【摘要】 目的:探究磁共振动态增强扫描成像（DCE-MRI）联合血清癌胚抗原（CEA）、糖类抗原125（CA125）评估进展期乳腺癌（ABC）新辅助化疗（NAC）疗效的价值。方法:选取2016年2月至2019年12月本院收治的73例ABC患者进行研究,分别行4周期NAC,化疗前后均进行DCE-MRI检查,并计算容量转移常数(K^trans)、速率常数(K_ep)及血管外细胞外间隙容积比（V_e）。按照ABC患者NAC后病理疗效检查结果,将患者分为缓解组和未缓解组。以化学发光微粒子免疫分析法检测两组患者CEA、CA125水平,以受试者工作特征（ROC）曲线评估血清CEA、CA125对ABC患者NAC疗效的价值。以病理疗效检查结果为金标准,以DCE-MRI、血清CEA、CA125及三者联合评价ABC患者NAC的价值。结果:病理学评价NAC疗效:病理缓解共59例,占80.82%;未缓解共14例,占19.18%。DCE-MRI评估NAC疗效的灵敏度、特异度、准确度分别为89.83%、92.86%、90.41%。两组患者化疗前K^trans、K_ep、V_e比较差异无统计学意义（P>0.05）,化疗后病理学缓解组K^trans、K_ep较病理学未缓解组低（P<0.05）。病理学未缓解组CEA、CA125水平明显高于病理学缓解组（P<0.05）,二者诊断NAC疗效的截断值分别为5.49μg/L、25.82 U/mL,灵敏度分别为79.66%、 83.05%,特异度分别为78.57%、78.57%,准确度分别为79.46%、82.19%;DCE-MRI联合血清CEA、CA125诊断NAC疗效的灵敏度、准确度分别为98.31%、95.89%,高于单独检测。结论:DCE-MRI联合血清CEA、CA125对NAC疗效具有较高诊断效能,可一定程度提高灵敏度、准确度,具有较高特异度。更多还原

【Abstract】 Objective:To explore the value of dynamic contrast-enhanced magnetic resonance imaging（DCE-MRI）combined with serum carcinoembryonic antigen（CEA）and carbohydrate antigen 125（CA125）in evaluating the therapeutic effect of neoadjuvant chemotherapy（NAC）for advanced breast cancer（ABC）.Methods:A total of 73 ABC patients in our hospital from February 2016 to December 2019 were selected for study, and NAC was performed in 4 cycles respectively.DCE-MRI was performed before and after chemotherapy, and the volume transfer constant(K^trans),rate constant(K_ep),extravascular extracellular volume fraction（V_e）.According to the pathological results of ABC patients after NAC,the patients were divided into remission group and non remission group.The levels of CEA and CA125 were measured by chemiluminescent particle immunoassay, and the effects of serum CEA and CA125 on NAC in ABC patients were evaluated by receiver operating characteristic（ROC）curve.The results of pathological examination were taken as the gold standard, and the values of DCE-MRI,serum CEA,CA125 and their combination in the evaluating the efficacy of NAC for ABC patients were evaluated.Results:The curative effect of NAC was evaluated by pathology.There were 59 cases of pathological remission, accounted for 80.82%.There were 14 cases were no remission, accounted for 19.18%.The sensitivity, specificity and accuracy of DCE-MRI in the evaluation of the efficacy of NAC were 89.83%,92.86% and 90.41% respectively.There was no significant difference in K^trans,K_ep and V_e between the two groups before chemotherapy（P>0.05）,K^trans and K_ep in the group with pathological remission after chemotherapy were lower than those in the group without pathological remission（P<0.05）.The levels of CEA and CA125 in the pathological non-remission group were significantly higher than those in the pathological remission group（P<0.05）.The cutoff value of the them in the diagnosis of the efficacy of NAC was 5.49 μg/L and 25.82 U/mL respectively.The sensitivity was 79.66% and 83.05% respectively, the specificity was 78.57% and 78.57% respectively, and the accuracy was 79.46% and 82.19% respectively.The sensitivity and accuracy of DCE-MRI combined with serum CEA and CA125 in the diagnosis of NAC were 98.31% and 95.89% respectively, which were higher than those of single detection. Conclusion: DCE-MRI combined with serum CEA and CA125 has a high diagnostic effect on NAC,which can improve the sensitivity and accuracy to a certain extent,and with higher specificity.更多还原