目的

评价动态增强磁共振联合弥散加权成像在新辅助化疗乳腺癌患者术前评估中的作用。

方法

30位经巴德针（Bard magnum biopsy needles）穿刺活检确诊为乳腺癌的患者， 临床分期Ⅱ_A～Ⅲ_C，均予以新辅助化疗（含紫杉醇类和/或蒽环类）2～5 周期。 所有患者手术前均行磁共振成像（MRI）、B超及临床检查，以术后病理检查结果为金标准，3 种方法所测出肿块的最长径与最短径分别与之相对比，评价MRI 在评估肿块大小范围上的准确性及在判断肿块化疗后形态改变上的作用，并且评估MRI 在判断腋窝淋巴结转移方面的作用。

结果

MRI 检查测出的肿块最长径与病理检查测出的最长径的关联性最高（ r=0.840， P﹤0.05），B超检查与病理检查呈中度关联（ r=0.635，P﹤0.05） ，临床检查与病理检查的关联性最低（ r=0.583， P﹤0.05） ；最短径得出的结果与之类似。新辅助化疗后残留肿块在MRI 上呈现两种形态：20%为多发结节型及树枝型，80%为单发结节型。MRI 在腋窝淋巴结是否转移的判断上，敏感度为45.5% ，特异度为50.0% ，准确度为46.7% 。 根据最后动态增强磁共振联合弥散加权成像的结果，有5 例患者改变了原订的手术方案。

结论

动态增强磁共振联合弥散加权成像在乳腺癌新辅助化疗后能更好评估残留癌的范围及形态，帮助外科医师更好地进行术前评估，更好地选择手术方式和确定手术切缘，但其在判断腋窝淋巴结状态的价值有待进一步探讨。

Objective

To evaluate the effectiveness of dynamic-enhanced magnetic resonance imaging （MRI） with diffusion-weighted imaging for preoperative evaluation of breast cancer patients treated with neoadjuvant chemotherapy （NAC）.

Methods

Thirty patients with clinical stage Ⅱ_A ～Ⅲ_C breast cancer diagnosed by Bard magnum biopsy needles were enrolled in this study. NAC with paclitaxel or adriamycin or combination of both was given to all the patients. After NAC they were examined by caliper， ultrasonography and dynamic-enhanced MRI with diffusion-weighted imaging before operation. The pathological results were taken as gold standard. The longest diameters and the shortest diameters determined by the three methods mentioned above were compared with the pathological results in order to judge the accuracy of MRI evaluation of the residual tumor size and morphouses and evaluate the role of MRI in judging whether axillary nodes were metastasized.

Results

A strong correlation of the longest diameter between MRI and pathology （ r=0.840， P﹤0.005）， a moderate correlation between ultrasonography and pathology （ r = 0.635， P﹤0.005）， and a moderate correlation between calipers and pathology（ r=0.583，P﹤0.005） were observed.Essentially the same results were obtained for the shortest diameters， that is， the strongest correlation was found between MRI and pathology. Residual tumors after NAC presented two morphouses： 20% with multinodus and branches， and 80% with single nodus. Whether axillary nodes were metastasized by MRI， dy namic-enhanced MRI with diffusion-weighted imaging，showing45. 5 % sensitivitiy，50. 0 % specificity，and 46.7% accuracy rating. According to the final result of dynamic-enhanced MRI with diffusion-weighted imaging，the original operation plans were changed in 5 patients.

Conclusions

Dynamic-enhanced MRI with diffusion-weighted imaging can evaluate the residual tumor size and morphouses after NAC exactly， which helps surgeons with preoperative evaluation and selecting better operation plans and margins. It is better than conventional methods. But for detecting the metastasis status of axillary nodes， further investigation is needed.