CAJ | 학술논문

目的探讨乳腺癌新辅助化疗早期肿瘤最大径变化率,以及肿瘤治疗前和术后组织病理学变化,评价化疗疗效的意义.方法 49例乳腺癌患者,新辅助化疗前和术后均具有完整的组织病理结果;新辅助化疗前和化疗第2周期后及术前行3次乳腺增强MR检查,分别于注入对比剂前和注药后连续采集8次(8个时相).注射对比剂后2 min的图像与蒙片减影后行MIP重组.在MIP图像上测量肿块的最大径线(△d),根据△d值将直径变化率分为6级.根据实体肿瘤的疗效评价标准(RECIST)设△d晚≥30%为金标准,通过ROC分析观察△d早在判断疗效时的敏感度和特异度.病理分级与RECIST标准间进行Spearman相关分析.结果新辅助化疗有效30例,无效19例.Ad早 10%时,评价疗效的敏感度为96.7%(29/30),特异度为84.2%(16/19);曲线下面积0.960.病理分级与RECIST标准间具有相关性(r=0.613,P=0.000).结论新辅助化疗早期通过直径评价疗效,将阈值设为10%,其敏感度和特异度均较高.病理评价疗效与RECIST径线评价疗效间具有一定相关性,但病理评价会导致高估疗效.
목적 탐토유선암신보조화료조기종류최대경변화솔,이급종류치료전화술후조직병이학변화,평개화료료효적의의.방법 49례유선암환자,신보조화료전화술후균구유완정적조직병리결과;신보조화료전화화료제2주기후급술전행3차유선증강MR검사,분별우주입대비제전화주약후련속채집8차(8개시상).주사대비제후2 min적도상여몽편감영후행MIP중조.재MIP도상상측량종괴적최대경선(△d),근거△d치장직경변화솔분위6급.근거실체종류적료효평개표준(RECIST)설△d만≥30%위금표준,통과ROC분석관찰△d조재판단료효시적민감도화특이도.병리분급여RECIST표준간진행Spearman상관분석.결과 신보조화료유효30례,무효19례.Ad조 10%시,평개료효적민감도위96.7%(29/30),특이도위84.2%(16/19);곡선하면적0.960.병리분급여RECIST표준간구유상관성(r=0.613,P=0.000).결론 신보조화료조기통과직경평개료효,장역치설위10%,기민감도화특이도균교고.병리평개료효여RECIST경선평개료효간구유일정상관성,단병리평개회도치고고료효.
Objective To assess the value of initial MRI measurements of breast tumor diameter and pathological responses for predicting response to neoadjuvant chemotherapy (NAC). Methods Fortynine patients who underwent neoadjuvant chemotherapy were included in this study. The longest diameter of each tumor was measured on MRI before and after two cycles of NAC and just before operation. Pathological responses were evaluated by Miller and Payne grading system criteria by comparing post-operation breast tissue with large core biopsy tissue. Changes of diameter after two cycles of NAC and before operation were compared and pathological responses were evaluated. ROC and spearman correlation analysis was used.Results The sensitivity and specificity of initial diameter for predicting response to NAC were 96. 7% (29/30) and 84.2% (16/19). There was a moderate correlation between pathological responses and diameter measured pre-operation ( r = 0. 613, P = 0. 000 ). Conclusion The initial diameter changes of breast tumor could predict response to neoadjuvant chemotherapy, pathological response have moderate correlation with changes of tumor diameter.