PDF(Pubmed)
Abstract：
UNASSIGNED: To investigate what pre-treatment clinical-pathological features and MRI characteristics influence the performance of breast MRI in assessing the pathologic complete response (pCR) of breast cancer patients to Neoadjuvant Chemotherapy (NAC).
UNASSIGNED: A total of 225 patients with pathologically-confirmed breast cancer who underwent pre- and post-NAC breast MRI between January 2020 and April 2023 were retrospectively analyzed. All patients were categorized into radiologic complete response (rCR) and non-rCR groups based on pre-operative MRI. Univariable and multivariable logistic regression were used to identify independent clinicopathological and imaging features associated with imaging-pathological discordance. The performance of pre-operative MRI for predicting pCR to NAC was assessed according to the baseline characteristics of the clinicopathological data and pre-NAC MRI. In addition, the discrepancy between the pre-operative MRI and post-operative pathological findings was further analyzed by a case-control approach.
UNASSIGNED: Among 225 patients, 99 (44.0%) achieved pCR after NAC. MRI showed the overall sensitivity of 97.6%, specificity of 58.6%, accuracy of 80.4%, a positive predictive value (PPV) of 75.0%, and a negative predictive value (NPV) of 95.1% in identifying pCR. Of baseline features, presence of ductal carcinoma in situ (DCIS) (OR, 3.975 [95% CI: 1.448-10.908], p = 0.007), luminal B (OR, 5.076 [95% CI: 1.401-18.391], p = 0.013), HER2-enriched subtype (OR, 10.949 [95% CI: 3.262-36.747], p < 0.001), multifocal or multicentric lesions (OR, 2.467 [95% CI: 1.067-5.706], p = 0.035), segmental or regional distribution of NME (OR, 8.514 [95% CI: 1.049-69.098], p = 0.045) and rim enhancement of mass (OR, 4.261 [95% CI: 1.347-13.477], p = 0.014) were significantly associated with the discrepancy between MRI and pathology.
UNASSIGNED: Presence of DCIS, luminal B or HER2-enriched subtype, multicentric or multifocal lesions, segmental or regional distribution of NME and rim enhancement of mass may lead to a decrease in diagnostic accuracy of MRI in patients of breast cancer treated with NAC.
UNASSIGNED: A total of 225 patients with pathologically-confirmed breast cancer who underwent pre- and post-NAC breast MRI between January 2020 and April 2023 were retrospectively analyzed. All patients were categorized into radiologic complete response (rCR) and non-rCR groups based on pre-operative MRI. Univariable and multivariable logistic regression were used to identify independent clinicopathological and imaging features associated with imaging-pathological discordance. The performance of pre-operative MRI for predicting pCR to NAC was assessed according to the baseline characteristics of the clinicopathological data and pre-NAC MRI. In addition, the discrepancy between the pre-operative MRI and post-operative pathological findings was further analyzed by a case-control approach.
UNASSIGNED: Among 225 patients, 99 (44.0%) achieved pCR after NAC. MRI showed the overall sensitivity of 97.6%, specificity of 58.6%, accuracy of 80.4%, a positive predictive value (PPV) of 75.0%, and a negative predictive value (NPV) of 95.1% in identifying pCR. Of baseline features, presence of ductal carcinoma in situ (DCIS) (OR, 3.975 [95% CI: 1.448-10.908], p = 0.007), luminal B (OR, 5.076 [95% CI: 1.401-18.391], p = 0.013), HER2-enriched subtype (OR, 10.949 [95% CI: 3.262-36.747], p < 0.001), multifocal or multicentric lesions (OR, 2.467 [95% CI: 1.067-5.706], p = 0.035), segmental or regional distribution of NME (OR, 8.514 [95% CI: 1.049-69.098], p = 0.045) and rim enhancement of mass (OR, 4.261 [95% CI: 1.347-13.477], p = 0.014) were significantly associated with the discrepancy between MRI and pathology.
UNASSIGNED: Presence of DCIS, luminal B or HER2-enriched subtype, multicentric or multifocal lesions, segmental or regional distribution of NME and rim enhancement of mass may lead to a decrease in diagnostic accuracy of MRI in patients of breast cancer treated with NAC.
摘要：
■探讨治疗前的临床病理特征和MRI特征在评估乳腺癌患者对新辅助化疗（NAC）的病理完全缓解（pCR）时影响乳腺MRI的表现。
■对2020年1月至2023年4月期间行NAC前后乳腺MRI检查的225例经病理证实的乳腺癌患者进行回顾性分析。根据术前MRI将所有患者分为放射学完全缓解（rCR）和非rCR组。使用单变量和多变量逻辑回归来识别与影像学-病理学不一致相关的独立临床病理和影像学特征。根据临床病理数据的基线特征和NAC前MRI评估术前MRI预测pCR到NAC的性能。此外,通过病例对照方法进一步分析了术前MRI和术后病理结果之间的差异.
■在225名患者中，99（44.0%）在NAC后达到pCR。MRI显示总体敏感度为97.6%,特异性58.6%，精度为80.4%，阳性预测值(PPV)为75.0%，鉴定pCR的阴性预测值(NPV)为95.1%。在基线特征中，存在导管原位癌（DCIS）（OR，3.975[95%CI：1.448-10.908]，p=0.007),管腔B（或，5.076[95%CI：1.401-18.391]，p=0.013),HER2富集亚型（OR，10.949[95%CI：3.262-36.747]，p<0.001)，多灶性或多中心性病变(OR，2.467[95%CI：1.067-5.706]，p=0.035),NME的分段或区域分布(或，8.514[95%CI：1.049-69.098]，p=0.045)和轮缘质量增强(OR，4.261[95%CI：1.347-13.477]，p=0.014）与MRI和病理学之间的差异显着相关。
■存在DCIS，管腔B或HER2富集亚型，多中心或多病灶,在接受NAC治疗的乳腺癌患者中，NME的节段或区域分布和肿块边缘增强可能导致MRI诊断准确性降低。
■对2020年1月至2023年4月期间行NAC前后乳腺MRI检查的225例经病理证实的乳腺癌患者进行回顾性分析。根据术前MRI将所有患者分为放射学完全缓解（rCR）和非rCR组。使用单变量和多变量逻辑回归来识别与影像学-病理学不一致相关的独立临床病理和影像学特征。根据临床病理数据的基线特征和NAC前MRI评估术前MRI预测pCR到NAC的性能。此外,通过病例对照方法进一步分析了术前MRI和术后病理结果之间的差异.
■在225名患者中，99（44.0%）在NAC后达到pCR。MRI显示总体敏感度为97.6%,特异性58.6%，精度为80.4%，阳性预测值(PPV)为75.0%，鉴定pCR的阴性预测值(NPV)为95.1%。在基线特征中，存在导管原位癌（DCIS）（OR，3.975[95%CI：1.448-10.908]，p=0.007),管腔B（或，5.076[95%CI：1.401-18.391]，p=0.013),HER2富集亚型（OR，10.949[95%CI：3.262-36.747]，p<0.001)，多灶性或多中心性病变(OR，2.467[95%CI：1.067-5.706]，p=0.035),NME的分段或区域分布(或，8.514[95%CI：1.049-69.098]，p=0.045)和轮缘质量增强(OR，4.261[95%CI：1.347-13.477]，p=0.014）与MRI和病理学之间的差异显着相关。
■存在DCIS，管腔B或HER2富集亚型，多中心或多病灶,在接受NAC治疗的乳腺癌患者中，NME的节段或区域分布和肿块边缘增强可能导致MRI诊断准确性降低。
