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Neoadjuvante Chemotherapie des Mammakarzinoms

Welche posttherapeutischen (präoperativen) Informationen liefert die quantitative dynamische MRT?

Neoadjuvant chemotherapy of breast carcinomas

What post-therapeutic (preoperative) information is provided by quantitative dynamic MRI?

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Zusammenfassung

Fragestellung

Stehen die quantitativen Veränderungen der Kontrastmittel- (KM-)Dynamik des Mammakarzinoms nach neoadjuvanter Chemotherapie (NC) in Zusammenhang mit der histologischen Tumorregression? Wie genau ist die präoperative Tumorausdehnung anhand der quantitativen dynamischen MRT (dMRT) bestimmbar, verglichen mit Mammographie (MG) und Ultraschall (US)?

Methodik

31 Patientinnen erhielten vor und nach NC eine MRT. Die mittels Turbo-FLASH-Sequenz untersuchte KM-Dynamik wurde mit einem Zweikompartimentemodell mit den Parametern A (Amplitude) und kep (Austauschratenkonstante) quantifiziert und farbkodiert.

Ergebnisse

Tumoren mit histologischer Regression im Operationspräparat (n=17) zeigten gegenüber Tumoren ohne Regression (n=12) einen signifikanten Rückgang der Parameter A und kep. Die Korrelation zwischen der Tumorgröße in der dMRT und Histopathologie betrug r=0,81, wenn Areale mit unspezifischer KM-Dynamik berücksichtigt wurden; ohne Berücksichtigung r=0,66 mit systematischer Unterschätzung. In 26 Fällen war eine Gegenüberstellung zur MG möglich (r=0,51; MRT r=0,80), in 22 Fällen zum US (r=0,60; MRT r=0,75).

Schlussfolgerung

Veränderungen in der KM-Dynamik stehen im Zusammenhang mit der histologischen Tumorregression. Die dMRT ermöglicht eine valide Bestimmung des Resttumors mit Überlegenheit gegenüber MG und US. Verbliebene unspezifische KM-Anreicherungen im Tumorbett sollten als potenziell maligne angesehen werden.

Abstract

Purpose

The aim of this study was to evaluate whether quantitative changes in contrast enhancement (CE) after neoadjuvant chemotherapy (NC) are associated with histological signs of tumor regression and whether quantitative dynamic MRI (dMRI) is capable of accurately assessing preoperative tumor size compared to mammography (MG) and ultrasound (US).

Methods

Thirty-one patients with breast cancer underwent MRI before and after NC. Dynamic CE was measured using a turbo-FLASH sequence and quantified by a two-compartment model, where two parameters, kep (distribution constant rate) and A (amplitude), were calculated and color mapped.

Results

When tumors had signs of histological regression in the operative specimen (n=17) decrease of the parameters A and kep was significantly more marked compared to tumors without regression (n=12). The correlation between tumor size measured by dMRI and histopathology was 0.81 when areas of unspecific CE were included; when they were not included the correlation was 0.66 and tumor size was systematically underestimated. In 26 patients dMRI was retrospectively compared with MG (r=0.51; dMRI, r=0.80) and in 22 patients with US (r=0.60; dMRI, r=0.75).

Conclusion

Changes in dynamic CE are associated with histological tumor regression. Quantitative dMRI enables a valid assessment of tumor residue and is superior to MG and US. Remaining unspecific CE within the original tumor site should be considered as potentially malignant.

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Authors and Affiliations

  1. Abteilung onkologische Diagnostik und Therapie, Deutsches Krebsforschungszentrum Heidelberg

    K. Wasser, H. U. Kauczor & S. Delorme

  2. Institut für klinische Radiologie, Universitätsklinikum Mannheim

    K. Wasser & W. Neff

  3. Abteilung gynäkologische Radiologie, Radiologische Universitätsklinik Heidelberg

    S. K. Klein & S. Darai

  4. Zentralkrankenhaus Bremen

    H. Junkermann

  5. Institut für Pathologie, Universität Heidelberg

    H. P. Sinn

  6. Institut für klinische Radiologie, Universitätsklinikum, Theodor-Kutzer-Ufer 1–3, 68167 , Mannheim

    K. Wasser

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  1. K. Wasser
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Correspondence to K. Wasser.

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Wasser, K., Klein, S.K., Junkermann, H. et al. Neoadjuvante Chemotherapie des Mammakarzinoms. Radiologe 47, 421–429 (2007). https://doi.org/10.1007/s00117-005-1303-1

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