|摘要||目的 探讨MRI动态增强扫描时间-信号曲线(TIC)流出段斜率(Swash-out),对局部进展期乳腺癌新辅助化疗(NAC)疗效的评估效能.方法 回顾性分析59例术后病理确诊为浸润性导管癌患者的资料,所有患者均接受4个周期吡喃阿霉素+紫杉醇新辅助化疗.以改良病理反应性标准为金标准,分为组织学显著反应(MHR)与组织学非显著反应(NMHR)组.采用重复测量的方差检验分别对两组患者NAC不同周期后MRI动态增强扫描TIC曲线Swash-out进行比较,采用非参数检验Mann-Whitney法对两组NAC治疗不同周期后TIC曲线Swash-out进行比较.以病理反应性标准分组为金标准对NAC治疗2、4个周期后TIC曲线Swash-out进行ROC分析,分别计算曲线下面积(Az),评价其对NAC疗效的预测效能,并与常用TIC曲线半定量分析指标最大线性斜率(Smax)、增强峰值百分数(PPE)比较.结果 MHR组34例,NMHR组25例.NAC前MHR组Swash-out中位数为-16.99,NAC治疗2个周期后为5.66,NAC治疗4个周期后为15.95；NMHR组NAC前Swash-out中位数为-23.08(-64.24～ 34.39),NAC治疗2个周期后为-23.01(-52.72～28.70),NAC治疗4个周期后Swash-out为-11.45(-50.49 ～50.93).MHR组NAC治疗2个周期后及4个周期后Swash-out变化率分别为-1.18(-31.32 ～60.86)及1.50(-86.27 ～3.61),NMHR组NAC治疗2个周期后及4个周期后Swash-out变化率分别为-0.28(-3.24～9.46)及0.27(-5.34～3.11),NAC前MHR组Swash-out与NMHR组差异无统计学意义(Z=-0.97,P＞0.05).NAC治疗2个周期后MHR组Swash-out及Swash-out变化率显著高于NMHR组(Z值分别为-3.97与-3.02,P＜0.01).NAC治疗4个周期后MHR组Swash-out及Swash-out变化率显著高于NMHR组(Z值分别为-3.96与-3.16,P＜0.01).以病理反应性分级为金标准,采用ROC评价Swash-out预测病理反应性的效能,NAC治疗2个周期和4个周期后Swash-out的曲线下面积分别为0.805和0.804,两者差异无统计学意义(Z =0.019,P＞0.05),诊断最佳截断点分别为-8.670和4.105,诊断敏感度均为79.42％,特异度均为76.00％,约登指数均为0.554.结论 NAC前Swash-out不能预测病理反应性,NAC治疗2个周期、4个周期后Swash-out对NAC疗效具有较高的评估价值.
Objective To study the value of the semiquantitative-parameter analysis of wash out index of time-intensity curve (Swash-out) in evaluating the therapeutic effect of neoadjuvant chemotherapy for locally advanced breast cancer (LABC).Methods Fifty-nine women with LABC underwent dynamic contrast enhancedt MRI examination before chemotherapy,after the 2nd cycle and the 4th cycle of chemotherapy.All patients were divided into major histological response group (MHR) and non-major histological response group (NMHR) according to the final pathologic response.Swash-out and the variancetrends of Swash-out before NAC,after the 2nd cycle of NAC and after the 4th cycle of NAC were compared in each group and between the two groups.According to the gold standard of Miller & Payne criterion,Receiver operating characteristic curve (ROC) analysis was performed to evaluate the predicting effect of Swash-out for NAC response,and to compare it with Semi-quantitative TIC curve indicators Smax (steepest slope) and PPE (peak percent enhancement).Results Fifty-nine patients of LABC patients were divided into a MHR group of 34 patients and a NMHR group of 25 patients.Swash before NAC of MHR group was-16.99 (-56.72-41.20),Swash-out after the 2nd cycle of NAC was 5.66(-69.45-53.08),Swash-out after 4th cycle of NAC was 15.95 (-7.80-54.23).Swash-out before NAC of NMHR group was-23.08 (-64.24-34.39),Swash-out after the 2nd cycle of NAC of NMHR group was-23.01 (-52.72-28.70),Swash-out after 4th cycle of NAC of NMHR group was-11.45 (-50.49-50.93).Swash-out variance rate of MHR group after the 2nd and the 4th cycle of NAC were-1.18 (-31.32-60.86) and 1.50 (-86.27-3.61),respectively.Swash-out variance rate of NMHR group after the 2nd and the 4th cycle of NAC were-0.28(-3.24-9.46) and 0.27 (-5.34-3.11),respectively.Swash-out was not significantly different between the two groups before NAC (Z =-0.97,P ＞0.05).Swash-out and Swash-out variance rate of MHR group after the 2nd cycle of NAC were significant higher than that of NMHR group (Z =-3.97 and-3.02,P ＜0.01).Swash-out and Swash-out variance rate of MHR group after the 4th cycle of NAC were significant higher than that of NMHR group (Z =-3.96 and-3.16,P ＜ 0.01).Area under curve (Az) after the 2nd and the 4th cycle of NAC were 0.805 and 0.804,respectively,and no significant difference was found between them (Z =0.019,P ＞0.05).Diagnostic cut-off points were-8.670 for the 2nd cycle of NAC and 4.105 for the 4th cycle of NAC.Diagnostic sensitivity was 79.42％,specificity was 76.00％ and Youden index was 0.554,for after the 2nd and the 4th cycle of NAC.Conclusion Swash-out of TIC curve before NAC cannot predict the response of NAC,Swash-out of TIC curve after the 2nd cycle of NAC and after the 4th cycle of NAC are efficient in predicting the response of NAC.|
石桥,王霄英,郭丽,等. MRI动态增强流出参数半定量分析对局部进展期乳腺癌新辅助化疗疗效评估的价值[J]. 中华放射学杂志,2013,47(8):699-703.