乳腺癌肿块弹性特征及免疫组化指标预测腋窝淋巴结转移的价值

Elastic Characteristics of Breast Cancer Mass and the Value of Immunohistochemistry in Predicting Axillary Lymph Node Metastasis

目的探讨乳腺癌肿块超声弹性特征预测腋窝淋巴结转移的价值及其与免疫组化表达的相关性。资料与方法纳入2020年5月—2021年4月于石河子大学医学院第一附属医院进行手术的134个乳腺癌肿块的声像图,术前均行声触诊组织量化成像检查,记录肿块的实时超声弹性成像评分和弹性硬度值,包括剪切波速度最大值(SWVmax)、最小值(SWVmin)、中间值(SWVcentre)、肿块周边剪切波速度平均值(SWVmean)、SWVmax与SWVmin的比值(SWVratio1)及SWVmax与其同等深度腺体SWV的比值(SWVratio2)等,术后完善病理结果及淋巴结转移情况,获得免疫组化指标雌激素受体、孕激素受体、HER-2、Ki-67,评估各弹性参数及免疫组化指标与腋窝淋巴结转移的相关性,最终筛选出独立危险因素,建立预测模型,并评价其诊断价值。结果单因素分析结果显示,肿块最大径、SWVmax、SWVmean、SWVratio1及HER-2、Ki-67表达与腋窝淋巴结转移有关,差异有统计学意义(Z/χ^(2)=-2.436、-6.369、-6.442、-4.224、5.547、4.865,P均<0.05);多因素分析结果显示,SWVmean、SWVratio1与腋窝淋巴结转移密切相关,两者建立的预测模型受试者工作特征曲线下面积为0.888。结论乳腺癌肿块的SWVmean、SWVratio1是预测腋窝淋巴结转移的独立危险因素,预测模型具有较高的诊断价值。

Purpose To investigate the value of ultrasonographic elastic characteristics in predicting axillary lymph node metastasis of breast cancer mass and its correlation with immunohistochemical expression. Materials and Methods The sonographic data from May 2020to April 2021 in the First Affiliated Hospital of Medical College of Shihezi University of 134 cases of breast cancer masses were included, all underwent virtual touch tissue imaging quantification before surgery, the mass of real-time ultrasonic elasticity imaging score and elastic hardness values, including maximum shear wave velocity(SWVmax), minimum shear wave velocity(SWVmin), centre shear wave velocity(SWVcentre), mean shear wave velocity around lesions(SWVmean), ratio of SWVmax to SWVmin(SWVratio1), ratio of SWVmax to shear wave velocity of gland at the same depth(SWVratio2) were recorded, the pathological results and lymph node metastasis were improved after surgery, immunohistochemical indicators estrogen receptor, progesterone receptor, Her-2 and Ki-67 were obtained. The correlation between various elastic parameters and immunohistochemical indicators and axillary lymph node metastasis was evaluated, independent risk factors were selected to establish a prediction model and evaluate their diagnostic value. Results Univariate analysis showed that the maximal diameter, SWVmax, SWVmean, SWVratio1 and HER-2, Ki-67 expression were significantly different(Z/χ^(2)=-2.436,-6.369,-6.442,-4.224,5.547, 4.865, all P<0.05). Multivariate analysis showed that SWVmean and SWVratio1 were closely related to axillary lymph node metastasis,and the area under receiver operating characteristic curve of the prediction model established by SWVmax and SWVratio1 was 0.888.Conclusion SWVmean and SWVratio1 of breast cancer tumor are independent risk factors for predicting axillary lymph node metastasis,and the prediction model has high diagnostic value.