CAJ | 학술논문

目的研究乳腺癌患者新辅助化疗前、后各周期ADC值及其变化率(△ADC%),探讨两种参数对新辅助化疗病理反应性评估的价值.方法 35例穿刺活检证实为乳腺癌的患者分别于新辅助化疗前、化疗第2和第3周期之间、化疗第4周期后行MR DWI及增强扫描,根据其术后病理对化疗反应的分级将其分为组织学反应显著(MHR)与非显著(NMHR)2组,利用重复测量的单因素方差分析及t检验分析2组患者癌灶区与对应正常腺体的ADC值,采用秩和检验分析3次ADC值及△ADC%,并应用ROC分析其对病理反应性评估的效能.结果 MHR组的乳腺癌灶手术前ADC值[中位数(范围)]为1.54×10~(-3)mm~2/s[(1.01～1.88)× 10~(-3)mm~2/s],△ ADC%为42.70%(6.31%～67.86%);在化疗第4周期后明显高于NMHR组的1.22 × 10~(-3)mm~2/s[(0.83～1.83)×10~(-3)mm~2/s]和14.88%(-28.87%～39.69%),差异有统计学意义(Z值分别为-2.77、-4.10,P值均＜0.05),而化疗早期MHR组ADC值为1.15×10~(-3)mm~2/s[(0.85～1.62)× 10~(-3)mm~2/s],△ADC%值为12.00%(-12.96%～30.65%);NMHR组ADC值为1.15×10~(-3)mm~2/s[(0.94～1.60)×10~(-3)mm~2/s],△ ADC%值为10.74%(-20.80%～41.81%);2组差异无统计学意义(P＞0.05).分别以病灶ADC及△ADC%为评估值,对MHR和NMHR组进行ROC分析,其中只有△ ADC3%的评估效能较高(Az△ADC3%=0.88).结论化疗晚期△ADC%可以较准确预测乳腺癌对新辅助化疗的最终病理反应性.
목적 연구유선암환자신보조화료전、후각주기ADC치급기변화솔(△ADC%),탐토량충삼수대신보조화료병리반응성평고적개치.방법 35례천자활검증실위유선암적환자분별우신보조화료전、화료제2화제3주기지간、화료제4주기후행MR DWI급증강소묘,근거기술후병리대화료반응적분급장기분위조직학반응현저(MHR)여비현저(NMHR)2조,이용중복측량적단인소방차분석급t검험분석2조환자암조구여대응정상선체적ADC치,채용질화검험분석3차ADC치급△ADC%,병응용ROC분석기대병리반응성평고적효능.결과 MHR조적유선암조수술전ADC치[중위수(범위)]위1.54×10~(-3)mm~2/s[(1.01～1.88)× 10~(-3)mm~2/s],△ ADC%위42.70%(6.31%～67.86%);재화료제4주기후명현고우NMHR조적1.22 × 10~(-3)mm~2/s[(0.83～1.83)×10~(-3)mm~2/s]화14.88%(-28.87%～39.69%),차이유통계학의의(Z치분별위-2.77、-4.10,P치균＜0.05),이화료조기MHR조ADC치위1.15×10~(-3)mm~2/s[(0.85～1.62)× 10~(-3)mm~2/s],△ADC%치위12.00%(-12.96%～30.65%);NMHR조ADC치위1.15×10~(-3)mm~2/s[(0.94～1.60)×10~(-3)mm~2/s],△ ADC%치위10.74%(-20.80%～41.81%);2조차이무통계학의의(P＞0.05).분별이병조ADC급△ADC%위평고치,대MHR화NMHR조진행ROC분석,기중지유△ ADC3%적평고효능교고(Az△ADC3%=0.88).결론 화료만기△ADC%가이교준학예측유선암대신보조화료적최종병리반응성.
Objective To characterize the value of ADC and their changes (⊿ADC%) before and during the neoadjuvant chemotherapy,and their value in predicting the pathologic response of breast cancer to neoadjuvant chemotherapy. Methods Diffusion weighted imaging and dynamic contrast enhanced magnetic resonance examinations were performed in 35 women with breast cancer before treatment and after the second and the forth cycle of neoadjuvant chemotherapy.All patients were divided into MHR (major histological response) group and NMHR (non-major histological response) group according to the final pathologic response.One-way ANOVA and t test were used to compare the differences of cancer tissue and normal tissue.Rank sum test was used to compare the difference of ADC and ⊿ADC% between two groups.ROC analysis of ADC values and ⊿ADC% were used to identify which parameter could be used to predict the pathologic response to neoadjuvant chemotherapy.Results After the forth cycle,the ADC value and ⊿ADC% in MHR group [1.54×10~(-3) mm~2/s (1.01-1.88)×10~(-3) mm~2/s and 42.70% (6.31%-67.86%)]were significant higher than those in NMHR group [1.22×10~(-3) mm~2/s (0.83-1.83)×10~(-3) mm~2/s,14.88%(-28.87%-39.69%,P<0.05)].However,the ADC value and ⊿ADC% in the two groups were not different before treatment and after second cycle treatment:1.15×10~(-3) mm~2/s(0.85-1.62)×10~(-3) mm~2/s and 12.00%(-12.96%-30.65%)in MHR;1.15×10~(-3) mm~2/s(0.94-1.60)×10~(-3) mm~2/s and 10.74%(-20.80%-41. 81%,P<0.05)in NMHR.Only the ⊿ADC_3% showed high efficacy in predicting the pathologic response(area under ROC curve was 0.88).Conclusion The rate of ADC change in late cycle could be used to predict the pathologic reaponse of breast cancer to neoadjuvant chemotherapy.