钼靶乳腺摄像在乳腺癌新辅助化疗疗效评价中的应用

目的X观察线钼靶乳腺摄像在乳腺癌新辅助化疗疗效评价中的作用。方法对比分析31例乳腺癌新辅助化疗前后钼靶乳腺摄像病灶各主要征象的变化,比较化疗前后乳腺肿块大小、形状、钙化、病灶周围等变化,并对其疗效进行判定。结果化疗后有31个病灶（占病灶总数81．60%）出现明显的变化,表现为肿块缩小、边界清晰、周围毛刺减少或消失、钙化减少或聚集;3个模糊形肿块、2个毛刺形肿块及2个钙化肿块未发生改变。结论钼靶摄像可清晰显示乳腺癌病灶及其化疗后变化,对乳腺癌新辅助化疗疗效评价具有一定的临床价值。     

DCE-MRI联合MSCT在进展期乳腺癌新辅助化疗疗效评价中的价值

目的探讨DCE-MRI联合MSCT在晚期乳腺癌新辅助化疗疗效评估中的价值。方法回顾性分析2004年1月~2013年12月本院45例经穿刺活检确诊的进展期乳腺癌患者,分别行2~4周期新辅助化疗,化疗前后均进行DCE-MRI及MSCT检查,对比化疗前后肿块最长直径、强化模式、腋窝淋巴结数目及大小等,并与术后病理学结果对照。结果 DCE-MRI评估完全缓解(CR)者3例,部分缓解(PR)者30例,稳定(SD)者8例,进展(PD)者4例;MSCT评价CR者2例,PR者28例,SD者11例,PD者4例;DCE-MRI、MSCT评价乳腺癌化疗后临床缓解率分别为73.3%、67.7%;化疗后病理缓解率为82.2%。结论 DCE-MRI能够更好显示乳腺癌原发灶形态学、血流动力学变化,MSCT更准确反应腋窝淋巴结的情况,还能发现肺内隐匿的转移灶。DCE-MRI联合MSCT对预测乳腺癌新辅助化疗疗效具有重要价值。     

乳腺癌的多层螺旋CT表现与C-erbB-2、ER、PR表达的相关性研究

目的:探讨乳腺癌的多层螺旋CT表现与C-erbB-2、ER、PR表达之间的相关性。方法:回顾性分析72例经手术病理证实为乳腺癌的患者的多层螺旋CT表现,患者术前皆未行化疗或放疗,术后标本行免疫组织化学染色测定肿瘤细胞C-erbB-2、ER、PR的表达情况,并分析其与相应病灶多层螺旋CT表现的关系。结果:乳腺癌的多层螺旋CT主要征象表现为边缘形态不规则呈浅分叶或毛刺状边缘,边界模糊,瘤内有坏死、细沙砾样钙化,增强后不均匀强化为主,可伴有腋窝淋巴结转移,表现为淋巴结直径增大,长短径比例小于2,淋巴结实变,实质厚度不均,淋巴结边缘模糊。乳腺癌病灶的大小、钙化、淋巴结转移与C-erbB-2阳性表达正相关(P0.05),毛刺状边缘与ER、PR阳性表达呈正相关(P0.05)。结论:乳腺癌的多层螺旋CT表现与分子生物学指标C-erbB-2、ER、PR之间存在一定的相关性。乳腺癌的多层螺旋CT表现在一定程度上反映了乳腺癌细胞的生物学行为,对乳腺癌的预后评估具有较重要的临床价值。     

Radiology科学论著摘要（2010年3月、4月杂志）

乳腺癌动态增强MRI：计算机表征作为基于影像的评价预后指标;细针穿刺检测CA-15-3和癌胚抗原浓度对乳腺癌腋窝淋巴结转移的术前评估研究;320层容积扫描CT在单一心动周期冠状动脉成像中放射剂量研究;采用^18F-FDGPET预测食管癌病人新辅助化疗疗效：系统评价;多层螺旋CT和MRI评价猪冠状动脉微栓子导致异质性微栓塞研究;     

