Radiology 2011 Dec;261 (3): 735-43. [IF:6.066]
Breast Cancer: Evaluation of Response to Neoadjuvant Chemotherapy with 3.0-T MR Imaging.
Chen JH , Bahri S , Mehta RS , Kuzucan A , Yu HJ , Carpenter PM , Feig SA , Lin M , Hsiang DJ , Lane KT , Butler JA , Nalcioglu O , Su MY .
Tu and Yuen Center for Functional Onco-Imaging and Departments of Radiological Sciences, Medicine, Pathology, and Surgery, University of California, 164 Irvine Hall, Irvine, CA 92697-5020; Department of Radiology, China Medical University Hospital, Taichung, Taiwan.
中国医药大学附属医院，美国加州大学
Abstract
Purpose: To assess how the molecular biomarker status of a breast cancer, including human epidermal growth factor receptor 2 (HER2), hormone receptors, and the proliferation marker Ki-67 status, affects the diagnosis at 3.0-T magnetic resonance (MR) imaging. Materials and Methods: This study was approved by the institutional review board and was HIPAA compliant. Fifty patients (age range, 28-82 years; mean age, 49 years) receiving neoadjuvant chemotherapy were monitored with 3.0-T MR imaging. The longest dimension of the residual cancer was measured at MR imaging and correlated with pathologic findings. Patients were further divided into subgroups on the basis of HER2, hormone receptor, and Ki-67 status. Pathologic complete response (pCR) was defined as when there were no residual invasive cancer cells. The Pearson correlation was used to correlate MR imaging-determined and pathologic tumor size, and the unpaired t test was used to compare MR imaging-pathologic size discrepancies. Results: Of the 50 women, 14 achieved pCR. There were seven false-negative diagnoses at MR imaging. The overall sensitivity, specificity, and accuracy for diagnosing invasive residual disease at MR imaging were 81%, 93%, and 84%, respectively. The mean MR imaging-pathologic size discrepancy was 0.5 cm ± 0.9 (standard deviation) for HER2-positive cancer and 2.3 cm ± 3.5 for HER2-negative cancer (P = .009). In the HER2-negative group, the size discrepancy was smaller for hormone receptor-negative than for hormone receptor-positive cancers (1.0 cm ± 1.1 vs 3.0 cm ± 4.0, P = .04). The size discrepancy was smaller in patients with 40% or greater Ki-67 expression (0.8 cm ± 1.1) than in patients with 10% or less Ki-67 expression (3.9 cm ± 5.1, P = .06). Conclusion: The diagnostic accuracy of breast MR imaging is better in more aggressive than in less aggressive cancers. When MR imaging is used for surgical planning, caution should be taken with HER2-negative hormone receptor-positive cancers. RSNA, 2011 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11110814/-/DC1.
摘要：
目的：评估人表皮生长因子受体（HER2）、激素受体和增值标志Ki-67状态等分子生物标志如何影响3.0-T磁共振成像对乳腺癌的诊断。材料和方法：本研究是经机构审查委员会批准并且符合健康保险流通与责任法案（HIPAA）。50例接受了新辅助化疗的患者（年龄28-82岁，平均年龄49岁）进行了3.0-T磁共振成像扫描。应用MR成像来测量残余癌病灶的最大尺寸并关联其病理结果。根据HER2，激素受体及Ki-67水平进一步将患者分成亚组。病理完全缓解(pCR)定义为没有残余侵袭性癌细胞。应用皮尔逊相关系数将决定MR成像与病理学肿瘤大小相关联，用非配对t检验比较MR成像与病理学癌肿大小的差异。结果：50名女患中14名达到了病理完全缓解(pCR)。有7例MR成像假阴性。应用MR成像诊断侵袭性残余癌的总体的敏感度、特异性和准确性分别是81%、93%和84%。HER2阳性的癌症患者MR成像-病理尺寸的平均差异为0.5 cm ± 0.9（标准差），而HER2阴性的癌症患者其平均差异为2.3 cm ± 3.5（标准差）（P = .009)。在HER2阴性组，激素受体阴性者较激素受体阳性者肿瘤大小差异小(1.0 cm ± 1.1 比 3.0 cm ± 4.0, P = .04)。在表达40%或以上Ki-67的患者(0.8 cm ± 1.1)，肿瘤大小差异性比表达10%或更少Ki-67的患者小(3.9 cm ± 5.1, P = .06)。结论： MR成像诊断侵袭性高的乳腺癌准确度要高于侵袭性低的乳腺癌。在MR成像应用于外科制定手术计划时，应注意HER2阴性而激素受体阳性的乳腺癌患者。
