动态增强MRI对乳腺癌新辅助化疗疗效评价分析

目的] 研究动态增强MRI对乳腺癌新辅助化疗疗效的评价作用。方法] 以2007年10月至2008年9月接受新辅助化疗的原发性乳腺癌为研究对象，选择乳腺肿瘤为靶病灶，在新辅助化疗前及新辅助化疗期间进行动态增强MRI检查，参照RECIST（Response Evaluation Criteria in Solid Tumors，RECIST）标准及Miller-Payne病理评价系统分别评价疗效，分析二者之间的相关性并研究时间-信号强度曲线 ( time-signal intensity curve，T-SI)变化的临床意义。结果]：新辅助化疗4周期后MRI疗效评价CR 0例，PR 58例，SD 29例，PD 4例；有效率（CR+PR）63.7%（58/91）。术后组织病理评价G5（pCR）7例（7.7%），G4 39例（42.9%），G3 16例（17.6%），G2 23例（25.3%），G1 6例（6.6%）。有效率（G5+G4+G3）68.1%（62/91）。MRI T-SI评价有效53例，稳定29例，进展9例；有效率58.2%（53/91）。结论] 动态增强MRI对乳腺癌新辅助化疗疗效评价与组织病理学评价高度相关，联合时间-信号强度曲线分析有益于临床疗效评价。

Effectiveness of dynamic contrast-enhanced MRI in evaluating clinical responses to neoadjuvant chemotherapy in breast cancer

Purpose: To investigate the effectiveness of dynamic contrast-enhanced MRI for evaluating clinical responses to neoadjuvant chemotherapy in breast cancer patients. Patients and Methods: We examined patients receiving neoadjuvant chemotherapy for primary breast cancer between October 2007 and September 2008. Dynamic contrast-enhanced MRI was used to examine breast tumors prior to and after neoadjuvant chemotherapy. This MRI examination assesses tumors using Response Evaluation Criteria in Solid Tumors (RECIST). The Miller-Payne grading system was used as a histopathological examination to assess the effect of the treatment. We examined the relationship between the results of RECIST and histopathological criteria. In addition, we used time-signal intensity curves (MRI T-SI) to further evaluate the effects of neoadjuvant chemotherapy on tumor response. Results: MRI examination of patients completing four three-week anthracycline-taxanes chemotherapy treatment revealed that there were no CR cases, 58 PR cases, 29 SD cases, and four PD cases. The effectiveness of neoadjuvant chemotherapy (CR + PR) was 63.7% (58/ 91). The postoperative histopathological evaluations revealed the following: seven G5 (pCR) cases (7.7%), 39 G4 cases (42.9%), 16 G3 cases (17.6%), 23 G2 cases (25.3%), and six G1 cases (6.6%). The effectiveness (G5 + G4 + G3) is 68.1% (62/91). MRI T-SI standards classified 53 effective cases, 29 stable cases, and nine progressing cases. These results indicate that the treatment was 58.2% effective (53/91) overall. Conclusions: Dynamic contrast-enhanced MRI and histopathological standards were highly correlated. Importantly, MRI T-SI evaluation was found to be useful in assessing the clinical significance of neoadjuvant chemotherapy.