扩散加权成像预测不同分子亚型乳腺癌新辅助化疗疗效的研究

摘要

目的 探讨 MRDWI参数ADC值及相对ADC(rADC)值在新辅助化疗(NAC)早期预测及评估不同分子亚型乳腺癌的最终病理反应的价值.方法 回顾性分析116例患者的2次DWI检查结果(NAC前、NAC2周期后1周内),测量并记录病灶最小ADC值、rADC值并分别计算其在2周期的变化率(ADC%、rADC%).根据术前免疫组化结果记录分子分型;按照术后Miller&Payne病理学诊断结果分为组织学显著反应组(MHR)及组织学非显著反应组(NMHR).结果 ADC值在NAC前对各亚型均无预测效能;2个周期NAC后,除LuminalA型外,ADC值及ADC%对其余各亚型有预测最终病理反应的效能,以ADC%对三阴性诊断效能最高.NAC前的rADC值对LuminlB型和HER-2过表达型有预测效能;2个周期NAC后,rADC值仅在HER-2过表达型、三阴性的不同病理反应组间有差异,且诊断效能有限;rADC%仅对三阴性型有预测效能.结论 NAC前的ADC值对各亚型最终病理反应均无预测效能;NAC前rADC值、NAC治疗2周期后DWI各参数及其变化率对相应的部分不同亚型乳腺癌最终病理反应具有一定的评估价值.%Objective ToinvestigatethevalueoftheADCandtherelativeADC(rADC)ofDWIparameterstopredictthefinal pathologicalresponseintheearlystageofneoadjuvantchemotherapy(NAC)fordifferentmolecularsubtypesofbreastcancer.Methods TheresultsoftwoDWI(beforeNACandwithinoneweekaftersecondcycleofNAC)in116patientsenrolledinthestudywere retrospectivelyanalyzed.Theminimum ADCandrADCofthelesionsweremeasuredandrecorded,andtheirratesofchangeaftersecond cycle(ADC%、rADC%)werecalculated.Molecularsubtypeswererecordedaccordingtotheresultsofpreoperativeimmunohistochemistry, andpatientsweredividedintomajorhistologicalresponse(MHR)groupandnon-majorhistologicalresponse(NMHR)groupaccording topostoperativepathologicalgradingcriteriaofMiller&Payne.Results TherewasnocorrelationbetweentheADCbeforeNACand thefinalpathologicalresponseofeachsubtype.AftersecondcycleofNAC,exceptforLuminalA,ADCandADC%hadtheabilityof predictingfinalpathologicalresponsesfortheremainingsubtypes,especiallyinthehighestefficacyofADC%forthetriple-negative. BeforeNAC,rADChadpredictiveefficacyforLuminlBandHER2-enrichedsubtypes;aftersecondcycleofNAC,therADCdiffered onlybetweenthedifferentpathologicalresponsegroupsofHER2-enrichedandthetriple-negative,andthediagnosticefficacy was limited.TherADC%hadpredictiveefficacyonlyinthetriple-negativegroup.Conclusion ADChasnopredictiveefficacyforeach subtypebeforeNAC;WhiletherADCbeforeNAC,everyDWIparametersafter2ndcycleofNAC,andtheirchangeshavecertainvalues toevaluatethefinalpathologicalresponseofthecorrespondingpartialsubtypesofbreastcancer.