多参数MRI预测HER2阳性乳腺癌新辅助化疗疗效价值

目的探讨应用多参数磁共振(mpMRI)预测HER2阳性乳腺癌新辅助化疗(NAC)疗效的可行性。方法回顾性分析2011年8月~2019年8月65例乳腺癌NAC患者,其中35例HER2阳性患者术前均接受靶向治疗(曲妥珠单抗、帕妥珠单抗或两者联合),在NAC前进行动态增强磁共振(DCE-MRI)及弥散加权成像(DWI)。由两位5年以上乳腺影像诊断经验的医师记录NAC前病灶最大直径、纤维腺体组织(FGT)、背景实质强化(BPE)、ADC值、最大强化率(PE)、达峰时间、时间信号强度曲线(TIC)、强化方式、Ki-67值及化疗后疗效,首先评估HER2阳性组与HER2阴性组各项指标的差异性,然后比较35例HER2阳性患者病理完全缓解(pCR)组及非pCR组各项指标的差异,并分析它们与HER2状态及靶向治疗疗效的相关性。结果HER2阳性组与HER2阴性组PE值及化疗疗效存在统计学差异(P<0.05),HER2阳性组pCR率(45%,16/19)明显高于HER2阴性组(10%,3/10),HER2阳性组PE值(3.04±1.48)高于HER2阴性组(2.29±1.04),PE值对HER2状态有中等预测价值(AUC 0.7;95%CI,0.52-0.79)。HER2阳性患者pCR组与非pCR组Ki-67、ADC值、FGT及强化方式存在统计学差异(P<0.05),pCR组ADC值(1.08±0.23)×10^-3mm^2/s明显高于非pCR组(0.84±0.24)×10^-3mm^2/s,pCR组以肿块样强化(75%)及d型乳腺多见(63%)。Logistic多因素回归模型显示,ADC值及强化模式可以作为HER2靶向治疗疗效的独立预测因素。结论PE值可以一定程度预测HER2状态。ADC值及强化模式可以作为HER2靶向治疗疗效独立预测指标;肿块样强化及较高的ADC值提示靶向治疗达pCR可能性越大。

Multi-parametric magnetic resonance imaging in predicting the efficacy of neoadjuvant chemotherapy in human epidermal growth factor receptor 2(HER2)positive breast cancer

Objective To evaluate the multiparameter magnetic resonance(mpMRI)in predicting the efficacy of neoadjuvant chemotherapy in human epidermal growth factor receptor 2(HER2)positive breast cancer.Methods This study retrospectively analysed 65 breast cancer patients with neoadjuvant chemotherapy from august 2011 to august 2019,in whom 35 HER2 positive patients received targeted therapy(trastuzumab,pastuzumab or combination of both)before surgery.dynamic enhanced magnetic resonance(DCE-MRI)and diffusion weighted imaging(DWI)were performed in all patients before therapy.The parameters were recorded by two mammographers with more than 5 years of experience,including the maximum diameter of the lesion,fibroglandular tissue(FGT),background parenchyma enhancement(BPE),apparent diffusion coefficient(ADC)values,peak enhancement(PE),peak time,time intensity curve(TIC),enhancement method,ki-76 value and post-chemotherapy efficacy.We first evaluated the differences in various indicators between the HER2-positive group and the negative group,then,compared the differences between the pathological complete remission(pCR)group and the non-pCR group in 35 HER2-positive patients,and lastly analyzed their correlation with her-2 status and the efficacy of targeted therapy.Results The difference in PE value and efficacy of neoadjuvant chemotherapy between the HER2 positive group and the negative group was significant(P<0.05).The pCR rate of the HER2 positive group(45%,16/19)was higher than the negative group(10%,3/10).The PE value of HER2 positive group(3.04±1.48)was higher than that of HER2 negative group(2.29±1.04).PE value had medium prediction value for HER2 state(AUC 0.7;95%CI,0.52-0.79).There were statistical differences in Ki-67,ADC value,FGT and enhancement mode between the pCR group and non-pCR group of HER2 positive patients(P<0.05).The value of ADC in the pCR group(1.08±0.23)×10^-3 mm^2/s was significantly higher than non-pCR group(0.84±0.24)×10^-3 mm^2/s,pCR group was more commonly seen with mass enhancement(75%)and extreme fibroglandular tissue(63%).Logistic model showed that ADC values and enhancement patterns were independent factors for predicting the efficacy of HER2 positive targeted therapy.ConclusionThe PE value of CE-MRI before neoadjuvant chemotherapy can predict HER2 status.ADC value and enhancement mode can be independent predictors of efficacy of HER2 targeted therapy,the mass enhancement and high ADC value are more likely to achieve pCR.