新辅助化疗后乳腺癌瘤床MRI表现与病理对比研究
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摘要
目的探讨MRI评价乳腺癌新辅助化疗后残余肿瘤收缩模式的能力。方法收集48例Ⅱ、Ⅲ期浸润性导管癌患者的MRI检查资料并与全乳腺大切片对比。48例患者均采用TE方案进行4个周期的新辅助化疗,并在新辅助化疗前后进行MRI检查。48例乳腺癌患者在化疗结束后均进行乳腺癌改良根治术,术后乳腺标本取一半制成全乳腺大切片,显微镜观察残余肿瘤瘤床表现。结果新辅助化疗后残余肿瘤表现为向心型收缩、树枝型收缩。48例新辅助化疗后的残余肿瘤在MRI上表现为向心型收缩的有39例,占81. 25%;表现为树枝型收缩的有9例,占18. 75%。全乳腺大切片显示为向心型收缩的有40例(83. 33%),树枝型收缩的有8例(16. 67%),MRI与全乳腺大切片评价残余肿瘤收缩模式的相关系数为0. 906(P=7. 37×10-8)。结论 MRI能正确评价残余肿瘤的收缩模式,能为临床手术方式的制定提供重要的依据。
Objective To evaluate the ability of residual tumor shrinkage pattern by MRI after neoadjuvant chemotherapy( NCT) for breast cancer. Methods MRI and whole subserial section( WSS) of 48 patients with clinical TNM stage Ⅱ and stage Ⅲ infiltrating duct carcinoma were compared. All of 48 patients achieved four courses of neoadjuvant chemotherapy with Taxol and Epirubicin( TE),and then examined by MRI. All of 48 patients received modified radical mastectomy after NCT,and the samples were subjected to perform WSS. Pathological changes of tumor bed and pericancerous tissues were examined with optical microscope. Results The shrinkage patterns were divided into two types,concentric shrinkage( CS) and dendritic shrinkage( DS). According to shrinkage pattern assessed by MRI,a total of 39( 81. 25%)patients showed CS after NCT,while,9( 18. 75%) patients showed DS. The WSS shrinkage pattern was CS in 40( 83. 33%) patients after NCT,and DS in 8( 16. 67%) patients. The correlation coefficient between the tumor shrinkage patterns assessed by MRI and that determined by pathological WSS after NCT was 0. 906( P = 7. 37 × 10-8). Conclusion MRI can correctly evaluate the shrinkage pattern of residual tumor and provide important basis for clinical operation.
Objective To evaluate the ability of residual tumor shrinkage pattern by MRI after neoadjuvant chemotherapy( NCT) for breast cancer. Methods MRI and whole subserial section( WSS) of 48 patients with clinical TNM stage Ⅱ and stage Ⅲ infiltrating duct carcinoma were compared. All of 48 patients achieved four courses of neoadjuvant chemotherapy with Taxol and Epirubicin( TE),and then examined by MRI. All of 48 patients received modified radical mastectomy after NCT,and the samples were subjected to perform WSS. Pathological changes of tumor bed and pericancerous tissues were examined with optical microscope. Results The shrinkage patterns were divided into two types,concentric shrinkage( CS) and dendritic shrinkage( DS). According to shrinkage pattern assessed by MRI,a total of 39( 81. 25%)patients showed CS after NCT,while,9( 18. 75%) patients showed DS. The WSS shrinkage pattern was CS in 40( 83. 33%) patients after NCT,and DS in 8( 16. 67%) patients. The correlation coefficient between the tumor shrinkage patterns assessed by MRI and that determined by pathological WSS after NCT was 0. 906( P = 7. 37 × 10-8). Conclusion MRI can correctly evaluate the shrinkage pattern of residual tumor and provide important basis for clinical operation.
引文
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[24]Bouzón A,Acea B,Soler R,et al.Diagnostic accuracy of MRI to evaluate tumour response and residual tumour size after neoadjuvant chemotherapy in breast cancer patients[J].Radio Oncol,2016,50(1):73-79.doi:10.1515/raon-2016-0007.
[2]Man VC,Cheung PS.Neoadjuvant chemotherapy increases rates of breast-conserving surgery in early operable breast cancer[J].Hong Kong Med J,2017,23(3):251-257.doi:10.12809/hkmj164972.
[3]Lagendijk M,van Maaren MC,Saadatmand S,et al.Breast conserving therapy and mastectomy revisited:Breast cancer-specific survival and the influence of prognostic factors in 129,692 patients[J].Int J Cancer,2018,142(1):165-175.doi:10.1002/ijc.31034.
[4]Baratte A,Mathelin C,Ruffenach L,et al.Oncoplastic breast surgery[J].Ann Chir Plast Esthet,2018,63(5-6):516-541.doi:10.1016/j.anplas.2018.05.002.
[5]Choi J,Laws A,Hu J,et al.Margins in breast-conserving surgery after neoadjuvant therapy[J].Ann Surg Oncol,2018,25(12):3541-3547.doi:10.1245/s10434-018-6702-4.
