3.0T MRI Evaluation Of Neoadjuvant Chemotherapa In Breast Cancer

ObjectiveTo assess the evaluate value of 3.0T magnetic resonance in breaste caneer patients receiving neoadjuvant chemotherapy.Materials and methods1.The object of study:A total of 45 breaste patients of the first affiliated hospital of Guangxi Medical University from October 2013 to February 2015 participated in this study on neoadjuvant chemotherapy.The patients were pathologically confirmed invasive breast cancer with clinical stage for ?A??C.Female patients aged 30?64 years old,as the median age was 46 years old.They were examined by MRI before and after four or six cycles neoadjuvant chemotherapy.All patients were adopted with the therapy of operation.2.Method:Siemens Magnetom Verio 3.0T superconducting magnetic resonance scanner,Mammary gland specialized coil and Magnetic resonance image processing software:Siemens 3.0T MRI workstation of Mean Cure software.Transverse T2WI fat suppression sequence,DWI sequence(Diffusion weighted imaging)(b = 1000 s/mm2),dynamic contrast-enhanced.Maximum diameter measurement:(1)To measure the maximum diameter line(D)in the the maximum level of foci range three times,and take its maximum value.According to RECIST standard[13]for multifocal carcinomathe,Each foci measuring a maximum diameter line and calculate the sum,which as the foci of the maximum diameter line.Calculate the maximum diameter line reduction rate of foci after neoadjuvant chemotherapy:?D%=[(D1-D2)/D1]�100%,maximum diameter,D1 was maximum diameter of lesions before neoadjuvant chemotherapy,and D2 was maximum diameter of lesions after neoadjuvant chemotherapy(4?6 sessions).(2)Drawing the time-signal curve(TIC):Select the interesting appropriate region by Mean Cure software,then generation time-signal curve automatically.(3)Measuring ADC values:ADC values were measured in the range of foci 3 times,and take its minimum value.Trying to avoid necrotic section of foci when selecting regions of interest.Calculating the changing rate of ADC values of foci after neoadjuvant chemotherapy:?ADC%=[(ADC2-ADC1)/ADC1]�100%,ADC1 was ADC values of lesions before adjuvant chemotherapy,ADC2 was ADC values of lesions after neoadjuvant chemotherapy(4?6 sessions).3.Research Project:Comparative analysised maximum diameter variation of tumor(D1,D2)before and afer neoadjuvant chemotherapy,and calculated the?D%.Comparative analysised MRI hemodynamic changes in tumor characteristics before and after neoadjuvant chemotherapy,namely the time-signal curve(TIC)type of changes.Comparative analysised the functional MRI changes of tumor manifestations before and afer neoadjuvant chemotherapy,namely ADC value(ADC1,ADC2)changes,and calculated ? ADC%.Drawing receiver operating characteristic curve(ROC),while calculated the area under the ROC curve(Az value)of ? D%?ADC2?? ADC%of tumor lesions after neoadjuvant chemotherapy,while determined the diagnostic cut-off point of MHR and NMHR and calculated its sensitivity and specificity.4.Statistic alanalysis:Using SPSS for windows 13.0.All the data express with(mean�standard deviation).45 cases were divided into histological significant response(MHR)and non-significant histologic response(NMHR)reactive groups according to the results of postoperative pathologic response(Miller&Payne grade).Measured foci enhanced scan maximum diameter,ADC value and the rate of change by two groups of patients before and after neoadjuvant chemotherapy(4 to 6 cycles),using two independent samples t test(non-normal distribution of data Mann--Whitney U test).Used paired t test to compare MHR group NMHR group foci maximum diameter and ADC before and after chemotherapy.Using receiver operating characteristic curve(ROC)analysis to determined the maximum diameter of reduction ratio,ADC2,ADC value of the rate of change of foci MR measurements for area under the curve of the NAC pathologic response assessment(Az value),than judgmented the diagnostic cut-off point,and calculate the assessment of sensitivity and specificity.P<0.05 was considered statistically significant.Rusults:1.Clinical:Forty-two patients were pathologically confirmed invasive ductal carcinoma(93.3%),while the other 3 patients were invasive lobular carcinoma(6.67%).In total 45cases,34 