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

Abstract

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

CLC Number:

R455.2

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.

Figures/Tables 9

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References 42

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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

Clinical value analysis of different MRI measurement methods in evaluating the efficacy of neoadjuvant therapy for breast cancer

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