超声联合病理参数预测乳腺癌腋窝淋巴结转移的价值

Value of ultrasound combined with pathological parameters in predicting axillary lymph node metastasis in breast cancer

目的探讨乳腺癌肿块常规超声特征、剪切波弹性参数及免疫组化指标预测腋窝淋巴结转移的价值。方法回顾性分析2020年5月至2021年10月于石河子大学医学院第一附属医院手术的152例乳腺癌患者共172个肿块的超声资料及病理结果,依据腋窝淋巴结状态分为转移组与未转移组,分析两组间乳腺癌肿块的常规超声特征、剪切波速度(SWV)值及免疫组化指标(ER、PR、HER-2、Ki-67)的差异,筛选出组间差异有统计学意义的参数并建立Logistic回归模型。结果乳腺癌患者转移组与未转移组肿块的纵横比、是否有钙化、剪切波速度平均值(SWVmean)及HER-2表达情况差异有统计学意义(均P<0.05),依据肿块纵横比>1、有钙化、高SWVmean及HER-2(+)构建预测模型,其ROC曲线下面积(AUC)为0.891,大于单一参数(均P<0.05),且与病理结果的一致性尚可(Kappa=0.731)。结论联合预测模型对判断淋巴结状态具有提示作用,乳腺癌肿块纵横比>1、有钙化、高SWVmean及HER-2(+)更易发生腋窝淋巴结转移。

Objective To evaluate the value of conventional ultrasound,shear wave elastic parameters and immunohistochemistry in predicting axillary lymph node metastasis of breast cancer.Methods The ultrasonographic features and pathological results of 172 masses in 152 breast cancer patients who underwent surgery in the First Affiliated Hospital of Shihezi University Medical College from May to October 2020 were analyzed retrospectively.The patients were divided into metastatic group and non-metastatic group according to the status of axillary lymph nodes.The conventional ultrasound characteristics,shear wave velocity(SWV)and immunohistochemical indexes(ER,PR,HER-2,Ki-67)of 2 groups of breast cancer masses were analyzed.Finally,the parameters with statistically significant difference between groups were selected and the Logistic regression model was established.Results There were significant differences in the aspect ratio,calcification,SWVmean and HER-2 expression between metastatic group and non-metastatic group(all P<0.05).A prediction model was constructed with aspect ratio>1,calcification,high SWVmean and HER-2(+).The area under receiver operating characteristic curve(AUC)of the subjects was 0.891,which was larger than the single parameter(all P<0.05),and was in good agreement with pathological results(Kappa=0.731).Conclusions The joint prediction model can be used to predict the status of lymph nodes,and the axillary lymph node metastasis is more likely to occur in breast cancer with the aspect ratio>1,calcification,high SWVmean and HER-2(+).