| objectiveThe dynamic changes of ADC values before and after chemotherapy for locally advanced breast cancer were prospectively studied,and the best time window for predicting NAC responses of different subtypes of advanced breast cancer was established.Materials and methodsPatients with breast cancer before and after chemotherapy were selected as the research group,and patients with non-puerperal mastitis mastitis and benign breast tumors in the same period as the control group.All cases were confirmed by pathology.Routine,dynamic contrast-enhanced and DWI scans were performed with 3.OT MR.The diffusion sensitivity coefficient B was 1000s/mm2.MR images were analyzed blindly by two doctors.1.Retrospective analysis of diffusion-weighted imaging in the diagnosis of breast cancer and non-breast-feeding mastitis,and the relationship between ADC value and pathological grade of breast cancer.2.To compare the diagnostic value of different methods of magnetic resonance imaging in breast tumors.Draw time-signal intensity curve,measure ADC value and dynamic enhancement semi-quantitative(slope,SER)parameter value.3.Patients were divided into anthracycline group,paclitaxel group and paclitaxel combined with anthracycline group according to the chemotherapy regimen.The time points of MR examination were before chemotherapy(1 time)and after each cycle of chemotherapy(7 times).SPSS 19.0 statistical software was used.The measurements were expressed as(x±s).Two independent samples t test were used for comparison between groups,and χ2 test was used for comparison of counting data.The difference was statistically significant with P<0.05.Result1.On DWI,breast cancer showed high signal,inflammatory lesions showed diffusehigh signal or heterogeneous high signal,while benign tumors showed slightly high signal.On ADC,breast cancer is low signal,inflammatory lesions are high signal,and benign tumors are intermediate signal.The ADC value of solid components of breast malignant tumors was(0.813(+0.277)x10-3 mm2/s,and that of mastitis cases was(1.369(+0.217)x10-3 mm2/s’There was a significant difference between the two groups(P<0.05).2.The ADC value of breast cancer grade Ⅰ was higher,followed by grade Ⅱ,and gradeⅢ was the lowest.There were significant differences between groups(P<0.05).The ADC value was contrary to the pathological grade(r=-0.947,P<0.05);there was no significant difference between ADC value and different pathological types(P>0.05).3.There were significant differences in DWI between benign and malignant breast tumors.Dynamic contrast-enhanced scan:Type Ⅱ curve is visible in benign and malignant tumors.The difference between benign and malignant breast tumors of slope and SER was statistically significant(P<0.01).Compared with benign and malignant breast tumors,ADC value was the highest,signal enhancement rate was medium,and early enhancement rate was the lowest.4.The ADC values of different genotypes were significantly different between the PCR and non-PCR groups(P<0.05).Therefore,the baseline time point can be considered as the best time point regardless of the genome subtype.ADC values of pCR group and non-pCR group were different at most time points(p<0.05).5.For Luminal A or Luminal B subtypes,the ideal time for chemotherapy was after T1 in the taxanes or anthracyclines group.For Basal-like or HER2-enriched subtypes,post-T2 is the ideal time point during chemotherapy.In the taxanes combined with anthracycline chemotherapy group,Luminal A subtype was treated after T2 as the ideal time point,while the other subtypes were treated after T1 as the ideal time point.conclusionFirst,the characteristics of DWI signal in non-lactating mammary inflammation and breast cancer are obviously different.The ADC value of breast cancer is lower than that of mastitis tissue.The pathological grade of breast cancer is was inversely correlated with the ADC value.Therefore,DWI scanning can be used as an important index for differential diagnosis and pathological grading of breast cancer and mastitis.Secondly,there are limitations in using this method to evaluate benign and malignant breast tumors.Combining the DWI and ADC values can better evaluate quantitatively,and finally get a definite diagnosis.Thirdly,DWI and ADC value have remarkable effect in evaluating the efficacy of NAC.The time point before NAC treatment can be considered as the best time point,regardless of genomic subtypes.For all chemotherapy regimen,the optimal time point during chemotherapy varies from genome subtype to genome subtype.ADC is a more valuable parameter for evaluating tumor response.These results provide useful information for predicting the pathological response of NAC and provide useful guidance for more rapid adjustment of individual treatment regimens. |
