早期、延迟或联合对比增强乳腺X线摄影检测新辅助化疗后乳腺癌残留病灶
该回顾性单中心研究纳入202例活检证实乳腺癌并接受新辅助化疗前后对比增强乳腺X线摄影（含早期和延迟采集）及手术的患者，比较早期、延迟及联合方案检测残留病灶的诊断性能。延迟和联合方案的敏感度显著高于早期方案（85.7%和86.6% vs 68.1%，p<0.0001），延迟方案阴性预测值也显著提高（71.2% vs 58.2%，p=0.04）。早期图像与病理肿瘤大小一致性略好（平均差异5.7 mm vs 11.8 mm）。
要点
- 延迟CEM可提高残留病灶检测敏感度和阴性预测值，支持纳入新辅助化疗后评估。
- 早期CEM图像用于残余肿瘤大小评估与病理一致性略优。
- 联合方案敏感度与延迟方案相近，但未显著优于延迟单独方案。
局限性
- 回顾性单中心设计。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVES: To evaluate the diagnostic performance of contrast-enhanced mammography (CEM) for detecting residual disease (RD) and assessing residual tumor size after neoadjuvant chemotherapy (NAC) in breast cancer, comparing early-only, delayed-only, and combined acquisition protocols.
MATERIALS AND METHODS: This retrospective single-center diagnostic performance study included consecutive women with biopsy-proven breast cancer who underwent pre- and post-NAC CEM with both early and delayed acquisitions and subsequent surgery (2016-2024). Patients without complete CEM protocols or surgical pathology were excluded. CEM images were independently analyzed for each protocol by two experienced breast radiologists in consensus. Radiological response was categorized per RECIST and dichotomized as complete response versus RD. Pathological tumor staging (ypT) at surgery was the gold standard; pathologic complete response (pCR) was defined as ypT0/ypTis. Diagnostic performance in predicting RD was calculated for each protocol with sensitivity and negative predictive value (NPV) as primary endpoints (χ² test). Bland-Altman analysis compared imaging-measured and pathological tumor sizes.
RESULTS: Of 202 women included (mean age, 54.7 ± 12.7), 83 (41.1%) achieved pCR. Sensitivity for detecting RD was higher for delayed (85.7%, 95% CI 78.1-91.5%) and combined protocols (86.6%, 79.1-92.1%) compared to early (68.1%, 58.9-76.3%; p < 0.0001). NPV improved from 58.2% (95% CI 48.3-67.6%) to 71.2% (62.3-79.0%; p = 0.04) with delayed acquisitions. Bland-Altman analysis showed slightly better agreement between early images and pathology (mean difference 5.7 mm) than for delayed acquisitions (11.8 mm).
CONCLUSIONS: Delayed CEM images significantly improved sensitivity and NPV in predicting RD, supporting the inclusion of delayed acquisitions in the neoadjuvant setting.
KEY POINTS: Question Can contrast-enhanced mammography protocols be optimized after neoadjuvant chemotherapy to improve the detection of pathological residual disease and residual tumor size assessment? Findings Delayed contrast-enhanced mammography acquisitions significantly improved sensitivity and negative predictive value for residual disease detection, whereas early acquisitions provided slightly better agreement for residual tumor size. Clinical relevance Including delayed images in post-neoadjuvant contrast-enhanced mammography improves detection of residual invasive disease, supporting surgical planning, while early images remain useful for tumor size estimation.
引用
- Bellini C, Bicchierai G, Maiello C, et al. Early, delayed, or combined contrast-enhanced mammography for detecting residual disease after neoadjuvant chemotherapy in breast cancer. Eur Radiol. 2026. PMID: 42141291. doi:10.1007/s00330-026-12633-1
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。