疗的完全病理反应。(C)RSNA，2018年。
Purpose To determine if the change in tumor apparent diffusion coefficient (ADC) at diffusion-weighted (DW) MRI is predictive of pathologic complete response (pCR) to neoadjuvant chemotherapy for breast cancer.Materials and Methods In this prospective multicenter study, 272 consecutive women with breast cancer were enrolled at 10 institutions (from August 2012 to January 2015) and were randomized to treatment with 12 weekly doses of paclitaxel (with or without an experimental agent), followed by 12 weeks of treatment with four cycles of anthracycline. Each woman underwent breast DW MRI before treatment, at early treatment (3 weeks), at midtreatment (12 weeks), and after treatment. Percentage change in tumor ADC from that before treatment (Delta ADC) was measured at each time point. Performance for predicting pCR was assessed by using the area under the receiver operating characteristic curve (AUC) for the overall cohort and according to tumor hormone receptor (HR)/human epidermal growth factor receptor 2 (HER2) disease subtype.Results The final analysis included 242 patients with evaluable serial imaging data, with a mean age of 48 years +/- 10 (standard deviation); 99 patients had HR-positive (hereafter, HR+)/HER2-negative (hereafter, HER2-) disease, 77 patients had HR-/HER2- disease, 42 patients had HR+/HER2+ disease, and 24 patients had HR-/HER2+ disease. Eighty (33%) of 242 patients experienced pCR. Overall, Delta ADC was moderately predictive of pCR at midtreatment/12 weeks (AUC = 0.60; 95% confidence interval [CI]: 0.52, 0.68; P = .017) and after treatment (AUC = 0.61; 95% CI: 0.52, 0.69; P = .013). Across the four disease subtypes, midtreatment Delta ADC was predictive only for HR+/HER2- tumors (AUC = 0.76; 95% CI: 0.62, 0.89; P < .001). In a test subset, a model combining tumor subtype and midtreatment Delta ADC improved predictive performance (AUC = 0.72; 95% CI: 0.61, 0.83) over Delta ADC alone (AUC = 0.57; 95% CI: 0.44, 0.70; P = .032.).Conclusion After 12 weeks of therapy, change in breast tumor apparent diffusion coefficient at MRI predicts complete pathologic response to neoadjuvant chemotherapy. (C) RSNA, 2018.