超声联合技术在乳腺癌新辅助化疗疗效评价中的应用价值

目的 回顾性分析常规超声及超声造影在乳腺癌新辅助化疗疗效评价中的应用价值,为临床进行疗效评价提供帮助。方法 选择我院行新辅助化疗的乳腺癌患者56例于治疗前后行常规超声及超声造影检查,对比分析治疗前后声像图和超声造影表现的变化。结果 常规超声及超声造影显示乳腺癌新辅助化疗后,瘤体缩小,造影剂灌注区域面积减小,强度减弱,新辅助化疗前后差异有统计学意义(P0.05),化疗后明显好于化疗前。结论 在乳腺癌新辅助化疗的疗效评价中,常规超声及超声造影技术能够清楚、准确的反映肿瘤状态,直观显示新辅助化疗的治疗效果,检查安全无创,有着积极的临床应用价值。     

多层螺旋CT对膀胱癌的诊断价值

目的:探讨多层螺旋CT对膀胱癌的诊断价值.方法:回顾性分析经手术病理证实的82例膀胱癌,分析多层螺旋CT对肿瘤大小及数目的显示情况、病灶的强化程度以及判断侵犯范围的准确性.结果:多层螺旋CT能较准确地显示膀胱癌的大小和数目,较好地显示膀胱癌的大体形态、生长方式及强化程度,评价膀胱癌侵犯范围的敏感性、特异性和准确性均处于较高水平;CT定性诊断准确性达到93.90%.结论:多层螺旋CT是诊断膀胱癌最具价值的影像学检查手段,作为膀胱癌的常规检查项目,检查技术关键在于薄层和增强多期扫描,这对于发现病灶、大体分型、分期和定性诊断均十分重要.     

多层螺旋CT诊断肝门胆管癌及邻近结构侵犯的价值

目的 探讨多层螺旋CT多平面重建诊断肝门胆管癌及邻近结构侵犯的价值.方法 分析29例经手术及病理证实的肝门胆管癌螺旋CT表现,所有病例均行CT平扫及增强扫描,并行多平面重建.分析肝门胆管癌的大体类型及邻近结构侵犯情况,并与手术及病理结果比较,评价术前多层螺旋CT诊断价值.结果 ①病变表现为肿块型18例, 管壁浸润型9例, 结节型2例,术前诊断准确率为100%;②根据Bismuth-Corlette胆管受侵犯分型法,术前诊断准确率为79.3%;③肝门血管受侵犯诊断准确率为59%;④肝门淋巴结转移诊断准确率为50%.结论 多层螺旋CT在显示肝门部肿块大小、范围,沿胆管壁浸润方面,诊断价值较高;而显示血管侵犯及淋巴结转移方面诊断准确率较低.     

基于动态增强MRI特征的乳腺癌新辅助化疗疗效预测研究

目的探讨动态增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)在评价和预测乳腺癌新辅助化疗疗效方面的价值。方法回顾性分析57例行术前新辅助化疗,且化疗前、后2周期行MRI检查的乳腺癌恶性患者,对其按病理学反应分为化疗有效组和无效组。提取患者的乳腺MRI病灶和背景特征进行统计分析。结果化疗前MRI不对称特征、正常侧动态增强特征与化疗结果显著相关(单变量逻辑回归P0.05)。在多变量回归分析中,病灶表面积和正常侧动态增强特征与乳腺癌新辅助化疗结果显著相关(P0.05)。结论 DCE-MRI中正常侧背景区域动态增强特征与乳腺癌新辅助化疗疗效结果显著相关,在新辅助化疗疗效的预测与治疗中有重要的参考价值。     

MRI评估及预测乳腺癌新辅助化疗疗效研究进展

准确评估及预测乳腺癌新辅助化疗后的病理反应有助于了解病情变化。MRI可以反映肿瘤形态、乳腺背景实质强化、肿瘤血流灌注及水分子扩散运动变化等重要信息,对评估和预测乳腺癌新辅助化疗疗效具有重要作用。基于MRI的影像组学可以从医学图像中获取定量和高通量的特征,反映肿瘤的异质性,从而实现对乳腺癌新辅助化疗疗效的精准评估及预测。就MRI评估及预测乳腺癌新辅助化疗疗效的研究进展予以综述。     

