超声结合临床特征对乳腺癌新辅助化疗后腋窝淋巴结状态的预测价值

Predictive Value of Ultrasound Combined with Clinical Features for Axillary Lymph Status after Neoadjuvant Chemotherapy in Breast Cancer

目的:探讨超声结合临床特征对乳腺癌新辅助化疗(NAC)后腋窝淋巴结状态的预测价值。方法:选取2019年1月-2021年12月南通市肿瘤医院收治的113例行NAC的乳腺癌患者作为研究对象,对所有患者术前的腋窝淋巴结的穿刺活检、超声检查结果及病理结果进行回顾性分析,采用单因素、多因素分析乳腺癌患者NAC后腋窝淋巴结状态的相关因素,并建立腋窝淋巴结状态的预测模型。结果:113例乳腺癌NAC后有63例为腋窝淋巴结阳性,50例腋窝淋巴结阴性。单因素分析结果显示,不同腋窝淋巴结状态患者淋巴结长径、长短径比、淋巴结皮髓质分界、CDFI血流信号比较,差异均有统计学意义(P<0.05);多因素分析结果显示,分子分型为Luminal B、乳腺癌原发灶临床疗效为SD和超声显示有CDFI血流信号均是乳腺癌患者NAC后腋窝淋巴结阳性的影响因素(P<0.05);ROC曲线分析超声结合临床特征的预测模型预测腋窝淋巴结状态的AUC为0.773(SE=0.039,95%CI:0.697,0.849,P<0.001)。结论:分子分型为Luminal B、乳腺癌原发灶临床疗效为SD和超声显示有CDFI血流信号均是乳腺癌患者NAC后腋窝淋巴结阳性的重要影响因素,超声结合临床特征对乳腺癌患者NAC后腋窝淋巴结状态的预测价值较好。

Objective:To investigate the predictive value of ultrasound combined with clinical features in the prediction of axillary lymph status after neoadjuvant chemotherapy(NAC)in breast cancer.Method:A total of 113 breast cancer patients with NAC who treated in Nantong Cancer Hospital from January 2019 to December 2021 were selected as the research subjects.The preoperative axillary lymph node biopsy,ultrasonography and pathological results of all patients were retrospectively analyzed.Univariate and multivariate analysis was used to analyze the related factors of axillary lymph node status after NAC in breast cancer patients,and a predictive model for axillary lymph node status was established combined with ultrasound and clinical features.Result:After NAC in 113 breast cancer cases,63 cases were positive for axillary lymph nodes,and 50 cases were negative for axillary lymph nodes.The results of single factor analysis showed that there were statistically significant differences in the long diameter,long short diameter ratio,skin medullary boundary,CDFI blood flow signals of lymph nodes in patients with different axillary lymph node states(P<0.05);multivariate analysis results showed that the molecular type of Luminal B,clinical efficacy of breast cancer primary tumor as SD and presence of CDFI blood flow signal on ultrasound were influencing factors for positive axillary lymph nodes after NAC in breast cancer patients(P<0.05);ROC curve analyzed that the ultrasound combined with clinical characteristics of the prediction model of AUC of axillary lymph node status was 0.773(SE=0.039,95%CI:0.697,0.849,P<0.001).Conclusion:Molecular typing of Luminal B,clinical efficacy of primary breast cancer lesions of SD,and CDFI blood flow signal displayed by ultrasound are important influencing factors for positive axillary lymph nodes after NAC in breast cancer patients.Ultrasound combined with clinical characteristics has a better predictive value for the status of axillary lymph after NAC in breast cancer patients.