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近年来,全球乳腺癌发病率呈上升趋势,且发病年龄年轻化。据2008年统计数据显示,我国城市的乳腺癌发病率高于农村,50岁以上妇女的发病率高于其他年龄段[1]。新辅助化疗(neoadjuvant chemotherapy,NAC)是指手术前给予的化疗,可早期治疗微小转移灶,缩小肿瘤,能够指导手术及术后治疗计划,确定患者对化疗的敏感度,避免发生抗药性等。NAC也可降低临床分期,使更多患者得到保乳治疗的机会,在相当程度上提高治愈率,所以正确评价NAC的疗效是关键。
影像学检查对乳腺癌NAC的疗效评价一般包括:检测肿瘤在NAC前、后大小的变化;判断肿瘤边界;观测病变区的代谢、功能及血管分布变化等。早期实体瘤评价常用标准为WHO的实体瘤疗效评价标准,将评价结果分为:完全缓解(无肿瘤残留)、部分反应(肿瘤缩小50%以上)、进展(肿瘤增大超过25%或出现新发病灶)和稳定(肿瘤变化介于部分反应与进展之间)。由于肿瘤的代谢改变较形态学大小改变发生更早,早期观测其分子生物学改变要优于单纯观测其形态学改变。
多种影像学方法评价乳腺癌新辅助化疗疗效的价值比较
Comparision on the values of different image modalities in monitoring the response to neoadjuvant chemotherapy in breast cancer patients
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摘要: 影像学方法在乳腺癌新辅助化疗(NAC)疗效评价中具有重要地位。钼靶X线操作简单,曾是早期发现乳腺癌的简便、有效的方法,可显示微小钙化灶,但不常用于疗效评价;CT适应人群广、扫描时间短、密度分辨率高,后处理时可以三维重建以更好显示癌灶,可用于诊断及疗效评价;MRI具有多种参数和良好的软组织分辨率,可显示癌灶周围的微小浸润及炎症反应;超声无放射性、检查角度灵活、可重复性强,可以显示病灶和转移淋巴结的形态、结构及血流,并引导介入操作。PET/CT显像可以反映肿瘤细胞的代谢水平,其将分子代谢变化与解剖结构的准确定位相结合,在评估NAC疗效方面拥有更高的灵敏度及特异度,比单纯测量肿瘤大小的改变更准确。
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关键词:
- 乳腺肿瘤 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 磁共振成像 /
- 超声检查 /
- 乳房X线摄影术 /
- 肿瘤辅助疗法
Abstract: Imaging examinations are important in monitoring the response to neoadjuvant chemotherapy(NAC) in breast cancer patients. Mammography is easy to operate, which used to be the predominant imaging procedure used for breast cancer screening. It has great advantage in the detection of calcification, but it is not commonly used in therapeutic evaluation. CT provides high-spatial resolution, clear anatomical structures and powerful reconstruction ability, and the post-processing 3D reconstruction can show cancer more clearly, which could be used for diagnosis and therapeutic evaluation. MRI gives various sequence parameters to choose and provides the best soft tissue resolution which can show the small infiltration and inflammatory reaction around the tumor. Ultrasonic examination, as a technique without radioactivity, can show the shapes, structures and blood supplies of tumor sites and lymph node metastasis, and also can used as guidance for intervention procedures. PET/CT has unique advantage in monitoring the response to NAC by observing the changes of tumor metabolism. The image fusion of molecular metabolic changes and anatomical location can offer higher sensibility and specificity in curative effect of NAC, which is more accurate than measuring the tumor size. -
[1] 周纯武, 李二妮.乳腺影像学发展历程及展望[J].中华放射学杂志, 2013, 47增刊: 27-29. doi: 10.3760/cma.j.issn.1005-1201.2013.z1.008
[2] 田荣华, 王艳, 汪娇, 等.钼靶X线对乳腺癌的诊断(附174例分析)[J].实用放射学杂志, 2011, 27(11): 1670-1672. doi: 10.3969/j.issn.1002-1671.2011.11.015
[3] 张洪涛, 赵一冰, 宋培记, 等.钼靶乳腺摄像在乳腺癌新辅助化疗疗效评价中的应用[J].军事医学, 2012, 36(8): 616-618. doi: 10.3969/j.issn.1674-9960.2012.08.016
