Dynamic Enhanced Magnetic Resonance Imaging And Diffusion Weighted Imaging In Predicting The Efficacy Of Neoadjuvant Chemotherapy

Objective:To investigate whether the dynamic enhanced MRI combined with DWI can accurately predict the efficacy of neoadjuvant chemotherapy in breast cancer,and the effect of molecular typing on the accuracy of the evaluation.,Provide basis for clinical development and adjustment of treatment plan.Methods:Collected locally advanced breast cancer from March 2014 to December 2015 at the Second Affiliated Hospital of Nanchang University,diagnosis and treatment plan neoadjuvant chemotherapy but without distant metastases in 31 cases,respectively,before neoadjuvant chemotherapy,2 cycles,preoperative using3.0T superconductive MRI,Test items including DWI and DCE-MRI.The 4-6 cycle of NAC after chemotherapy were treated by surgery,according to the Miller Payne classification system can be divided into major histological response group(MHR)and non significant histological response group(NMHR).Measuring tumor size,quantitative parameters(Ktrans,kep,Ve).Well as ADC value.The quantitative parameters of the MHR group and NMHR group were compared before and after 2cycles of neoadjuvant chemotherapy,before and after the chemotherapy.In addition,the parameters of different molecular subtypes were compared.Between the two groups using t test or two independent samples rank test.Count data using chi-square test.Statistical analysis was performed using SPSS software.To determine if the P<0.05 differences have statistical significance.Drawing the ROC curve to find the early prediction,evaluation of neoadjuvant chemotherapy optimum parameters and diagnostic threshold.Results:MHR group 21 cases,10 cases of MHR group.Before NAC and MHR group and NMR group of tumor size,ADC value,quantitative parameters(Ktrans and kep,VE)were not statistically significant,P > 0.05,and after NAC,between the two groups of all parameters and their changes value have significant difference P <0.05.And Ktrans,kep,Ve in the MHR group of NAC before and after NAC2 were statistically different.In the NMHR group,only Ktrans was statistically significant before and after chemotherapy,while Ve and kep had no difference.,on magnetic resonance measurements and postoperative pathological measurements of tumor the longest diameter linear correlation analysis,correlation coefficient was 0.801,P <0.001.And after NAC,the ADC values of the two groups were all higher than that before neoadjuvant chemotherapy.The changes of Ktrans,kep and ROC were the Ve curves.The results showed that: the change of Ktrans value predicted the area under the curve of NAC curative effect was the largest,and the highest sensitivity was.Kep..Different molecular typing on the reaction of neoadjuvant chemotherapy in breast cancer is different,luminal A are NMHR group.From triple negative to the Her-2 type and then luminal B,and finally the luminal A,the number of cases which MHR gradually reduced.The difference was statistically significant.Conclusion: DCE-MRI and DWI can be used as an important method to evaluate the efficacy of neoadjuvant chemotherapy in the treatment of breast cancer.After neoadjuvant chemotherapy,the maximum diameter of the tumor has reduced overall than before,The change of value can assess the final pathological tumor response.And the maximum diameter of residual tumor after surgery to do correlation analysis showed a significant correlation ? But there are also overestimated the situation.The ADC value of DWI and its change value can predict the response of the lesion in early stage.But because of low spatial resolution of DWI,easy to produce artifacts,and affected by many factors,and other reasons,DCE-MRI quantitative parameters reflect changes in the internal blood flow of the cancer.Evaluation of neoadjuvant chemotherapy for breast cancer in early stage.And the accuracy of kep and Ktrans prediction evaluation is relatively high.Can be a predictive factor.Although the MRI accuracy in predicting the effect of neoadjuvant chemotherapy is influenced by the molecular typing.But the quantitative parameters,compared with other parameters,are less affected by molecular typing.However,the analysis of quantitative parameters may be due to the enhanced scan time resolution and other factors,the accuracy of the evaluation is affected.Therefore,the DCE-MRI combined with DWI to predict the efficacy of NAC is higher,The sensitivity of patients to neoadjuvant chemotherapy was different from that of molecular typing,and the luminal type,HER-2 overexpression and three negative were more sensitive to neoadjuvant chemotherapy.Screen out those who are not sensitive to chemotherapy,Will contribute to the development of clinical treatment programs to avoid excessive medical treatment for breast cancer has a guiding significance for individual treatment.