多种影像学方法评价乳腺癌新辅助化疗疗效的价值比较

影像学方法在乳腺癌新辅助化疗（NAC）疗效评价中具有重要地位.钼靶X线操作简单,曾是早期发现乳腺癌的简便、有效的方法,可显示微小钙化灶,但不常用于疗效评价;CT适应人群广、扫描时间短、密度分辨率高,后处理时可以三维重建以更好显示癌灶,可用于诊断及疗效评价;MRI具有多种参数和良好的软组织分辨率,可显示癌灶周围的微小浸润及炎症反应;超声无放射性、检查角度灵活、可重复性强,可以显示病灶和转移淋巴结的形态、结构及血流,并引导介入操作.PET/CT显像可以反映肿瘤细胞的代谢水平,其将分子代谢变化与解剖结构的准确定位相结合,在评估NAC疗效方面拥有更高的灵敏度及特异度,比单纯测量肿瘤大小的改变更准确.     

The usefulness of Tc-99m-tetrofosmin SPECT/CT in the detection of residual tumors and axillary lymph node metastases in breast cancer patients following neoadjuvant therapy

Single photon emission computed tomography (SPECT)/CT is emerging as a useful diagnostic tool in several oncological fields. In this prospective study, we assessed the usefulness of Tc-99m-tetrofosmin SPECT/CT in the detection of both residual breast tumors and axillary lymph node metastases following neoadjuvant therapy. Thirty-seven consecutive breast cancer patients scheduled to surgery following neoadjuvant therapy preoperatively underwent a Tc-99m-tetrofosmin SPECT/CT study, using a dual head gamma camera integrated with a x-ray tube for low-dose CT, including both breasts and axillary regions in the field of view. Within 1 week of SPECT/CT, all 37 patients had breast surgery with associated axillary lymph node dissection in 33/37 cases. At surgery, 31/37 patients had breast residues (microscopic in 4/31 cases and macroscopic in 27/31 cases). Axillary lymph node metastases were ascertained in 19/33 cases (N1mi: 2 cases, N1a: 8 cases, N2a: 6 cases, N2b: 3 cases). SPECT/CT sensitivity, specificity, and accuracy in detecting residual tumors were 87%, 100%, and 89.2%, respectively; the corresponding values in detecting axillary lymph node metastases were 36.8%, 92.8%, and 60.6%. SPECT/CT missed breast cancer residues in 4/31 patients, including 2 cases with microscopic residual disease. Moreover, lymph node metastases were missed in 12/19 patients (10/12 with pN1mi or pN1a metastases), all with lymph nodes with post-therapy fibrotic changes and small deposits of metastases. Tc-99m-tetrofosmin SPECT/CT proved a useful diagnostic tool in the detection and in the localization of residual breast tumors following neoadjuvant therapy. The procedure lacked in sensitivity in identifying axillary lymph node metastases, especially in patients with a limited lymph node involvement. According to our data, SPECT/CT may guide the surgeon to the most appropriate breast surgical treatment and to eventually select the most suitable axillary lymph node sampling (axillary lymph node dissection or sentinel node biopsy).     

乳腔镜下应用核素联合染料示踪法对新辅助化疗后乳腺癌患者行前哨淋巴结活检的研究(附41例报告)

目的 在乳腔镜下采用核素联合染料示踪法对新辅助化疗后的乳腺癌患者行前哨淋巴结活检(SLNB),探讨通过前哨淋巴结(SLN)对腋窝淋巴结内癌细胞转移情况进行预测的可行性.方法 选择行新辅助化疗2～4个疗程后的乳腺癌患者41例,术前15～18h在肿块或活检腔周围分4点注射~(99)Tc~m标记的硫胶体0.5～1.0mCi(1Ci=3.7×10~(10)Bq),术中在同样部化皮下注射美蓝4～6ml.使用γ探测仪在存在高放射活性的部位进行体表定位,腋窝注射溶脂剂,吸脂后,乳腔镜下行SLNB,然后行腋窝淋巴结清扫.将检出的淋巴结制成石蜡切片行常规病理检查,将结果显示有癌细胞转移的淋巴结确定为转移阳性;对病理检查显示为转移阴性的SLN进一步采用免疫组化法检测CK19的表达.计算采用SLN进行预测的准确率、敏感性、特异性、假阴性率和假阳性率.结果 41例患者中,39例患者(95.12%)检出SLN,共126枚,每例平均3.07(1～5)枚.病理检查显示,18例患者的SLN转移阳性(均为真阳性),21例SLN转移阴性(其中20例为真阴性,1例为假阴性).SLN对腋窝淋巴结内癌细胞转移情况的预测准确性为97.43%,敏感性为94.74%,特异性100%,假阴性率为5.26%,假阳性率0%.免疫组化法检测显示,1例病理检查显示转移阴性的SLN内CK19表达阳性.所有患者均对SLNB术后的美容效果较为满意.结论 乳腔镜下应用核素联合染料示踪法能提高SLN的检出率,且具有微创、美容的优点.通过SLN内癌细胞转移情况能够较为准确地预测新辅助化疗后乳腺癌患者腋窝淋巴结内癌细胞的转移情况.     