[4] Sperber F, Weinstein Y, Sarid D, et al. Preoperative clinical, mammographic and sonographic assessment of neoadjuvant chemotherapy response in breast cancer[J]. Isr Med Assoc J, 2006, 8(5): 342-346. [5] 夏晓天, 张永学.影像学检查在乳腺癌的诊断及疗效评估中的应用价值[J].国际放射医学核医学杂志, 2010, 34(4): 242-246, 249. doi: 10.3760/cma.j.issn.1673-4114.2010.04.014
[6] Belli P, Costantini M, Malaspina C, et al. MRI accuracy in residual disease evaluation in breast cancer patients treated with neoadjuvant chemotherapy[J]. Clin Radiol, 2006, 61(11): 946-953. doi: 10.1016/j.crad.2006.07.004 [7] Choi JH, Lim HJ, Lee SK, et al. The role of PET CT to evaluate the response to neoadjuvant chemotherapy in advanced breast cancer: comparison with ultrasonography and magnetic resonance imaging[J]. J Sur Oncol, 2010, 102(5): 392-397. [8] Wu LM, HuJN, Gu HY, et al. Can diffusion-weighted MR imaging and contrast-enhanced MR imaging precisely evaluate and predict pathological response to neoadjuvant chemotherapy in patients with breast cancer?[J]. Breast Cancer Res Treat, 2012, 135(1): 17-28. [9] 袁建伟, 杨劼, 贺小红, 等.乳腺癌18F-FDG PET/CT和3. 0T MRI联合显像评分与Ki-67表达水平的相关性分析[J].国际放射医学核医学杂志, 2013, 37(2): 84-87. doi: 10.3760/cma.j.issn.1673-4114.2013.02.006
[10] 郁骐襄, 陈小松, 沈坤炜. MRI在乳腺癌新辅助化疗中的地位[J].中华外科学杂志, 2011, 49(9): 845-847.
[11] 李蔚萍, 苗华栋, 唐健雄, 等.多排螺旋CT在乳腺癌诊断和术前评估中的价值[J].中华普通外科杂志, 2011, 26(1): 29-32. doi: 10.3760/cma.j.issn.1007-631X.2011.01.010
[12] 徐民, 纪建松, 卢陈英, 等.多层螺旋CT对进展期乳腺癌新辅助化疗的疗效评估[J].医学影像学杂志, 2012, 22(10): 1677-1680. doi: 10.3969/j.issn.1006-9011.2012.10.025
[13] Tozaki M, Kobayashi T, Uno S, et al. Breast-conserving surgery after chemotherapy: value of MDCT for determining tumor distribution and shrinkage pattern[J]. AJR Am J Roentgenol, 2006, 186(2): 431-439. doi: 10.2214/AJR.04.1520 [14] 黄朝光, 辛付莹, 鲁毅.彩超、钼靶评价新辅助化疗疗效的应用研究[J].中外医疗, 2011(17): 181. doi: 10.3969/j.issn.1674-0742.2011.17.140
[15] Chen M, Zhan WW, Han BS, et al. Accuracy of physical examination, ultrasonography, and magnetic resonance imaging in predicting response to neo-adjuvant chemotherapy for breast cancer[J]. Chin Med J(Engl), 2012, 120: 1862-1866. [16] Cao X, Xue J, Zhao B, et al. Potential application value of contrast-enhanced ultrasound in neoadjuvant chemotherapy of breast cancer[J]. Ultrasound Med Biol, 2012, 38(12): 2065-2071. doi: 10.1016/j.ultrasmedbio.2012.07.027 [17] 陈谦谦, 薛恩生.超声、钼靶X线联合MRI在乳腺癌术前评价中的应用[J].中国医学影像学杂志, 2012, 20(2): 148-152. doi: 10.3969/j.issn.1005-5185.2012.02.023
[18] Dietl B, Marienhagen J. The therapeutic impact of 18F-FDG whole body PET A radiooncologist's view[J]. Nuklearmedizin, 2005, 44(1): 8-14. [19] 席云, 张敏, 郭睿, 等. 18F-FDG PET或PET/CT评估乳腺癌新辅助化疗疗效价值的meta分析[J].中华核医学与分子影像杂志, 2012, 32(3): 192-197. doi: 10.3760/cma.j.issn.2095-2848.2012.03.008
[20] 贾丽, 于金明, 王仁本, 等. 18F-FDG PET/CT对乳腺癌新辅助化疗疗效预测的价值[J].中国肿瘤临床与康复, 2006, 13(3): 215-218. doi: 10.3969/j.issn.1005-8664.2006.03.009
