超声检查联合临床病理指标对乳腺癌前哨淋巴结状态预测价值分析

Analysis of predictive value of ultrasonography combined with clinical pathological factors in sentinel lymph node status of breast cancer

目的通过分析整理临床病理指标及超声检查数据,探讨超声下腋窝淋巴结状态联合临床病理指标对早期乳腺癌前哨淋巴结(sentinel lymph node,SLN)状态的预测价值。方法回顾性分析2010-07-01-2016-12-31郑州大学附属肿瘤医院接受前哨淋巴结活检术(sentinel lymph node biospy,SLNB)并且临床病理指标及超声检查结果完整的1 491例患者的临床病例资料,通过单因素和多因素分析明确早期乳腺癌SLN阳性的相关因素,并联合超声检查和临床病理指标建立SLN状态的预测模型。结果1 491例乳腺癌(3例男性)患者中,年龄19~84岁,平均年龄(48.8±10.5)岁。SLN平均检出数为(4.43±2.42)枚,SLN阳性率为27.0%(403/1 491)。单因素分析结果显示,病理类型(P<0.001)、ER状态(P<0.001)、PR状态(P<0.001)、Ki-67表达水平(P=0.010)、肿瘤大小(P<0.001)、肿瘤位置(P=0.016)、月经状态(P=0.002)、超声下腋窝淋巴结数目(P<0.001)、长径(P=0.037)及腋窝淋巴结长短径比(P<0.001)与SLN转移相关,而年龄和HER2表达状态与SLN状态无关。多因素分析显示,病理类型(P<0.001)、ER表达状态(P=0.001)、肿瘤大小(P<0.05)、月经状态(P=0.004)、超声下淋巴结长径(P<0.05)及淋巴结长短径比(P<0.001)均是SLN转移的独立危险因素。腋窝淋巴结超声下可见的乳腺癌患者,结合临床病理学指标和超声检查结果的回归模型ROC曲线下面积为0.731,灵敏度为72.5%,特异度为82.6%。结论病理类型、ER表达状态、肿瘤大小、月经状态、超声下淋巴结长径及淋巴结长短径比均是SLN转移的独立预测因素,结合超声下腋窝淋巴结状态和临床病理指标的回归模型具有较高的特异度和灵敏度。

OBJECTIVE To explore the predictive value of sentinel lymph nodal（SLN）status in patients with early breast cancer by combining color Doppler ultrasonography with clinical pathological characteristics.METHODS Clinical data of 1 491 patients with early breast cancer were retrieved from Affiliated Cancer Hospital of Zhengzhou University between2010-07-01 to 2016-12-31.Chi-square test and Logistic multivariate regression analysis were carried out to identify relevant factors predictive of sentinel limph nodal status.A probability level（P〈0.05）was considered statistically significant.RESULTS The group was consisted of 1 491 patients whose ages ranged from 19 to 84 years old with an average of（48.8±10.5）years in age.Totally 27.0%（403/1 491）positive sentinel lymph nodes were found in all patients,and the mean number of sentinel lymph node removed by the surgeon was 4.43±2.42.In the univariate analysis,the incidence of entinel lymph node metastasis（ELNM）was significantly associated with pathological type（P〈0.001）,ER（P〈0.001）,PR（P〈0.001）,Ki-67（P=0.010）expression tumor size（P〈0.001）,tumor location（P=0.016）,menopausal status（P=0.002）,lymph node aspect ratio（P〈0.001）,the number of lymph node（P〈0.001）and major axis（P=0.037）,while age and HER2 status were irrelevant（P〈0.05）.In multivariate analyse,pathological type（P〈0.001）,ER receptor status（P=0.001）,tumor size（P〈0.05）,menopausal status（P=0.004）,limph node aspect ratio（P〈0.001）and major axis（P〈0.05）were the independent risk factors of ELNM（P〈0.05）.The new model was accurate and discriminating（with an AUC of 0.731 when applied to the modeling group,sensitivity was 72.5 percent and the specificity was 82.6 percent）.CONCLUSIONS The tumor size,pathological type,menopausal status,ER receptor status,limph node aspect ratio and major axis were the independent risk factors of ELNM.In all,the logistic regression model has a good diagnostic efficacy in the diagnosis of benign and malignant axillary lymph nodes and has better sensitivity and specificity.