对比增强能谱乳腺摄影对乳腺癌新辅助化疗的效果评估及与分期和分子分型的关系研究

Assessment of contrast-enhanced spectral mammography for evaluating the efficacy of neoadjuvant chemotherapy in breast cancer and its relationship with staging and molecular subtypes

摘要:

目的 探讨在乳腺癌新辅助化疗效果评估中，对比增强能谱乳腺摄影（CESM）的应用价值及CESM特征与乳腺癌分期和分子分型的关系。方法 选取2021年5月—2022年10月在河北大学附属医院就诊的87例乳腺癌患者，均给予新辅助化疗，以及CESM和磁共振成像（MRI）检查，分析CESM及MRI判断乳腺癌新辅助化疗的价值，同时分析不同临床分期、分子分型病灶CESM影像特征差异。结果 CESM判断化疗疗效与病理疗效判断，结果一致性较好（κ =0.800，P <0.05）；判断化疗有效的敏感性、特异性、准确性、阳性预测值和阴性预测值比较，CESM和MRI差异无统计学意义（P >0.05）；临床分期Ⅰ期、Ⅱ期和Ⅲ期病灶CESM影像特点比较，差异无统计学意义（P >0.05）；Luminal A型、Luminal B型、三阴性型病灶病灶直径、形态不规则、病灶边界模糊和明显强化比较，差异有统计学意义（P <0.05），Luminal A型病灶直径> 2 cm、形态不规则和明显强化占比分别为25.47%、29.41%和14.71%，明显低于Luminal B型、三阴性型病灶（P <0.05），而病灶边界模糊占比为70.59%，明显高于Luminal B型、三阴性型病灶（P <0.05）；Luminal A型、Luminal B型、三阴性型病灶有钙化占比比较，差异无统计学意义（P >0.05）。结论 CESM评估乳腺癌新辅助化疗效果有较好的效果，同时病灶直径、形态、边界、强化等CESM特征与乳腺癌分子分型有关。

Abstract:

Objective This study aimed to investigate the application value of Contrast-Enhanced Spectral Mammography (CESM) in evaluating the efficacy of neoadjuvant chemotherapy (NAC) in breast cancer and to explore the relationship between CESM features and breast cancer staging as well as molecular subtypes.Methods A total of 87 breast cancer patients treated with neoadjuvant chemotherapy at Hebei University Affiliated Hospital between May 2021 and October 2022 were included in this study. CESM and magnetic resonance imaging (MRI) were performed to assess the value of CESM and MRI in predicting the response to neoadjuvant chemotherapy. Additionally, the differences in CESM imaging characteristics among different clinical stages and molecular subtypes of breast cancer lesions were analyzed.Results CESM showed good consistency with pathological assessment of chemotherapy response (κ = 0.800, P < 0.05). There were no statistically significant differences in sensitivity, specificity, accuracy, positive predictive value, and negative predictive value between CESM and MRI in assessing chemotherapy effectiveness (P > 0.05). The CESM imaging characteristics of lesions in clinical stages I, Ⅱ, and Ⅲ showed no significant differences (P > 0.05). However, significant differences were observed in lesion diameter, irregular shape, indistinct borders, and significant enhancement among Luminal A, Luminal B, and Triple-negative subtypes (P < 0.05). Notably, the proportion of Luminal A subtype lesions with a diameter > 2 cm, irregular shape, and significant enhancement was significantly lower than that of Luminal B and Triple-negative subtypes (P < 0.05), while the proportion with indistinct borders was significantly higher (P < 0.05). There were no significant differences in the proportion of lesions with calcifications among Luminal A, Luminal B, and Triple-negative subtypes (P > 0.05).Conclusion CESM is effective in evaluating the efficacy of neoadjuvant chemotherapy in breast cancer. Additionally, CESM features such as lesion diameter, shape, borders, and enhancement are associated with breast cancer molecular subtypes.