| 朱超,刘春玲,黎娇,李品雄,叶慧芬,陈明蕾,刘再毅,梁长虹.乳腺X射线摄影及MRI评估伴微钙化乳腺癌新辅助治疗后残余病灶[J].中国医学影像技术,2021,37(12):1839~1843 |
| 乳腺X射线摄影及MRI评估伴微钙化乳腺癌新辅助治疗后残余病灶 |
| Mammography and MRI in evaluation residual lesion of breast neoplasms with microcalcifications after neoadjuvant therapy |
| 投稿时间：2021-04-09 修订日期：2021-08-08 |
| DOI：10.13929/j.issn.1003-3289.2021.12.019 |
| 中文关键词: 乳腺肿瘤 乳腺X射线摄影 磁共振成像 新辅助治疗 |
| 英文关键词:breast neoplasms mammography magnetic resonance imaging neoadjuvant therapy |
| 基金项目:国家自然科学基金（82071892）。 |
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| 中文摘要: |
| 目的 观察乳腺X射线摄影（MG）及MRI评估伴微钙化乳腺癌新辅助治疗（NAT）后残余病灶的效能。方法 回顾性分析145例经手术病理证实伴微钙化的乳腺癌患者，均接受NAT及NAT前、后MG及乳腺MR检查，测量X线片中钙化最大径及增强MRI所示病灶强化最大径，评估NAT后X线片所示钙化范围变化，并记录病理所见残余肿瘤大小及完全缓解（pCR）等。观察NAT后X线片所见残余钙化范围最大径及增强MRI残余肿瘤强化灶大小与病理残余肿瘤大小的相关性，分析X线片钙化范围变化与pCR的相关性。以病理结果为标准，计算MRI评估残余肿瘤pCR的敏感度、特异度、假阳性率及假阴性率。结果 145例中，144例浸润性癌，1例导管原位癌；NAT后67例达pCR。NAT后X线片所示钙化范围最大径与病理残余肿瘤大小无明显相关（P=0.49），增强MRI残余肿瘤强化灶大小与病理残余肿瘤大小呈中等相关（r=0.69，P<0.01）。NAT后钙化范围52例不变、65例缩小、28例增加，其间pCR差异无统计学意义（χ2=1.79，P=0.44）。MRI评估残余肿瘤pCR的敏感度为93.59%（73/78），特异度为62.69%（42/67），假阳性率37.31%（25/67），假阴性6.41%（5/78）。结论 NAT后X线片所示乳腺癌残余钙化最大径与病理残余肿瘤大小之间无明显相关；MRI残余病灶大小与病理残余肿瘤大小呈中度相关，且以之评估残余肿瘤达pCR与否的效能较佳。 |
| 英文摘要: |
| Objective To observe the efficacy of mammography (MG) and MRI in assessing the residual size of breast cancer with microcalcifications after neoadjuvant therapy (NAT). Methods Data of 145 patients with microcalcified breast cancer confirmed by operation and pathology were retrospectively analyzed. All patients underwent NAT and MG and MR examinations before and after NAT. The maximum diameter of microcalcifications on X-ray films and the maximum diameter of lesion enhancement on enhanced MRI were measured, and the changes of microcalcifications range were evaluated. The pathological tumor size and tumor pathological complete response (pCR) were recorded. The correlations of the maximum diameter of the residual microcalcifications on X-ray films and lesion enhancement on enhanced MRI after NAT with pathological residual tumor size were observed. The correlations of the changes of residual calcification range on X-ray films and pCR were analyzed. Based on pathological results, the sensitivity, specificity, false positive rate and false negative rate of MRI for diagnosing residual tumor pCR were calculated. Results Among 145 patients, 144 were found with invasive carcinoma, and the rest 1 with ductal carcinoma in situ, and 67 achieved pCR after NAT. There was no significant correlation between the maximum diameter of residual microcalcifications and pathological tumor size (P=0.49), while the maximum diameter of lesion enhancement on enhanced MRI was moderately correlated with pathological tumor size (r=0.69, P<0.01).Among 145 patients, 52 were detected with unchanged microcalcifications, 65 with decreased and 28 with increased microcalcifications. No significant difference of pCR was found among different changes of residual calcification ranges (χ2=1.79, P=0.44). The sensitivity, specificity, false positive rate and false negative rate of MRI for diagnosing residual tumor pCR was 93.59% (73/78), 62.69% (42/67), 37.31% (25/67) and 6.41% (5/78), respectively. Conclusion There was no significant correlation between the maximum diameter of residual microcalcifications on X-ray films after NAT and pathological tumor size. The size of residual lesions measured on MRI was moderately correlated with the size of pathological residual tumors, which had good performance of evaluating residual tumors pathological response. |
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