patients(75.6%)received TC regimen(Docetaxel+ carboplatin),8 patients(17.8%)received TX regimen(Docetaxel +capecitabine),and 3 patients(6.7%)with other regimen chemotherapy.2.Postoperative pathological evaluation:4 cases were G1(8.9%),9 cases were G2(20.0%),12 cases were G3(26.7%),15 cases were G4(33.3%),and 5 cases were G5(11.1%).20 cases were MHR group(44.4%),and 25 cases were MHR group(55.6%).3.In the 5 cases of postoperative evaluation of reactivity for G5 patients,pathology indicated no residal cancer cells with 3 case,while cofirmed ductal carcinoma in situ with the 2 cases showed punctate enhancement by MR after chemotherapy.Pathological complete response rate was 11.1%.4.The maximum diameter measurement:In the MHR group twice MR examination,neoadjuvant chemotherapy before and after diameter respectively were(4.76�1.57),(1.56�1.43).In the NMHR group twice MR examination,neoadjuvant chemotherapy before and after diameters respectively were(4.66 �1.86),(2.72 � 1.56).Both foci are D1>D2,and the difference was statistically significant(P<0.01).Among pathology groups:two groups showed no significant between data D1(P=0.855).MHR group was significantly higher than NMHR group by D2 and ?D%after chemotherapy(P<0.05).MHR group and NMHR group ?D%were respectively(70.94�22.88),(42.05�24.60).By the ROC curve analysis,the area under the curve foci ? D%to 0.788(P value 0.001),taking the cut-off point ?D%>42.50%,the sensitivity of the assessment was 95.0%,specificity was 48.0%.5.TIC curve measurement:Before chemotherapy,the time-signal intensity curve type were type? 32cases,type? 13 cases,type ? 0 cases(in totol 45 cases),while after chemotherapy time-signal intensity curve type were type? 6cases,type ? 20 cases,type ? 13 cases(in totol 39 cases).6 cases of lesions disappear or strengthening too small to measure tumor after chemotherapy,which 5 cases pathological response level were G5,and 1 case was G4.In the 13 cases of type ?,11 cases were in MHN group,and in the 23 cases of type ?,17 cases were in NMHR group,indicating MHN group based intype I curve,and NMHR group based in type II curve after neoadjuvant chemotherapy.Histologically confirmed cancer remaining 40 cases,the time-signal intensity curve type lower than before(16 cases were type? to type ?,5 cases were type? to type ?,8 cases were type II turn into type I,)were 29 cases(29/39,74.4%),while the type unchanged(6 cases were type?-?,4 cases were type ?-?)were 10 patients(10/39,25.6%),1 case was type? was disappeared.6.The ADC measurements:MHR group before and after treatment foci mean ADC values were(0.959�0.10)�10-3mm2/s,(1.367�0.25)�10-3mm2/s,and NMHR group before and after treatment foci mean ADC values were(0.955� 0.12)�10-3mm2/s,(1.092 � 0.14)�10-3mm2/s.Through MHR group and NMHR group twice MR examinations,both of the foci were ADC2>ADC1,and the difference was statistically significant(P<0.01).ADC1 data were similar between the two groups,which have no statistical significance(P=0.855).The ADC2 and ADC%of MHR group were significantly higher than NMHR group after chemotherapy(P<0.05).MHR group and NMHR group A ADC%were respectively(43.76�27.78),(15.60�16.84).Using ADC2 and ADC%as to assess value,ROC analysis was carried out on the MHR and NMHR group,Az?ADC2=0.83,Az?ADC%=0.83(P<0.001),and ADC2 and AADC1%have diagnostic value.Taking a cut-off point of ADC2>1.173,it sensitivity was 90.0%,and specificity was 68.0%.When ADC%>31.92%,the assessment of the sensitivity was 75.0%,specificity was 92.0%.Conclusion:1.The change of tumor size and ADC value associated with neoadjuvant chemotherapy,tumor size and ADC value can be used as indicators to assess the effect of breast cancer treatment.2.The largest diameter of the tumor decreased rate ?D%,ADC2 and the rate of ADC value change ?ADC%measured by dynamic enhanced magnetic resonance imaging of breast cancer before and after chemotherapy can be used to appraise the tumor pathological reaction after neoadjuvant chemotherapy.3.The residual lesion enhancement rate decreased and blood flow reduced significantly in breast cancer patients after neoadjuvant chemotherapy,with downgrade trend of time signal intensity curve pattern by ? type to ? type.? type time signal intensity curve was concerned with effective chemotherapy.