不同MRI测量方式评估乳腺癌新辅助治疗疗效的临床价值

doi:10.3969/j.issn.1006-5725.2025.14.005

摘要/Abstract

摘要：

目的比较乳腺磁共振（MRI）三种测量方法——RECIST 1.1标准、最优法和三维（3D）体积测量法在乳腺癌新辅助化疗（NAC）疗效评估中的诊断性能差异，筛选更具临床实用性的影像学评估方式。方法纳入2019—2023年间接受NAC及手术治疗的乳腺癌患者110例。化疗前后分别于1周内完成乳腺MRI，采用RECIST 1.1、最优法和3D体积测量法进行疗效评估，以MP病理分级为金标准。比较3种方法的敏感度、特异度、准确性及受试者工作特征曲线（ROC）下面积（AUC），并通过Delong检验进行统计比较。结果 RECIST 1.1、最优法和3D测量法的AUC分别为0.768、0.795和0.883，3D体积测量法显著优于其他两种方法（P < 0.05）。3D法在敏感度（98.9%）、特异度（77.8%）和准确性（95.5%）方面均表现最优。最优法在部分指标上亦优于RECIST 1.1。结论 3D体积测量法在乳腺癌NAC疗效评估中显示出最佳的诊断性能，具有更高的临床应用价值。最优法相较于传统RECIST 1.1方法也表现出更优的判别能力，是资源受限情况下的可行替代方案。

关键词: 乳腺癌, 磁共振成像, 新辅助化疗, 三维测量, 疗效评估, ROC曲线

Abstract:

Objective To compare the diagnostic performance of three breast MRI measurement methods—RECIST 1.1， the optimal method， and three-dimensional （3D） volumetric assessment—in assessing the efficacy of neoadjuvant chemotherapy （NAC） in breast cancer patients， with the objective of identifying the most clinically practical approach. Methods A total of 110 breast cancer patients who underwent NAC followed by surgical treatment between 2019 and 2023 were included in the study. Breast magnetic resonance imaging （MRI） was conducted within one week before and after the completion of NAC. Tumor response was evaluated using RECIST 1.1 criteria， widely recognized as the optimal method， as well as 3D volume measurement. Pathological response was determined according to the Miller-Payne grading system. Sensitivity， specificity， accuracy， and the area under the receiver operating characteristic curve （AUC） were computed and compared using the DeLong test. Results The AUC values for RECIST 1.1， the optimal method， and 3D volumetric assessment were 0.768， 0.795， and 0.883， respectively. The 3D volumetric assessment exhibited significantly better discriminative performance （P < 0.05）， with the highest sensitivity （98.9%）， specificity （77.8%）， and accuracy （95.5%）. Additionally， the optimal method demonstrated superior performance over RECIST 1.1 across multiple parameters. Conclusions 3D volumetric measurement demonstrates superior performance compared to RECIST 1.1 and the optimal method in evaluating the response to NAC， offering a more accurate and comprehensive assessment tool. Additionally， the optimal method shows advantages over RECIST 1.1 and may serve as a practical alternative in settings where 3D software is not available.

Key words: breast cancer, magnetic resonance imaging, neoadjuvant chemotherapy, 3D volume measurement, efficacy evaluation, ROC curve

中图分类号:

R455.2

段玉灵,周雪枝,李永义,马丽霞,杨德盛,程姣,伍燕,刘桃,蒋国元,王梅. 不同MRI测量方式评估乳腺癌新辅助治疗疗效的临床价值[J]. 实用医学杂志, 2025, 41(14): 2152-2159.

Yuling DUAN,Xuezhi ZHOU,Yongyi LI,Lixia MA,Desheng YANG,Jiao CHENG,Yan WU,Tao LIU,Guoyuan JIANG,Mei. WANG. Clinical value analysis of different MRI measurement methods in evaluating the efficacy of neoadjuvant therapy for breast cancer[J]. The Journal of Practical Medicine, 2025, 41(14): 2152-2159.

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疗效评估	RISIST 1.1	二维面积评估标准	体积评估标准
CR	所有肿瘤病灶完全消失	所有肿瘤病灶完全消失	所有肿瘤病灶完全消失
PR	病灶最长直径缩小≥ 30%	病灶最长直径及其垂直径乘积缩小≥50%	病灶体积缩小≥ 65%
SD	病灶变化介于PR与PD之间	病灶变化介于PR与PD之间	病灶变化介于PR与PD之间
PD	靶病灶长径和增加20%或出现新病灶	靶病灶最长直径及其垂直径乘积增加≥ 25%或出现新病灶	增加73%或出现新病灶

检查方法	敏感度	特异度	PPV	NPV	假阴性率	假阳性率	准确性
RECIST 1.1	92.4	61.1	92.4	61.1	7.6	38.9	87.3
最优法	97.8	61.1	92.8	84.6	2.2	38.9	91.8
3D体积法	98.9	77.8	95.8	93.3	1.1	22.2	95.5

项目	3D体积测量法	最优法	Z值	P值
敏感度	98.9	97.8	0.636	0.52
特异度	77.8	61.1	2.683	< 0.01
准确性	95.5	91.8	1.105	0.27
PPV	95.8	92.4	0.960	0.34
NPV	93.3	84.6	2.064	< 0.05

项目	最优法	RECIST 1.1	Z值	P值
敏感度	97.8	92.4	1.869	0.06
特异度	61.1	61.1	0.000	1.00
准确性	91.8	87.3	1.102	0.27
PPV	92.4	92.4	0.111	0.91
NPV	84.6	61.1	3.920	< 0.01

项目	区域	标准误	95%CI
项目	区域	标准误	下限	上限
3D	0.883	0.059	0.767	1.000
RESISIT	0.768	0.072	0.626	0.909
最优	0.795	0.073	0.653	0.937