摘要目的 基于三维测量技术分析MRI评价乳腺癌新辅助化疗(NAC)后残余肿瘤的准确性和临床价值.方法 选取2010年7月至2013年8月山东省肿瘤医院乳腺病中心接受6～8周期NAC的61例乳腺浸润性导管癌患者为研究对象进行前瞻性研究.患者年龄31 ～ 70岁,中位年龄49岁.NAC后行MRI检查.NAC后手术标本制作次连续病理大切片,显微镜下勾画残余肿瘤范围,Photoshop软件配准,3D-DOCTOR软件三维重建病理及MRI残余肿瘤,三维测量病理和MRI残余肿瘤的最大径、最大截面积和体积,分别采用Spearman秩相关检验和Bland-Altman法评价两者测量残余肿瘤范围的相关性和一致性.结果 病理和MRI对残余肿瘤的最大径、最大截面积和体积的测量结果呈正相关(r分别为0.942、0.941、0.903,均P=0.00),在残余肿瘤的最大径、最大截面积方面,病理与MRI的相关性优于超声二维测量(Z=6.48、6.18,均P=0.00).MRI对最大径和最大截面积的测量较病理略有低估,而对体积的测量较病理略有高估,两者一致性较好(最大径平均差值0.3 cm,95％ CI:-1.43 ～1.90 cm;最大截面积平均差值1.39 cm2,95％ CI:-9.55～12.34 cm2;体积平均差值-0.433 cm3,95％CI:-7.065～6.199 cm3).结论 NAC后MRI三维重建图像能准确评价残余肿瘤的立体空间范围,有助于选择NAC后降期保乳患者.

abstractsObjective To evaluate the accuracy of MRI for estimating residual tumor size after neoadjuvant chemotherapy (NAC) with three-dimensional (3D) reconstruction technique.Methods This was a prospective study.The data of 61 patients with pathologically proven solitary invasive ductal carcinoma (Ⅱ A-ⅢC) who had received 6 to 8 cycles of NAC from July 2010 to August 2013 was analyzed.All the patients were female,aging from 31 to 70 years with a median of 49 years.Breast specimen after surgery was prepared with part-mount sub-serial section,and residual tumors were microscopically outlined,scanned and registered by Photoshop software.The 3D model of pathological and MRI residual tumors was reconstructed with 3D-DOCTOR software.The longest diameter,maximum cross-section area and volume of the residual tumors determined using 3D MRI were compared with 3D pathological findings,and the associations between MRI and pathology were analyzed by Spearman rank correlation and Bland-Altman analysis.Results The longest diameter,maximum cross-section area and volume of the residual tumors after NAC measured by MRI and pathology was highly correlated (r =0.942,0.941,0.903,all P =0.00).MRI appears to underestimate pathology in the longest diameter,maximum cross-section area,but slightly overestimate in volume,and two methods had a good consistence (MD =0.3 cm,95％ CI:-1.43 to 1.9 cm; MD =1.39 cm2,95％ CI:-9.55 to 12.34 cm2 ; MD =-0.433 cm3,95％ CI:-7.065 to 6.199 cm3).Conclusion 3D MRI reconstruction after NAC could accurately detects the residual tumors after neoadjuvant chemotherapy,and contribute to select patients who received breast conserving therapy after NAC with tumor downstaging.