Neoadjuvan kemoterapi öncesinde marker konulan kitlesel meme kanserlerinde patolojik yanıtı öngörmede dinamik meme MRG' nin rolü
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Tarih
2024
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Tümör lojuna marker konulan lokal ileri meme kanseri hastalarında, NAK sonrası marker çevresinden yapılan çoklu vakum biyopsiyle patolojik yanıtı destekleyip olası cerrahisiz tedaviye hedef olabilecek hasta popülasyonunu radyolojik olarak seçmek önemlidir. Bu nedenle çalışmamızda cerrahisiz izlem için rehber olması amacıyla NAK sonrası, MRG’ nin patolojik yanıtı tahmin edebilirliğini ve radyoloji-patoloji korelasyonunu araştırdık.
Gereç ve Yöntem: Kasım 2020 ve Ağustos 2023 tarihleri arasındaki primer kitlesel meme lezyonuna marker konulan 85 lezyon (71 hasta) çalışmamıza dahil edilmiştir. Radyolojik yanıt değerlendirmesinde RECIST 1.1 kriterleri kullanılmıştır. NAK sonrası MRG’ de radyolojik yanıt ile postoperatif patolojik yanıt arasındaki korelasyonu değerlendirmek için kappa testi kullanılmıştır.
Bulgular: Çalışmaya dahil edilen 85 lezyonun NAK sonrası MRG’ de; %52,9’ u (n:45) radyolojik tam yanıt, %47,1’ i (n:40) ise radyolojik tam olmayan yanıt olarak değerlendirilmiştir. Postoperatif patoloji sonucuna göre lezyonların %45,2’ si (n: 38) patolojik tam yanıt, %54,8’ i (n:46) ise patolojik tam olmayan yanıtla uyumlu bulunmuştur. Çalışmada araştırılan testlerin uyumunun değerlendirilmesinde Kappa testi kullanılmış olup radyolojik yanıt ve cerrahi sonrası patolojik yanıt arasında istatistiksel olarak anlamlı ve iyi derecede uyum olduğu saptanmıştır (p<0,001, ĸ=0,740). Patolojik değerlendirme referans test olarak alındığında MRG’ nin sensitivitesi %80, spesifitesi %94,7, pozitif prediktif değeri %95 ve negatif prediktif değeri ise %80 olarak hesaplanmıştır.
Sonuç: Araştırmamız sonucunda, NAK sonrası MRG ile patolojik yanıtı yüksek doğrulukla tespit edebileceğimizi gösterdik. Radyolojik-patolojik yanıt iyi derecede uyumlu olarak saptanmış olup MKC yapılacak hastalar için MRG ile patolojik yanıt tahmini yeterli orandadır. Patolojik yanıtın doğru öngörülebilmesi için NAK sonrası MRG’ de; yanlış pozitif ve negatifliğe sebep olabilecek moleküler alt tip, histolojik grade, NAK protokolü gibi durumlar göz önünde bulundurularak dikkatli değerlendirme yapılmalıdır.
Purpose: In locally advanced breast cancer patients with a marker in the tumor, it is important to radiologically select the patient population that can support the pathologic response with multiple vacuum biopsies performed around the marker after NAC and potentially be targeted for non-surgical treatment. Therefore, our study investigated the predictability of MRI for pathologic response and radiology-pathology correlation as a guide for non-surgical follow-up after post-NAC. Materials and Methods: 85 lesions (71 patients) in which markers were placed on the primary breast lesion between November 2020 and August 2023 were included in our study. RECIST 1.1 criteria were used in radiological response evaluation. The correlation between the radiological response of the lesions on MRI after NAC and the postoperative pathological response was compared. Kappa test was used. Results: Post-NAC MRI of 85 lesions included in the study; 52.9% (n:45) was evaluated as the radiological complete response, and 47.1% (n:40) was evaluated as the radiological incomplete response. According to the postoperative pathology results, 45.2% (n: 38) of the lesions were compatible with the pathological complete response, and 54.8% (n: 46) were compatible with the pathological incomplete response. The Kappa test was used to evaluate the agreement of the tests investigated in the study, and it was determined that there was a statistically significant and good degree of agreement between the radiological response and the pathological response after surgery (p<0.001, ĸ=0.740). When the pathological evaluation is taken as the reference test, the sensitivity of MRI is calculated as 80%, the specificity is 94.7%, the positive predictive value is 95%, and the negative predictive value is 80%. Conclusions: As a result of our research, we showed that we can detect the pathological response with high accuracy with MRI after NAC. The radiological-pathological response was found to be in good agreement, and the prediction of pathological response by MRI is sufficient for patients who will undergo BCS. In order to accurately predict the pathological response, MRI after NAC; Careful evaluation should be made, considering situations such as molecular subtype, histological grade, and NAC protocol that may cause false positives and negativity.
Purpose: In locally advanced breast cancer patients with a marker in the tumor, it is important to radiologically select the patient population that can support the pathologic response with multiple vacuum biopsies performed around the marker after NAC and potentially be targeted for non-surgical treatment. Therefore, our study investigated the predictability of MRI for pathologic response and radiology-pathology correlation as a guide for non-surgical follow-up after post-NAC. Materials and Methods: 85 lesions (71 patients) in which markers were placed on the primary breast lesion between November 2020 and August 2023 were included in our study. RECIST 1.1 criteria were used in radiological response evaluation. The correlation between the radiological response of the lesions on MRI after NAC and the postoperative pathological response was compared. Kappa test was used. Results: Post-NAC MRI of 85 lesions included in the study; 52.9% (n:45) was evaluated as the radiological complete response, and 47.1% (n:40) was evaluated as the radiological incomplete response. According to the postoperative pathology results, 45.2% (n: 38) of the lesions were compatible with the pathological complete response, and 54.8% (n: 46) were compatible with the pathological incomplete response. The Kappa test was used to evaluate the agreement of the tests investigated in the study, and it was determined that there was a statistically significant and good degree of agreement between the radiological response and the pathological response after surgery (p<0.001, ĸ=0.740). When the pathological evaluation is taken as the reference test, the sensitivity of MRI is calculated as 80%, the specificity is 94.7%, the positive predictive value is 95%, and the negative predictive value is 80%. Conclusions: As a result of our research, we showed that we can detect the pathological response with high accuracy with MRI after NAC. The radiological-pathological response was found to be in good agreement, and the prediction of pathological response by MRI is sufficient for patients who will undergo BCS. In order to accurately predict the pathological response, MRI after NAC; Careful evaluation should be made, considering situations such as molecular subtype, histological grade, and NAC protocol that may cause false positives and negativity.
Açıklama
Anahtar Kelimeler
Manyetik rezonans görüntüleme, Magnetic resonance imaging, Neoadjuvan kemoterapi, Neoadjuvant chemotherapy, Metalik marker, Metallic marker, Radyolojik yanıt, Radiologic response
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
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Künye
Ünüvar, Ş. (2024). Neoadjuvan kemoterapi öncesinde marker konulan kitlesel meme kanserlerinde patolojik yanıtı öngörmede dinamik meme MRG' nin rolü. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Radyoloji Anabilim Dalı, Konya.
