CAJ | 학술논문

目的：探讨乳腺癌的磁共振强化方式与新辅助化疗后退缩模式间的相关性，及其指导制定手术方案的临床意义。方法：55例局部进展期乳腺癌患者分别于新辅助化疗前及全程化疗后手术前，行乳腺磁共振动态增强扫描，观察化疗前肿瘤的磁共振强化方式和化疗后肿瘤退缩模式，分析两者之间的相关性。结果：55例患者中54例为单乳病变、1例为双乳病变，共56处病灶。肿块样强化为24处（43%），其中23处呈向心性退缩、1处呈环形退缩（P<0.01）；多灶肿块样强化为13处（23%），其中2处为单一肿块呈向心性退缩、11处退缩后仍呈多灶肿块（P<0.01）；肿块伴周边非肿块样强化为8处（14%），其中4处呈向心性退缩、4处呈蜂窝状多灶退缩（P>0.05）；非肿块样强化为11处（20%），其中4处呈向心性退缩、7处呈蜂窝状多灶退缩（P<0.01）。结论：新辅助化疗后肿瘤的退缩模式是保乳手术选择的关键因素之一，根据乳腺癌在新辅助化疗前的磁共振动态增强强化方式，可在一定程度上预测其在化疗后的退缩模式，进而预测患者保乳手术的可行性，为临床医生选择个体化的后续治疗方案提高患者生存质量提供参考。
목적：탐토유선암적자공진강화방식여신보조화료후퇴축모식간적상관성，급기지도제정수술방안적림상의의。방법：55례국부진전기유선암환자분별우신보조화료전급전정화료후수술전，행유선자공진동태증강소묘，관찰화료전종류적자공진강화방식화화료후종류퇴축모식，분석량자지간적상관성。결과：55례환자중54례위단유병변、1례위쌍유병변，공56처병조。종괴양강화위24처（43%），기중23처정향심성퇴축、1처정배형퇴축（P<0.01）；다조종괴양강화위13처（23%），기중2처위단일종괴정향심성퇴축、11처퇴축후잉정다조종괴（P<0.01）；종괴반주변비종괴양강화위8처（14%），기중4처정향심성퇴축、4처정봉와상다조퇴축（P>0.05）；비종괴양강화위11처（20%），기중4처정향심성퇴축、7처정봉와상다조퇴축（P<0.01）。결론：신보조화료후종류적퇴축모식시보유수술선택적관건인소지일，근거유선암재신보조화료전적자공진동태증강강화방식，가재일정정도상예측기재화료후적퇴축모식，진이예측환자보유수술적가행성，위림상의생선택개체화적후속치료방안제고환자생존질량제공삼고。
Objective:To investigate the correlation between the breast cancer MRI schedule of reinforcement and the shrinkage pattern of tumor after neo-adjuvant chemotherapy, and its clinical significance in the guidance of formulating operation plan. Methods:Dynamic contrast-enhanced MRI scan was performed before chemotherapy and before surgery after a whole-range N-Acety-L-Cysteine (NAC) treatment in 55 patients with loco-regionally advanced breast cancer who received the neo-adjuvant chemotherapy. MRI sched-ule of reinforcement and the shrinkage pattern of tumor after neo-adjuvant chemotherapy were obtained in the treatment, and the corre-lation between the two was analyzed. Results:Of the 55 patients, the unilateral breast mass was found in 54 and the bilateral lesion in 1. There were 56 neo-plastic foci in these patients. The mass-like enhanced image was seen in 24 of the total cases (43%), of which 23 presented with a centripetal shrinkage, 1 with an annular decline, (P<0.01). Multifocal mass-like enhancement image was found in 13 of the total cases, (23%), of which 2 centripetal shrinkages were the singular mass, 11 remained a multifocal lesion after the tumor shrinkage (P<0.01). The mass with peripheral non-tumor-like enhancement image was seen in 8 of the total cases (14%), of which 4 showed a centripetal shrinkage and another 4 a honeycombed multifocal decline (P>0.05). There were 11 of the total cases with non-tu-mor-like enhancement (20%), in which 4 assumed a centripetal shrinkage and 7 a honeycombed multifocal shrinkage (P<0.01). Conclu-sion:The tumor shrinking pattern and its accurate radiological image evaluation are the keys to the selection of breast-conserving sur-gery and the control of local recurrence after treatment of NAC regimen. We can predict the shrinking pattern through the type of the le-sion on baseline before NAC, which is important for the patients and surgeon to get a reasonable expectation in the subsequent treat-ments.