磁共振与超声评估乳腺癌患者新辅助化疗后病理完全缓解价值的比较

目的:比较磁共振增强成像（MRI）和超声检查（US）评估乳腺癌新辅助化疗后病理完全缓解(pCR)价值的研究。方法:收取2013年至2016年期间我院接受MRI和B超影像学随访、手术治疗和病理检查的75例乳腺癌患者。病理检查以及MRI和US的评估基于肿瘤的最长直径。结果:增强磁共振预测乳腺癌新辅助化疗患者pCR的敏感性为76.5%(13/17，95%CI 63%~84%)，特异性和准确性为91.6%(44/48，95%CI 87%~94%)和76%(57/75，95%CI 70%~81%)。超声预测pCR的敏感性58.8%(10/17，95%CI 45%~67%)，特异性和准确性为82.9%(34/41，95%CI 77%~91%)和58.6%(44/75，95%CI 42%~67%)。在影像检查和病理结果的一致性分析中，手术前MRI测量的肿瘤大小与病理学大小之间存在统计学上显著关系（P<0.005，CI:0.687）。这种相关关系在MRI测量中比在US中更强（P<0.001，CI:0.927）。结论:在接受新辅助化疗患者的术前pCR和肿瘤大小评估中，磁共振增强成像准确性优于超声，在病理反应分类的一致性明显高于超声。

Comparison of value between magnetic resonance and ultrasound in the evaluation of pathologic complete response after neoadjuvant chemotherapy in breast cancer patients

Objective:To compare the value of magnetic resonance enhanced imaging(MRI) and ultrasound examination(US) in pathologic complete response(pCR) after breast cancer neoadjuvant chemotherapy.Methods:This study included 75 patients who underwent radiological follow-up，surgery，and pathology and had MRI and ultrasound in our hospital from 2013 to 2016.Pathological examinations and assessments of aspects of MRI and US are based on the longest diameter of the tumor.Results:The sensitivity of pCR predicted by MRI was 76.5%(13/17,95%CI 63%~84%).Specificity and accuracy were 91.6%(44/48，95%CI 87%~94%) and 76%(57/75，95%CI 70%~81%).Sensitivity of pCR predicted by ultrasound was 58.8%(10/17,95%CI 45%~67%).The specificity and accuracy of pCR prediction were 82.9%(34/41，95%CI 77%~91%) and 58.6%(44/75，95%CI 42%~67%).In the consistency analysis of imaging and pathological results，there was a statistically significant relationship between the tumor size measured by pre-operative MRI and the pathological size(P<0.005，CI:0.687).This correlation was stronger in MR measurements than in US(P<0.001，CI:0.927).Conclusion:In preoperative pCR and tumor size evaluation of patients receiving neoadjuvant chemotherapy，the accuracy of enhanced MRI was superior to that of ultrasound.The consistency of pathological response classification was significantly higher than that of ultrasound.