The Advantage Of MRI Funcyional Imaging In The Evalution Of Neoadjuvant Chemotherapy For Breast Cancer

Objective:In the course of dynamic therapy,it is important to obtain the feedback information of breast MRI.The effect of neoadjuvant chemotherapy on breast cancer was evaluated by the changes of ADC and volume.Finally,a new evaluation model of neoadjuvant chemotherapy for breast cancer was established.Methods:From January 2017 to January 2019,breast cancer cases in the center of breast disease of Zhongda Hospital Affiliated to Southeast University were collected retrospectively.According to the inclusion and exclusion criteria,a total of 43 patients were included.The age of onset,TNM stage,Miller Payne grade,menopause status,histological type,ADC values of pre NAC,axillary lymph node metastasis,chemotherapy regimen,molecular typing,ADC values of the second and fourth cycles and the largest diameter of the tumor in the same period were collected.According to the gold standard of postoperative pathology,Miller Payne grading system,the patients were divided into two groups:the group with significant histological response and the group without response.A new evaluation mode is the largest diameter and ADC of the tumor.The two new methods were used to judge the efficacy separately and jointly,compared with the traditional evaluation mode of RESIST 1.1 standard.Result:1.A total of 43 breast cancer patients were included in this study.According to the pathology of Miller Payne,they were divided into two groups:the effective group(15 cases)and the ineffective group(28 cases).2.According to the traditional rest 1.1 standard,the sensitivity was 33.3%,73.3%,the specificity was 89.3%,50%,the area under the curve was 0.58(95%CI:0.428～0.798),0.67(95%CI:0.436～0.761).3.The long diameter and ADC value of NAC in the second and fourth cycles were significantly higher than those before treatment.The difference was statistically significant(P<0.001)in all the observed population,the effective group and the non-reactive group.4.There was a positive correlation between △ length and diameter and △ ADC value.The r values in the second and fourth cycles of NAC were 0.31(P<0.05)and 0.42(P<0.01),respectively.There was a moderate correlation between the two.5.In the second period of NAC,there was no significant difference in △ length and diameter 1 between the two groups,but △ length and diameter 1 only reached the critical statistical difference state(t=2.102,P=0.042).Therefore,in the second period of NAC,only the value of △ ADC was used to evaluate the curative effect of NAC alone.The best diagnostic demarcation point was 0.26,its sensitivity was 86.7%,and its specificity was 78.6%.The area under the curve is 0.857(95%CI:0.717-0.945).6.In the fourth period of NAC,there were statistically significant differences between the response group and the non-response group.Therefore,the best diagnostic demarcation points were 0.35,0.40 and 0.66,the sensitivity was 66.7%,93.3%and 73.3%,the specificity was 82.1%,78.6%and 100%.The area under the curve was 0.743(95%CI:0.587-0.864),0.894(95%CI:0.762,0.967),0.929(95%CI:0.807,0.985).7.The area under ROC curve(AUC)of △ ADC1 was significantly different from that of traditional resist 1.1 standard(Z=2.506,P=0.0122).8.There was no significant difference in the AUC between the new index △ long diameter 2 and functional △ ADC2,and between △ long diameter 2 and traditional resistance 1.1(Z=1.541,P=0.1233;Z=1.757,P=0.079).There was significant difference in AUC between △ADC2 alone and traditional resist 1.1(Z=4.213,P<0.0001).There was significant difference in AUC between △ long diameter 2 and △ ADC2 combined with traditional resist 1.1 index(Z=5.139,P<0.0001).Conclusion:1.The diagnostic efficacy of traditional resist 1.1 standard in evaluating the second and fourth cycles of neoadjuvant chemotherapy for breast cancer is general,and AUC under the curve is less than 70%.2.No matter in the whole observation population or in the effective group or the ineffective group of histological response,ADC and length of NAC after treatment were significantly different from those before treatment.3.In the second and fourth cycles of NAC,the response of tumor to cytotoxic drugs can be evaluated by the change of ADC value.The more the tumor shrinks,the higher the ADC value is.4.In the second period of NAC,the changes of MRI parameters were earlier than the changes of morphological parameters.△ ADC1 has higher diagnostic efficiency than the traditional resist 1.1 standard,and can be used as the evaluation index of NAC cycle 2.5.In the fourth period of NAC,△ ADC2 can be used alone,which has a higher diagnostic efficiency than the combination of △ long diameter 2,△ ADC2 can be used as a good index to predict the final curative effect of NAC in breast cancer patients.