MRI对乳腺癌新辅助化疗后腋窝淋巴结的评估

摘要： 目的 探讨 MRI 对乳腺癌新辅助化疗后腋窝淋巴结 （ALN） 评估的价值。方法 对 44 例乳腺癌患者进行新辅助化疗 （NAC）， 比较患者 NAC 前和 NAC4 周期后 MRI 测量患侧 ALN 直径、 肿瘤表观扩散系数 （ADC） 值变化及其间接相关性； 比较 MRI 与病理对患侧腋窝阳性淋巴结的检测结果。结果 所有患者均完成了 4 周期的 NAC， 有反应 （CR+PR） 率为 72.73% （32/44）， 无反应 （SD+PD） 率为 27.27% （12/44）。有反应组 NAC 前后的 ALN 最大直径由（1.37±1.06） cm 缩短为 （0.90±0.76） cm， NAC 前后的 ADC 值由 （0.91±0.28） ×10-3 mm2 /s 增加到 （1.01±0.32） ×10-3 mm2 /s （P＜0.01）； NAC 前后的 ADC 值变化(△ADC)与腋窝淋巴结 NAC 前后最大直径的变化(△L)不相关 （r=0.131， P= 0.413）。NAC 后 MRI 评估 ALN 的敏感度 100%， 特异度 62.5%， Kappa 值 0.68。结论 MRI 功能指标 ADC 值不能作为早期间接反映NAC 后 ALN 的疗效的独立指标， 但 MRI 仍是评估 NAC 后 ALN 状态的敏感指标。

Evaluation of MRI for axillary lymph node in breast cancer after neoadjuvant chemotherapy

Abstract:Objective To explore and evaluate the clinical value of MRI for status of axillary lymph node after neoadju⁃ vant chemotherapy (NAC) in patients with breast cancer. Methods Forty-four patients with 1ocally advanced breast cancer (LABC) were underwent NAC for four cycles. The longest diameter of axillary lymph node (ALN) measured by MRI scan. Val⁃ ue of apparent diffusion coefficient (ADC) and their correlation were compared before NAC and four cycles after NAC. Re⁃ sults of MRI and pathological data for ALN were compared between two groups of patients. Results All patients finished four cycles of NAC. The total response rate (CR+PR) was 72.7% (32/44), and the total non-response rate (SD+PD) was 27.3% (12/44). The longest diameter of ALN was significantly shortened in response group. The longest diameter was (1.37± 1.06) cm before NAC and (0.90±0.76) cm after NAC (P＜0.01). The ADC value of the tumor was significantly increased in re⁃ sponse group (0.91±0.28) ×10-3 mm2 /s before NAC and (1.01±0.32)×10-3 mm2 /s after NAC, P＜0.01)]. There was no signifi⁃ cant correlation between ADC value change (△ADC) and the longest diameter change of ALN (△L, r=0.131, P=0.413). The sensitivity, specificity and Kappa value of ALN evaluation after NAC were 100%, 62.5% and 0.68 measured by MRI. Con⁃ clusion The change of tumor longest diameter reflects the effect of chemotherapy directly. The tumor ADC value of MRI can not be used as an independent indicator of chemotherapy effect of ALN, eventhouth MRI was the sensitive index for eval⁃ uating the status of axillary lymph node after neoadjuvant chemotherapy for breast cancer.