دانلود رایگان مقاله انگلیسی نقش MRI در تشخیص بهبودی کامل و پاتولوژیکی بیماران مبتلا به سرطان سینه - الزویر 2017

Abstract

Pathologic complete remission after neoadjuvant chemotherapy has a role in guiding the management of breast cancer. The present meta-analysis examined the accuracy of contrast-enhanced magnetic resonance imaging (CEMRI) and diffusion-weighted magnetic resonance imaging (DW-MRI) in detecting the response to neoadjuvant chemotherapy and compared CE-MRI with ultrasonography, mammography, and positron emission tomography/ computed tomography (PET/CT). Medical subject heading terms and related keywords were searched to generate a compilation of eligible studies. The pooled sensitivity, specificity, diagnostic odds ratio, area under summary receiver operating characteristic curve (AUC), and Youden index (Q* index) were used to estimate the diagnostic efficacy of CE-MRI, DW-MRI, ultrasonography, mammography, and PET/CT. A total of 54 studies of CE-MRI and 8 studies of DW-MRI were included. The overall AUC and the Q* index values for CE-MRI and DW-MRI were 0.88 and 0.94 and 0.80 and 0.85, respectively. According to the summary receiver operating characteristic curves, CE-MRI resulted in a higher AUC value and Q* index compared with ultrasonography and mammography but had values similar to those of DW-MRI and PET/CT. CE-MRI accurately assessed pathologic complete remission in specificity, and PET/CT and DW-MRI accurately assessed pathologic complete remission in sensitivity. The present meta-analysis indicates that CE-MRI has high specificity and DW-MRI has high sensitivity in predicting pathologic complete remission after neoadjuvant chemotherapy. CE-MRI is more accurate than ultrasonography or mammography. Additionally, PET/CT is valuable for predicting pathologic complete remission. CE-MRI, combined with PET/CT or DW-MRI, might allow for a more precise assessment of pathologic complete remission.

Conclusion

We cannot accurately predict whether pCR is achieved until the final breast surgery has been performed, and this will always influence whether chemotherapy and surgery are deficient or excessive beforehand. In the present analysis, we found that CE-MRI had a high specificity and DW-MRI a high sensitivity in assessing the pCR. CE-MRI is more accurate than ultrasonography or mammography. Additionally, PET/CT is valuable for predicting pCR. PET/CT and DW-MRI monitoring reduced the incidence of overestimation using CE-MRI of the treatment response. Thus, PET/CT, DW-MRI, and CE-MRI could play different roles in monitoring the response to NAC. Therefore, the combined use of CE-MRI with PET/CT or DW-MRI might yield greater precision in assessing pCR. Additional well-designed clinical trials are required to further investigate this conclusion.