中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2010年
5期
465-469
,共5页
武春雪%王霄英%秦乃姗%蒋学祥
武春雪%王霄英%秦迺姍%蔣學祥
무춘설%왕소영%진내산%장학상
乳腺肿瘤%磁共振成像%药物疗法,联合
乳腺腫瘤%磁共振成像%藥物療法,聯閤
유선종류%자공진성상%약물요법,연합
Breast neoplasms%Magnetic resonance imaging%Drug therapy,combination
目的 评价局部进展期乳腺癌患者在术前新辅助化疗(NAC)前后癌灶MRI时间-信号强度曲线(TIC)类型、曲线最大线性斜率及其变化率对NAC病理反应性的评估效能.方法 回顾性分析36例局部进展期乳腺癌患者NAC前后3次MR检查中TIC类型及曲线最大线性斜率的变化,根据术后病理反应性结果分为组织学显著反应(MHR,16例)与组织学非显著反应(NMHR,20例)2组,采用非参数Mann-Whitney U检验比较2组NAC前、NAC第2周期后和第4周期后3种TIC类型的组成,以及曲线最大线性斜率及变化率的差异.利用ROC曲线分析判断TIC类型、曲线最大线性斜率及变化率对NAC病理反应性的评估价值.结果 NAC第2周期后,最大线性斜率及第1次变化率MHR组[(1.93±0.88)%/s、35.6%]与NMHR组[(2.73±1.22)%/s、-11.4%]差异有统计学意义(t=1.09,Z=-3.64,P=0.045、0.01);NAC第4周期后,MHR组Ⅰ型曲线比例(62.5%,10例)明显高于NMHR组(10.0%,2例;Z=-2.02,P=0.01),Ⅲ型曲线比例(6.2%,1例)明显低于NMHR组(60.0%,12例;Z=-1.48,P=0.01),最大线性斜率[MHR组(1.33±0.52)%/s,NMHR组(2.33±0.94)%/s]及第2次变化率(MHR组56.8%、NMHR组15.8%)差异也有统计学意义(t=1.82,Z=-3.58,P=0.002、＜0.01).以NAC第2周期后癌灶最大线性斜率及第1次变化率为评估参数,病理反应性为金标准,ROC曲线下面积分别为0.70(P=0.040)和0.80(P=0.001);NAC第4周期后癌灶Ⅰ型曲线、Ⅰ+Ⅱ型曲线、最大线性斜率及第2次变化率ROC曲线下面积分别为0.78(P=0.03)、0.69(P=0.06)、0.82(P=0.01)、0.92(P=0.01).结论 NAC第2周期后癌灶最大线性斜率及第1次变化率可评估NAC病理反应性,评估效能中等;NAC第4周期后癌灶Ⅰ型曲线、最大线性斜率及第2次变化率可评估NAC病理反应性,评估效能较高.
目的 評價跼部進展期乳腺癌患者在術前新輔助化療(NAC)前後癌竈MRI時間-信號彊度麯線(TIC)類型、麯線最大線性斜率及其變化率對NAC病理反應性的評估效能.方法 迴顧性分析36例跼部進展期乳腺癌患者NAC前後3次MR檢查中TIC類型及麯線最大線性斜率的變化,根據術後病理反應性結果分為組織學顯著反應(MHR,16例)與組織學非顯著反應(NMHR,20例)2組,採用非參數Mann-Whitney U檢驗比較2組NAC前、NAC第2週期後和第4週期後3種TIC類型的組成,以及麯線最大線性斜率及變化率的差異.利用ROC麯線分析判斷TIC類型、麯線最大線性斜率及變化率對NAC病理反應性的評估價值.結果 NAC第2週期後,最大線性斜率及第1次變化率MHR組[(1.93±0.88)%/s、35.6%]與NMHR組[(2.73±1.22)%/s、-11.4%]差異有統計學意義(t=1.09,Z=-3.64,P=0.045、0.01);NAC第4週期後,MHR組Ⅰ型麯線比例(62.5%,10例)明顯高于NMHR組(10.0%,2例;Z=-2.02,P=0.01),Ⅲ型麯線比例(6.2%,1例)明顯低于NMHR組(60.0%,12例;Z=-1.48,P=0.01),最大線性斜率[MHR組(1.33±0.52)%/s,NMHR組(2.33±0.94)%/s]及第2次變化率(MHR組56.8%、NMHR組15.8%)差異也有統計學意義(t=1.82,Z=-3.58,P=0.002、＜0.01).以NAC第2週期後癌竈最大線性斜率及第1次變化率為評估參數,病理反應性為金標準,ROC麯線下麵積分彆為0.70(P=0.040)和0.80(P=0.001);NAC第4週期後癌竈Ⅰ型麯線、Ⅰ+Ⅱ型麯線、最大線性斜率及第2次變化率ROC麯線下麵積分彆為0.78(P=0.03)、0.69(P=0.06)、0.82(P=0.01)、0.92(P=0.01).結論 NAC第2週期後癌竈最大線性斜率及第1次變化率可評估NAC病理反應性,評估效能中等;NAC第4週期後癌竈Ⅰ型麯線、最大線性斜率及第2次變化率可評估NAC病理反應性,評估效能較高.
