| Objective: To evaluate the value of contrast-enhanced magnetic resonance imaging(DCEMRI)combined with immunohistochemical results in predicting pathological complete response after breast cancer surgery,which may provide a reliable basis for determining disease prognosis and formulate treatment plans.Methods: A retrospective analysis was performed in 134 breast cancer patients who received core needle biopsy before NAC and postoperative paraffin sections confirmed in Affiliated Hospital of Qingdao University from Jan 2020 to Jan 2023 and the clinicopathological data and DCE-MRI imaging data of these patients were collected All patients underwent MR enhancement examinations twice before NAC and in the middle of NAC(2-3 cycles)andat the end of NAC.The clinicopathological data of patients included: age,body mass index(BMI),clinical stage,T-stage,histological grading,estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor 2(HER-2),cell nuclear proliferation index(Ki-67),lymph node status and p CR.The imaging data included: the length diameter(D)and the volume(V)of the tumor at each examination,the mode of enhancement,the mode of tumor regression,the rate of change of tumor length(ΔD%)and the volume(ΔV%)were calculated.The imaging description and analysis were based on the Breast Imaging Report and Data System(BIRADS)standard.The subjects were divided into p CR group(45cases)and non-p CR group(89cases)according to the postoperative Miller-Payne pathological response classification,and the receiver operating characteristic curve(ROC)was used to evaluate the effectiveness of each parameter in predicting complete pathological response of breast cancer.Results: All patients were females,range to 23～71 [mean age 49.2 ± 9.9years].Postoperative paraffin section confirmed that PCR accounted for 33.58%.(1)Univariate analysis showed statistically significant differences in ER,PR,HER-2 status and histological grading between the p CR and non-p CR groups(χ~2=10.600,6.871,-4.220/6.761,p=0.001,0.009,<0.001,0.009).In the middle stage of NAC,the change rate of tumor length and tumor volume in p CR group was higher than that in non-p CR group.(t=6.09,p<0.001);(2)The significant factors in the univariate analysis were included in the binary logistic regression analysis showed that the tumor volume change rate(OR=1.121,95%Cl=1.048-1.200,p=0.001),HER-2 expression status(OR= 7.380,95%C1=0.723～31.608,p=0.007)were independent predictors of p CR.(3)The efficacy of each parameter alone and in combination in predicting p CR showed that the AUC of single parameter in predicting p CR was 0.684(95% Cl=0.591-0.778)for length change rate,volume change rate and HER-2 were 0.831(95%Cl= 0.757～0.891),0.701(95%Cl=0.616～0.777),and the combined diagnostic AUC was 0.873,(95%Cl=0.805～0.924),with a sensitivity of 88.9%,specificity of 76.4%,and cut-off value of 0.365.The De Long test was applied to compare the efficacy of each ROC,and the results showed that the tumor volume change rate combined with HER-2 was the highest in predicting p CR,which was better than that of single parameter HER-2 state(p < 0.001),but there was no significant difference between the combination of the two(tumor volume change rate combined with HER-2)and the tumor volume change rate(p < 0.128).Tumor volume reduction > 65% was positively related to p CR.(4)The relationship between the expression of histopathology and molecular markers before neoadjuvant chemotherapy and postoperative MP grade: there were significant differences between estrogen receptor(ER)negative,progesterone receptor(PR)negative,HER-2 overexpression and postoperative MP grade before neoadjuvant chemotherapy(p=0.01,0.01,< 0.001),but there was no significant difference with tumor histological type(p=0.275).Conclusion: Neoadjuvant chemotherapy for breast cancer by DCE-MRI imaging performance combined with preoperative core needle pathology has high application value in predicting postoperative p CR and conduce to the assessment of prognosis,especially the rate of volume change. |
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