CT perfusion for the monitoring of neoadjuvant chemotherapy and radiation therapy in rectal carcinoma: initial experience

PURPOSE: To prospectively monitor changes in rectal cancer perfusion after combined neoadjuvant chemotherapy and radiation therapy with perfusion computed tomography (CT) and to evaluate whether perfusion CT findings correlate with response to therapy. MATERIALS AND METHODS: The study was approved by the institutional ethics committee of the European Institute of Oncology; written informed consent was obtained from all participants before the study. Twenty-five patients with rectal adenocarcinoma (18 men, seven women; age range, 42-72 years; mean age, 61.3 years) underwent perfusion CT; all of them underwent neoadjuvant chemotherapy and radiation therapy, followed by surgery. In 19 patients, perfusion CT was repeated after chemotherapy and radiation therapy. Dynamic perfusion CT was performed for 50 seconds after intravenous injection of contrast medium (40 mL, 370 mg iodine per milliliter, 4 mL/sec). Blood flow (BF), blood volume (BV), mean transit time, and permeability-surface area product (PS) were computed in the tumor and in normal rectal wall by two independent blinded radiologists. Microvessel density was evaluated in pretreatment biopsy specimens in nine patients and in surgical specimens in seven patients. Wilcoxon signed-rank and rank sum tests were used for paired and independent comparisons, respectively. RESULTS: BF, BV, and PS were significantly higher in rectal cancer than in normal rectal wall (P < .001). BF, BV, and PS significantly decreased after combined chemotherapy and radiation therapy (P < .009). No correlation was found between perfusion parameters and microvessel density, neither in baseline values nor in posttherapy changes. Baseline BF and BV in the seven patients who failed to respond to treatment were significantly lower than in the 17 responders (P = .02 for BF and < .001 for BV). CONCLUSION: Perfusion CT has potential for monitoring the effects of combined neoadjuvant chemotherapy and radiation therapy and predicting the response of rectal cancer to such therapy.     

Imaging of breast cancer diagnosed and treated with chemotherapy during pregnancy

PURPOSE: To retrospectively assess mammography, high-frequency-transducer ultrasonography (US), and color Doppler US for the initial and subsequent evaluation of breast cancer diagnosed and treated with chemotherapy during pregnancy. MATERIALS AND METHODS: A retrospective study of clinical records between January 1989 and December 2003 of women with breast cancer diagnosed and treated with chemotherapy during pregnancy was performed after waiver of informed consent was obtained. The study was approved by an institutional review board and was HIPAA compliant. Mammograms and sonograms were reviewed by two mammographers using the Breast Imaging Reporting and Data System (BI-RADS) mammographic and US lexicon. US assessment of the regional lymph node basins, including the axillary, infraclavicular, internal mammary, and supraclavicular regions, was documented. US was used to evaluate response to therapy in the breast and the regional lymph nodes in women who underwent neoadjuvant chemotherapy. RESULTS: Twenty-three women with 24 cancers that were imaged prior to surgery with mammography (n = 3), US (n = 4), or mammography and US (n = 17) were included in the study. The histologic diagnosis of the primary tumor was invasive ductal cancer in 22 lesions, and the diagnosis was invasive carcinoma in the two other cancers. The median age in this study was 34 years (range, 24-45 years). Of the 20 women who underwent preoperative mammography, findings were positive for malignancy in 18 of 20 (90%) cancers despite dense breast parenchymal patterns (BI-RADS types 3 and 4). A mass in all 21 cancers (100%) was depicted in the 20 women who underwent breast and nodal US. US correctly depicted axillary metastasis in 15 of 18 women who underwent US nodal assessment. Of the 12 patients who were evaluated for response to chemotherapy, US demonstrated complete response in two patients, partial response in three, stable findings in one, and progression of disease in six. CONCLUSION: Breast cancer diagnosed during pregnancy is mammographically evident despite dense parenchymal background. US, when performed, demonstrates all masses and provides information regarding response to neoadjuvant chemotherapy.     