목적 평개국부진전기유선암환자재술전신보조화료(NAC)전후암조MRI시간-신호강도곡선(TIC)류형、곡선최대선성사솔급기변화솔대NAC병리반응성적평고효능.방법 회고성분석36례국부진전기유선암환자NAC전후3차MR검사중TIC류형급곡선최대선성사솔적변화,근거술후병리반응성결과분위조직학현저반응(MHR,16례)여조직학비현저반응(NMHR,20례)2조,채용비삼수Mann-Whitney U검험비교2조NAC전、NAC제2주기후화제4주기후3충TIC류형적조성,이급곡선최대선성사솔급변화솔적차이.이용ROC곡선분석판단TIC류형、곡선최대선성사솔급변화솔대NAC병리반응성적평고개치.결과 NAC제2주기후,최대선성사솔급제1차변화솔MHR조[(1.93±0.88)%/s、35.6%]여NMHR조[(2.73±1.22)%/s、-11.4%]차이유통계학의의(t=1.09,Z=-3.64,P=0.045、0.01);NAC제4주기후,MHR조Ⅰ형곡선비례(62.5%,10례)명현고우NMHR조(10.0%,2례;Z=-2.02,P=0.01),Ⅲ형곡선비례(6.2%,1례)명현저우NMHR조(60.0%,12례;Z=-1.48,P=0.01),최대선성사솔[MHR조(1.33±0.52)%/s,NMHR조(2.33±0.94)%/s]급제2차변화솔(MHR조56.8%、NMHR조15.8%)차이야유통계학의의(t=1.82,Z=-3.58,P=0.002、＜0.01).이NAC제2주기후암조최대선성사솔급제1차변화솔위평고삼수,병리반응성위금표준,ROC곡선하면적분별위0.70(P=0.040)화0.80(P=0.001);NAC제4주기후암조Ⅰ형곡선、Ⅰ+Ⅱ형곡선、최대선성사솔급제2차변화솔ROC곡선하면적분별위0.78(P=0.03)、0.69(P=0.06)、0.82(P=0.01)、0.92(P=0.01).결론 NAC제2주기후암조최대선성사솔급제1차변화솔가평고NAC병리반응성,평고효능중등;NAC제4주기후암조Ⅰ형곡선、최대선성사솔급제2차변화솔가평고NAC병리반응성,평고효능교고.
Objective To investigate the clinical value of the type and the steepest slope of tumor's time-intensity curve (TIC) in assessing the pathologic response of locally advanced breast cancer treated with neoadjuvant chemotherapy (NAC). Methods Thirty-six patients with pathologically confirmed locally advanced breast cancer who finished four courses of neoadjuvant chemotherapy underwent preoperative breast MRI three times during the NAC. Pathologic response was assessed according Miller-Payne grading system, grade 4 and 5 were defined as major histological response ( MHR, n = 16) group, and grade 1 to 3 as nonmajor histological response( NMHR,n = 20)group. The type and the steepest slope of tumor's TIC were compared between two groups before NAC, after the second cycle and after the fourth cycle of NAC. ROC analysis was carried out to assess the clinical value of the TIC parameters. Results After the second cycle of NAC, the steepest slope of TIC and its first change rate were different between the MHR group [ ( 1.93 ±0.88) %/s, median 35.6%] and NMHR group [(2.73 ± 1.22) %/s, median - 11.4%] (P =0.045 and 0. 01,t=1. 09,Z= -3.64). After the fourth cycle, the proportion of type Ⅰ in MHR group (62.5% ,10/16) was significantly higher than that in NMHR group (10.0%, 2/20, P = 0.01, Z=-2. 02), and the proportion of type Ⅲ in MHR group (6. 2% ,1/16)was significantly lower than that in NMHR group (60. 0% ,12/20,P =0. 01 ,Z = -1.48). The steepest slope and its second change rate were different between the MHR group [ ( 1.33 ± 0. 52) %/s, median 56. 8% ] and NMHR group [ (2. 33 ±0. 94) %/s, median 15. 8% ] ( P ＜ 0. 01, t = 1.82, Z = - 3. 58 ). After the second cycle, the area under curve of the steepest slope of TIC and its first change rate were 0. 70 ( P = 0. 04 ), 0. 80 ( P = 0. 01 ),respectively. After the fourth cycle, the area under curve of the type Ⅰ, the type Ⅰ + Ⅱ, the steepest slope and its second change were 0. 78 ( P = 0. 03 ), 0. 69 ( P = 0. 06), 0. 82 ( P = 0. 01 ), 0. 92 ( P = 0. 01 ),respectively. Conclusion The steepest slope of TIC and its first change rate could assess the NAC response after the second cycle, and the type Ⅰ, the steepest slope and its second change could assess the NAC response after the fourth cycle.
