Meme Kanserinde Neoadjuvan Kemoterapi Sonrası Klinik ve Radyolojik Bulguların Diagnostik Değerlendirilmesi

Öz

Amaç: Bu çalışmadaki amacımız, meme biyopsisi ile tanı konulmuş malign kitlesi olan hastalarda neoadjuvan kemoterapi yanıtının değerlendirilmesi açısından PET/BT ve kontrastlı meme MRG’nin etkinliğini karşılaştırmaktır. Gereç ve Yöntemler: Şubat 2017’den itibaren Zonguldak Bülent Ecevit Üniversite Hastanesi’ne başvurup tru-cut iğne veya otomatik kesici biyopsi tabancası ile meme kanseri tanısı alarak Radyoloji Anabilim dalında değerlendirilen hastalar retrospektif olarak tarandı. Çalışmaya aksiller lenf nodu diseksiyonu ve mastektomi yapılan, neoadjuvan kemoterapi alan, kemoterapi sonrası kontrastlı dinamik MRG, difüzyon ağırlıklı MRG ve tüm vücut PET/BT görüntüleri olan 48 hasta dahil edildi. Hastaların histopatolojik raporlarındaki tümör varlığı ve lenf nodu tutulumu altın standart olarak kabul edildi. Görüntüleme yöntemlerinde (dinamik kontrastlı MRG ve PET/BT) tümör varlığı ve lenf nodu görülmesi pozitif olarak kabul edildi ve altın standart olan patoloji sonuçları ile karşılaştırıldı. Bulgular: Hastaların yaş ortalaması 51,08±12,21 yıl idi. Patolojik olarak hastaların %85,4’ünde rezidü tümör, %50,0’sinde ise lenf nodu tutulumu saptandı. MRG’de erken arteriyel (orta, hızlı) ve geç arterial (tip 2-3kontrast eğrisi) kontrastlanmaya göre tümör saptanan hasta sayısı 31 (%64,6) idi. PET/BT’de tümör saptanan hasta sayısı 22 (%45,8) idi. MRG’de lenf nodu tutulumu saptanan hasta sayısı 17 (%35,4), PET/BT’de lenf nodu tutulumu saptanan hasta sayısı 22 (%45,8) idi. Erken arterial (orta, hızlı) ve geç arterial (tip 2-3 kontrast eğrisi) kontrastlanmaya göre değerlendirilen MRG’nin tümör varlığını ön görmedeki duyarlılık, özgüllük, pozitif ve negatif prediktif değeri ve doğruluğu sırasıyla %65,8, %42,8, %87,1, %17,6, %62,5 iken, PET/BT’de ise sırasıyla %46,3, %57,1, %86,3, %15,3, %47,9 idi. MRG’nin lenf nodu tutulumunu öngörmedeki duyarlılık, özgüllük, pozitif ve negatif prediktif değeri ve doğruluğu sırasıyla %54,1, %83,3, %76,4, %64,5, %68,7 iken, bunlar PET/BT’de sırasıyla %29,1, %95,8, %87,5, %57,5, %62,5 idi. Sonuç: Neoadjuvan tedavi sonrası tümör yanıtını değerlendirmede, MRG’nin daha yüksek bir duyarlılığa ve PET/BT’nin daha yüksek bir özgüllüğe sahip olduğu bulunmuştur. Benzer olarak, lenf nodu tutulumunu belirlemede MRG’nin daha yüksek bir duyarlılığa ve PET/BT’nin ise daha yüksek bir özgüllüğe sahip olduğu bulunmuştur. Yalnızca neoadjuvan tedavi sonrası çekilirse, MRG ve PET/BT’nin her ikisinin de birlikte kullanılmasını öneriyoruz.

Anahtar Kelimeler

• Meme kanseri
• neoadjuvan kemoterapi
• MRG
• PET/BT
• rezidü tümör
• lenf nodu tutulumu

Teşekkür

Eğitimim sırasında desteklerini esirgemeyen eşim, ailem ve hocalarıma sonsuz teşekkür ederim

Diagnostic Evaluation of Clinical and Radiological Findings after Neoadjuvant Chemotherapy in Breast Cancer

Öz

Aim: The aim of this study is to compare the efficacy of PET/CT and contrast-enhanced breast MRI in the evaluation of neoadjuvant chemotherapy response in patients with malignant masses diagnosed by breast biopsy. Material and Method: As of February 2017, patients diagnosed with breast cancer using tru-cut needle or automated cuttingbiopsy gunin the General Surgery Department of the Zonguldak Bülent Ecevit University Medical Faculty Hospital were retrospectively screened. The study included 48 patients who underwent axillary lymph node dissection, mastectomy and received neoadjuvant chemotherapy. Weperformed breast MRI, diffusion-weighted MRI and whole-body PET/CT images after chemotherapy. We noted all demographic and histopathological parameters. The presence of tumor and lymph node metastasis in the histopathological reports of the patients was accepted as the gold standard, whereas thepresence of tumor and lymph node in imaging methods (MRI and PET/CT) was accepted as positive.The latter was compared with the pathological results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of imaging methods in predicting neoadjuvant chemotherapy response were calculated. Results: The mean age of the patients was 51.08±12.21 years. Residual tumor was found in pathological specimens in 85.4% of the patients whereas lymph node involvement was in 50.0%. In 35.4% of the patients, lymph node involvement was detected on MRI. The number of patients whose tumors were seenon MRI (intermediate, rapid arterial phase enhancement and type 2/3 enhancement curve) was 31 (64.6%). The number of patients whose lymph node involvements were seen on MRI was 17 (35.4%), whereas the number of patients whose lymph node involvements on PET/CT was 22 (45.8%). In predicting the presence of tumor, the sensitivity, specificity, positive and negative predictive value and accuracy of MRI, evaluated according to early arterial phase enhancement (intermediate, rapid arterial) and late arterial (type 2/3 enhancement curve) was calculated as 65.8%, 42.8%, 87,1%, 17,6%, and 62,5%, respectively. On PET/CT, these were 46.3%, 57.1%, 86.3%, 15.3%, and 47.9%, respectively. The sensitivity, specificity, positive and negative predictive value and accuracy of MRI in predicting lymph node involvement were 54.1%, 83.3%, 76.4%, 64.5%, and 68.7%, respectively, whereas these were 29.1%, 95.8%, 87.5%, 57.5%, and 62.5%, respectively on PET/CT. Conclusion: In the evaluation of neoadjuvant chemotherapy response, MRI was found to have a higher sensitivity and PET/CT a higher specificity in tumor.Likewise, MRI was found to have a higher sensitivity and PET/CT a higher specificityin lymph node involvement. Only taken after neoadjuvant chemotherapy, we recommend use together of both MRI and PET/CT for this evaluation.

Anahtar Kelimeler

• Breast cancer
• neoadjuvant chemotherapy
• MRI
• PET/CT
• residual tumor
• lymph node involvement

Kaynakça

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