Thymic hyperplasia after high-dose chemotherapy and autologous stem cell transplantation: incidence and significance in patients with breast cancer.

OBJECTIVE: The purpose of this study was to determine the incidence and clinical significance of thymic hyperplasia after high-dose chemotherapy and autologous stem cell transplantation for treatment of metastatic or high-risk primary (with at least four positive lymph nodes) breast cancer. MATERIALS AND METHODS: We retrospectively reviewed clinical records and CT scans of 102 breast cancer patients treated with high-dose chemotherapy and autologous stem cell transplantation. Patients were 26-63 years old (mean, 46 years). The length and width of the thymus gland were measured on serial CT scans obtained before and after treatment. Moderate thymic hyperplasia was recorded if a focal or diffuse increase was seen in the oblong, triangular soft-tissue opacity conforming to the configuration of the normal gland within the anterior mediastinum after therapy. Minimal hyperplasia was recorded when a minimal increase was seen in soft-tissue attenuation conforming to the configuration of the normal bilobed thymus gland within the anterior mediastinum, but no discrete mass was visible. RESULTS: CT showed no thymic hyperplasia in 91 (89%) of the 102 patients. CT showed thymic hyperplasia in the other 11 patients (11%). Three patients (3%) had moderate hyperplasia, and eight patients (8%) had minimal hyperplasia. When comparing patients with and without hyperplasia, we found no difference in mean age or survival. CONCLUSION: Thymic hyperplasia is rare after high-dose chemotherapy and autologous stem cell transplantation in adult patients with metastatic or high-risk primary breast cancer. In this population, thymic hyperplasia does not appear to correlate with survival.     

Application of conventional ultrasonography combined with contrast-enhanced ultrasonography in the axillary lymph nodes and evaluation of the efficacy of neoadjuvant chemotherapy in breast cancer patients

Objective:Axillary lymph node status assessment has always been an important issue in clinical treatment of breast cancer. However, there has been no effective method to accurately predict the pathological complete response (pCR) of axillary lymph node after neoadjuvant chemotherapy (NAC). The objective of our study was to investigate whether conventional ultrasonography combined with contrast-enhanced ultrasonography (CEUS) can be used to evaluate axillary lymph node status of breast cancer patients after NAC.Methods:A total of 74 patients who underwent NAC were recruited for the present study. Prior to and after NAC, examinations of conventional ultrasonography and CEUS were performed. After evaluating the images of conventional ultrasonography, four characteristics were recorded: lymph node medulla boundary, cortex of lymph node, lymph node hilus, and lymph node aspect ratio. Two additional imaging characteristics of CEUS were analyzed: CEUS way and CEUS pattern. Receiver operating characteristiccurve analysis was applied to evaluate their diagnostic performance.Results:After 6~8 cycles of NAC, 46 (71.9%) patients had negative axillary lymph node, and 18 (28.1%) patients turned out non-pCR. According to statistical analysis, lymph node medulla, lymph node aspect ratio and CEUS way were independently associated with pCR of axillary lymph node after NAC. The area under the curve of the prediction model with three imaging characteristics was 0.882 (95% confidence interval: 0.608–0.958), and the accuracy to predict the patients’ lymph node status was 78.1% (p < 0.01).Conclusions:Conventional ultrasonography combined with CEUS technology can accurately predict axillary lymph nodes status of breast cancer patients after NAC.Advances in knowledge:The usefulness of CEUS technology in predicting pCR after neoadjuvant chemotherapy is highlighted.     

The role of PET/CT for evaluating breast cancer.

Positron emission tomography combined with computed tomography (PET/CT) has been receiving increasing attention during the recent years for making the diagnosis, for determining the staging and for the follow-up of various malignancies. The PET/CT findings of 58 breast cancer patients (age range: 34-79 years old, mean age: 50 years) were retrospectively compared with the PET or CT scans alone. PET/CT was found to be better than PET or CT alone for detecting small tumors or multiple metastases, for accurately localizing lymph node metastasis and for monitoring the response to chemotherapy in breast cancer patients.     