[21] Humbert O, Berriolo-Riedinger A, Riedinger JM, et al. Changes in 18F-FDG tumor metabolism after a first course of neoadjuvant chemotherapy in breast cancer: influence of tumor subtypes[J]. Ann Oncol, 2012, 23(10): 2572-2577. doi: 10.1093/annonc/mds071 [22] Kumar A, Kumar R, Seenu V, et al. The role of 18F-FDG PET/CT in evaluation of early response to neoadjuvant chemotherapy in patients with locally advanced breast cancer[J]. Eur Radiol, 2009, 19(6): 1347-1357. doi: 10.1007/s00330-009-1303-z [23] Andrade WP, Lima EN, Osório CA, et al. Can FDG-PET/CT predict early response to neoadjuvant chemotherapy in breast cancer?[J]. Eur J Sur Onco, 2013, 39(12): 1358-1363. doi: 10.1016/j.ejso.2013.08.025 [24] Koolen BB, Valdés Olmos RA, Elkhuizen PH, et al. Locoregional lymph node involvement on 18F-FDG PET/CT in breast cancer patients scheduled for neoadjuvant chemotherapy[J]. Breast Cancer Res Treat. 2012, 135(1): 231-240. doi: 10.1007/s10549-012-2179-1 [25] Koolen BB, Vranckhen Peeters MJ, Aukema TS, et al. 18F-FDG PET/CT as a staging procedure in primary stage Ⅱ and Ⅲ breast cancer: comparison with conventional imaging techniques[J]. Breast Cancer Res Treat, 2012, 131(1): 117-126. [26] 吴建伟, 高红, 艾书跃, 等. PET/CT对乳腺癌术后转移的诊断意义[J].医学研究生学报, 2013, 26(1): 41-44. doi: 10.3969/j.issn.1008-8199.2013.01.012
[27] Smyezek-Gargya B, Fersis N, Dittmann H, et al. PET with[18F]fluorothymidine for imaging of primary breast cancer: a pilot study[J]. Eur J Nucl Med Mol Imaging, 2004, 31(5): 720-724. doi: 10.1007/s00259-004-1462-8 [28] van Waarde A, Cobben DC, Suurmeijer AJ, et al. Selectivity of 18F-FLT and 18F-FDG for differentiating tumor from inflammation in a rodent model[J]. J Nucl Med, 2004, 45(4): 695-700. [29] Yamamoto Y, Nishiyama Y, Ishikawa S, et al. 3'-Deoxy-3'-18F-fluorothymidine as a proliferation imaging tracer for diagnosis of lung tumors: comparison with 2-deoxy-2-18f-fluoro-D-glucose[J]. J Compute Assist Tomogr, 2008, 32(3): 432-437. doi: 10.1097/RCT.0b013e3180980db9 [30] 陈雷, 柳曦. 18F-FDG和18F-FLT的正电子发射断层显像对肿瘤放化疗疗效评价的实验研究[J].中国医药导报, 2013, 10(18): 41-43. doi: 10.3969/j.issn.1673-7210.2013.18.014
[31] Peterson LM, Mankoff DA, Lawton T, et al. Quantitative imaging of estrogen receptor expression in breast cancer with PET and 18F-fluoroestradiol[J]. J Nucl Med, 2008, 49(3): 367-374. [32] Dehdashti F, Flanagan FL, Mortimer JE, et al. Positron emission tomographic assessment of "metabolic flare" to predict response of metastatic breast cancer to antiestrogen therapy[J]. Eur J Nucl Med, 1999, 26(1): 51-56. [33] Mortimer JE, Dehdashti F, Siegel BA, et al. Metabolic flare: indicator of hormone responsiveness in advanced breast cancer[J]. J Clin Oncol, 2001, 19(11): 2797-2803. doi: 10.1200/JCO.2001.19.11.2797 [34] Brepoels L, Stroobants S, Verhoef G, et al. 18F-FDG and 18F-FLT uptake early after cyclophosphamide and mTOR inhibition in an experimental lymphoma model[J]. J Nucl Med, 2009, 50(7): 1102-1109. doi: 10.2967/jnumed.109.062208 [35] Song SL, Liu JJ, Huang G, et al. Changes in 18F-FDG uptake within minutes after chemotherapy in a rabbit VX2 tumor model[J]. J Nucl Med, 2008, 49(2): 303-309.
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