【摘要】 目的评价乳腺癌新辅助化疗后肿瘤不同退缩模式的临床、病理及影像特征,分析不同退缩模式的影响因素。方法选取我院经组织学确诊为单侧乳腺癌患者54例,均于NAC前及NAC后手术前2周内行乳腺动态增强MRI,且NAC前均行乳腺X线摄影检查。记录患者临床、病理资料及影像学相关指标。运用Kappa检验评价2名医师对退缩模式分型评价一致性。采用2检验比较NAC后不同肿瘤退缩模式患者的临床、病理及影像学指标的差异性,然后采用2检验比较不同分子亚型乳腺癌临床及影像的差异性。采用Binary logistic回归分析肿瘤退缩模式的独立预测因素。并采用四格表的方法评价MRI评估NAC后肿瘤达p CR的诊断效能。结果 NAC后经手术病理证实,p CR组19例,N-pCR组35例。NAC后肿瘤向心性退缩30例,非向心性退缩24例,两组间的年龄、是否淋巴结转移、肿瘤大小、BPE、疗效、ER、PR、HER-2、Ki-67表达情况的差异均无统计学意义(P均> 0.05),而绝经状态、分子分型、钙化情况及MRI强化方式在两组间的差异有统计学意义(P均<0.05)。非绝经状态以向心性退缩为主77%(23/30);在向心性退缩模式的肿瘤中以Luminal B型及三阴性乳腺癌比例较高均占43%(13/30);而非向心退缩模式中肿块钙化比例较高约占79%(19/24); 2名医师对化疗后肿瘤退缩模式定性评估的Kappa值为0.694,一致性为较好。不同分子亚型间患者的年龄、月经状态、淋巴结情况、肿瘤MRI强化方式、疗效差异均无统计学意义(P均> 0.05),而病灶含钙化情况的差异有统计学意义(P <0.05)。Logistic多因素回归模型显示,月经状态、分子分型及肿瘤MRI强化方式不是影响肿瘤退缩模式的独立因素,而病灶中含钙化情况是肿瘤退缩模式的独立预测因素(OR=2.3,P=0.018)。MRI评价乳腺NAC后p CR的准确性72.2%,灵敏度26.3%,特异度97.1%。结论非绝经状态、肿块样强化、Luminal B型及三阴性乳腺癌更加容易表现为向心性退缩模式,肿瘤钙化则更加容易表现为非向心退缩,钙化可以作为NAC后退缩模式的独立预测因素。MRI对NAC后残余肿瘤评估准确性较高,但也会对残余肿瘤造成一定高估及低估。更多还原

【Abstract】 Objective To evaluate the clinical,pathological and imaging characteristics of different shrinkage patterns of breast turmor after neoadjuvant chemotherapy( NAC),and to analyze the influencing factors of different regression modes. Methods 54 patients with histologically confirmed unilateral breast cancer from May 2016 to August 2019 are collected. All patients are examined with dynamic enhancement magnetic resonance imaging( MRI) before NAC and after NAC,performed mammography before NAC,undergo surgery within two weeks after NAC. The clinical,pathological data and imaging indicators of the patients are recorded. The kappa test is used to test the inter-observer agreement of the tumor shrinkage pattern. The 2 test is used to compare the clinical,pathological and imaging characteristics of tumor regression pattern after NAC. The 2 test is used to compare the clinical and pathological data of different subtypes of breast cancer. Associations are evaluated using Binary logistic regression models. Four grids are used to evaluate the diagnostic efficacy of p CR after NAC by MRI. Results 19 patients achieve p CR,and 35 patients have residual disease( non-pCR). A total of 30 lesions show concentric pattern,and 24 non-concentric.And age,lymph node metastasis,tumor size,background parenchymal enhancement( BPE) before NAC,efficacy,ER,PR,HER-2,Ki-67 status show no significance between the shrinkage modes( all P > 0. 05),the difference of menstrual status,molecular subtypes,calcification in the lesions and MRI enhancement of the tumors are statistically significant( all P < 0. 05). Nonmenopausal status is 77%( 23/30) with concentric pattern; Luminal B and triple-negative breast cancer are higher in tumors with concentric shrinkage,accounting for 43%( 13/30),respectively; The proportion of calcification in the non-concentric retraction mode is about 79%( 19/24). Inter-observer agreement regarding shrinkage pattern is great after NAC( Kappa value 0. 694).There are no significant differences in age,menstrual status,lymph node status,tumor MRI enhancement and efficacy between different molecular subtypes( all P > 0. 05),and while only calcification in the lesions shows a significant difference( P <0. 05). Logistic multivariate regression model shows that menopausal status,molecular typing and MRI enhancement of tumors are not independent factors affecting tumor regression pattern,while calcification in the lesions could serve as an additional imaging biomarker of tumour shrinkage pattern after NAC( OR = 2. 3,P = 0. 018). The accuracy of p CR after breast cancer NAC is72. 2%,sensitivity is 26. 3%,and specificity is 97. 1%. Conclusion Non-menopausal status,mass enhancement,Luminal B type and triple-negative breast cancer are more likely to manifest as concentric shrinkage,tumor calcification is more likely to be non-concentric shrinkage,the status of calcification in the lesions can serve as an additional imaging biomarker of tumor shrinkage pattern after NAC. MRI has a higher accuracy in the evaluation of residual tumors after NAC,but it also causes some overestimation and underestimation of residual tumors.更多还原