Early and delayed prediction of axillary lymph node neoadjuvant response by 18F-FDG PET/CT in patients with locally advanced breast cancer

Purpose

To determine the utility of ¹⁸F-FDG (FDG) PET/CT performed in an early and delayed phase during neoadjuvant chemotherapy in the prediction of lymph node histopathological response in patients with locally advanced breast cancer.

Methods

FDG PET/CT studies performed in 76 patients (mean age 53 years) at baseline (PET-1), after the second course of chemotherapy (PET-2) and after the last course of chemotherapy (PET-3) were prospectively analysed. Inclusion criteria were lymph node involvement detected by PET/CT and non-sentinel node biopsy before or after the baseline PET/CT scan. Following the recommendations of the 12th International Breast Conference (St. Gallen), the patients were divided into five subgroups in relation to biological prognostic factors by immunohistochemistry. For diagnosis visual and semiquantitative analyses was performed. Absence of detectable lymph node uptake on the PET-2 or PET-3 scan with respect to the PET-1 scan was considered metabolic complete response (mCR). Lymph nodes were histopathologically classified according the lymph node regression grade and in response groups as pathological complete response (pCR) or not pCR (type A/D or B/C of the Smith grading system, respectively). ROC analysis was performed to determine a cut-off value of Δ% SUV1–2 and SUV1–3 for prediction of nodal status after chemotherapy. An association between mCR and pCR was found (Cohen’s kappa analysis), and associations between phenotypes and metabolic behaviour and the final histopathological status were also found.

Results

Lymph node pCR was seen in 34 patients. The sensitivity, specificity, and positive and negative predictive values of PET-2 and PET-3 in establishing the final status of the axilla after chemotherapy were 52 %, 45 %, 50 % and 47 %, and 33 %, 84 %, 67 % and 56 %, respectively. No significant relationship was observed between mCR on PET-2 and PET-3 and pCR (p?=?0.31 and 0.99, respectively). Lymph node metabolism on PET-1 was not able to predict the final histopathological status, whereas basal carcinomas showed a higher rate of pCR (70.6 %) than the other groups (p?=?0.03).

Conclusion

FDG PET/CT seems to have limitations in both the early and delayed evaluation of lymph node status after chemotherapy, with reduced predictive values.     

The Prognostic Value of 18F-FDG PET/CT for Early Recurrence in Operable Breast Cancer: Comparison with TNM Stage

Purpose

We evaluated whether the maximum standardized uptake values (SUV_max) of primary tumor from the initial staging by ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) of patients with breast cancer could identify patients at risk for early recurrence within 2 years, particularly in comparison to the American Joint Committee on Cancer (AJCC) stage.

Methods

We reviewed the staging ¹⁸F-FDG PET/CT images of patients with primary breast cancer and their medical records. The SUV_max of the primary tumor was measured. The presence or absence of FDG uptake in the axillary lymph node (ALN) was also assessed. The patient’s pathologic primary tumor stage (pT), pathologic regional lymph node stage (pN), stage grouping, age, estrogen receptor (ER) and progesterone receptor (PR) status, and neoadjuvant chemotherapy history were evaluated with the FDG uptake parameters for recurrence within 2 years following the end of first-line therapy.

Results

Recurrence within 2 years was present in 9.1 % (n = 40) out of the 441 patients assessed. The FDG uptake in ALN, pT, pN, stage grouping and neoadjuvant chemotherapy history were prognostic for early recurrence, while primary tumor SUV_max, age, and ER or PR status were not significant on logistic regression. On multivariate analysis, only the stage grouping (odds ratio 2.79; 95 % CI 1.73, 4.48; p < 0.0001) and neoadjuvant chemotherapy history (odds ratio 2.70; 95 % CI 1.22, 5.98; p = 0.0141) could identify patients at increased risk for recurrence within 2 years.

Conclusions

Primary tumor FDG uptake measured by SUV_max, and visual assessment of FDG uptake in the ALN in the initial staging PET/CT of patients with breast cancer may not have additional prognostic value compared with the AJCC stage grouping for early recurrence.