肿块本身超声特征联合病理表现在预测乳腺浸润性导管癌前哨淋巴结转移中的价值

Value of ultrasound features combined with pathological findings in predicting sentinel lymph node metastasis of invasive ductal carcinoma

目的通过分析乳腺浸润性导管癌肿块本身超声特征及病理表现以预测前哨淋巴结(SLN)转移风险。方法选择经手术病理诊断证实为乳腺浸润性导管癌的女性患者72例,年龄30~85岁,平均年龄52.9岁。分析72例单发乳腺肿块的位置、大小、形态、内部结构、晕征、纵横比、微钙化和彩色多普勒血流分级等二维常规超声表现和超声造影的增强时间、增强强度、增强缺损、造影前后病灶最大径差值、“蟹足”征或血管扭曲征等增强指标及病理组织学分级、Ki-67等15个参数。采用χ^(2)检验和Logistic回归分别进行单因素及多因素分析,绘制受试者工作特性曲线,以检验诊断效能。结果根据SLN转移状态分为淋巴结转移组26例和无淋巴结转移组46例。单因素结果显示,选定的二维常规超声、超声造影及临床病理检查共15个参数中位置、最大径、微钙化、血流分级、增强时间、造影前后病灶最大径差值及病理组织学分级等7项参数与乳腺浸润性导管癌SLN转移相关(P<0.05)。后经多因素分析结果显示,微钙化[比值比(OR)=30.646]、“蟹足”征或血管扭曲征(OR=24.055)、病理组织学分级(OR=35.982)、最大径(OR=16.820)和造影前后病灶最大径差值(OR=27.199)是预测乳腺浸润性导管癌SLN转移的独立危险因素,经独立危险因素所构建的回归模型曲线下面积为0.865。结论乳腺浸润性导管癌肿块本身超声特征和病理检查参数所构建的回归模型在临床上可用于预测腋窝SLN转移。

Objective To predict the risk of sentinel lymph node(SLN)metastasis by analyzing the ultrasound characteristics and pathologic finding of invasive ductal carcinoma of breast.Methods A total of 72 female patients with invasive ductal carcinoma of breast were enrolled,which aged 30-85 years old with mean age of 52.9 years old.The location,size,shape,internal structure,halo sign,aspect ratio,micro-calcification and color Doppler flow grading of 72 cases single breast mass were analyzed by two-dimensional conventional ultrasound,and arrival time,enhancement intensity,enhancement defect,maximum diameter difference of lesions before and after contrast enhancement,“crab-foot-like”or vascular torsion sign,histological grade,Ki-67 and other 15 pathological parameters were analyzed.The univariate and multivariate analyses were performed byχ^(2)test and Logistic regression respectively to draw receiver operating character curve and test the diagnostic efficacy.Results According to status of SLN metastasis,there were 26 cases with lymph node metastasis and 46 without lymph node metastasis.The univariate results showed that 7 parameters including location,maximum diameter,microcalcification,color Doppler flow classification,arrival time,maximum diameter difference value before and after contrast-enhanced ultrasound and histopathological grade were correlated with SLN metastasis of invasive ductal carcinoma(P<0.05).The multivariate analysis results showed microcalcification[odds ratio(OR)=30.646],“crab foot-like”or vascular distortion sign(OR=24.055),histopathological grade(OR=35.982),maximum diameter(OR=16.820)and maximum diameter difference value before and after contrast-enhanced ultrasound(OR=27.199)were independent risk factors for predicting sentinel lymph node metastasis of invasive ductal carcinoma.The area under the curve of regression model based on risk factors was 0.865.Conclusion It is demonstrated that the regression model based on ultrasound characteristics and pathological data of invasive ductal carcinoma can be used to predict axillary SLN metastasis in clinic.