[6]Van Zee KJ,Subhedar P,Olcese C,et al.Relationship between margin width and recurrence of ductal carcinoma in situ:analysis of 2996 women treated with breast-conserving surgery for 30 years[J].Ann Surg,2015,262(4):623-631.doi:10.1097/SLA.0000000000001454.
[7]Chen AM,Meric-Bernstam F,Hunt KK,et al.Breast conservation after neoadjuvant chemotherapy[J].Cancer,2005,103(4):689-695.doi:10.1002/cncr.20815.
[8]Le-Petross HT,Lim B.Role of MR imaging in neoadjuvant therapy monitoring[J].Magn Reson Imaging Clin N Am,2018,26(2):207-220.doi:10.1016/j.mric.2017.12.011.
[9]Teshome M,Kuerer HM.Breast conserving surgery and locoregional control after neoadjuvant chemotherapy[J].Eur J Surg Oncol,2017,43(5):865-874.doi:10.1016/j.ejso.2017.02.002.
[10]Untch M,Konecny GE,Paepke S,et al.Current and future role of neoadjuvant therapy for breast cancer[J].Breast,2014,23(5):526-537.doi:10.1016/j.breast.2014.06.004.
[11]Mc Laughlin SA.Surgical management of the breast:breast conservation therapy and mastectomy[J].Surg Clin North Am,2013,93(2):411-428.doi:10.1016/j.suc.2012.12.006.
[12]Shin SU,Cho N,Lee HB,et al.Neoadjuvant chemotherapy and surgery for breast cancer:preoperative mri features associated with local recurrence[J].Radiology,2018,289(1):30-38.doi:10.1148/radiol.2018172888.
[13]Teshome M,Hunt KK.Neoadjuvant therapy in the treatment of breast cancer[J].Surg Oncol Clin N Am,2014,23(3):505-523.doi:10.1016/j.soc.2014.03.006.
[14]Valachis A,Mamounas EP,Mittendorf EA,et al.Risk factors for locoregional disease recurrence after breast-conserving therapy in patients with breast cancer treated with neoadjuvant chemotherapy:an international collaboration and individual patient meta-analysis[J].Cancer,2018,124(14):2923-2930.doi:10.1002/cncr.31518.
[15]Kim TH,Kang DK,Yim H,et al.Magnetic resonance imaging patterns of tumor regression after neoadjuvant chemotherapy in breast cancer patients:correlation with pathological response grading system based on tumor cellularity[J].J Comput Assist Tomogr,2012,36(2):200-206.doi:10.1097/RCT.0b013e318246abf3.
[16]Chen AM,Meric-Bernstam F,Hunt KK,et al.Breast conservation after neoadjuvant chemotherapy:the MD Anderson cancer center experience[J].J Clin Oncol,2004,22(12):2303-2312.doi:10.1200/JCO.2004.09.062.
[17]Marinovich ML,Houssami N,Macaskill P,et al.Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy[J].J Natl Cancer Inst,2013,105(5):321-333.doi:10.1093/jnci/djs528.
[18]Tomida K,Ishida M,Umeda T,et al.Magnetic resonance imaging shrinkage patterns following neoadjuvant chemotherapy for breast carcinomas with an emphasis on the radiopathological correlations[J].Mole Clin Oncol,2014,2(5):783-788.doi:10.3892/mco.2014.333.
[19]王姝姝,张毅,齐晓伟,等.乳腺癌新辅助化疗后残留灶分型与ER、PR、HER-2的关系[J].第三军医大学学报,2010,32(21):2336-2339.doi:10.16016/j.1000-5404.2010.21.019.
[20]Bouzon A,Acea B,Soler R,et al.Diagnostic accuracy of MRI to evaluate tumour response and residual tumour size after neoadjuvant chemotherapy in breast cancer patients[J].Radiol Oncol,2016,50(1):73-79.doi:10.1515/raon-2016-0007.
[21]Chu W,Jin W,Liu D,et al.Diffusion-weighted imaging in identifying breast cancer pathological response to neoadjuvant chemotherapy:a meta-analysis[J].Oncotarget,2017,9(6):7088-7100.doi:10.18632/oncotarget.23195.
[22]Marinovich ML,Macaskill P,Irwig L,et al.Agreement between MRIand pathologic breast tumor size after neoadjuvant chemotherapy,and comparison with alternative tests:individual patient data meta-analysis[J].BMC Cancer,2015,15:662-674.doi:10.1186/s12885-015-1664-4.
[23]Haraldsdottir KH,Jonsson P,Halldorsdottir AB,et al.Tumor size of invasive breast cancer on magnetic resonance imaging and conventional imaging(mammogram/ultrasound):comparison with pathological size and clinical implications[J].Scand J Sur,2017,106(1):68-73.doi:10.1177/1457496916631855.
[24]Bouzón A,Acea B,Soler R,et al.Diagnostic accuracy of MRI to evaluate tumour response and residual tumour size after neoadjuvant chemotherapy in breast cancer patients[J].Radio Oncol,2016,50(1):73-79.doi:10.1515/raon-2016-0007.