乳腺癌前哨淋巴结经皮淋巴管超声造影结合临床病理特征的Logistic回归分析

Regression analysis of percutaneous lymphatic contrast-enhanced ultrasound combined with clinicopathological features in the diagnosis of sentinel lymph nodes in breast cancer

目的探讨经皮淋巴管超声造影(LCEUS)联合临床病理特征对乳腺癌前哨淋巴结(SLN)的诊断效能。方法前瞻性纳入2018年7月至2021年6月在南京中医药大学附属医院就诊的乳腺癌患者135例,术前1周内进行乳腺肿块和SLN常规超声、超声造影及LCEUS评估。外科医师术前记录患者临床特征,术后记录乳腺肿块和SLN病理。采用单因素分析和多因素Logistic回归分析确定乳腺癌超声临床病理特征与SLN转移的相关性,建立模型并评估模型的诊断效能。结果单因素分析显示乳腺癌SLN转移与年龄、腋窝肿大淋巴结、肿块病理类型、淋巴门、皮质增厚形式、SLN边缘血流、LCEUS增强模式有关(均P<0.05)。Logistic回归分析结果显示腋窝淋巴结触诊、边缘血流和LCEUS是SLN性质的独立预测因素,OR值分别为6.90(P=0.030)、16.06(P<0.001)、12.71(P<0.001),回归方程Logit(P)=0.887+1.932×腋窝淋巴结触诊+2.776×边缘血流+2.542×LCEUS。结论LCEUS结合SLN边缘血流和腋窝淋巴结触诊可帮助判断乳腺癌SLN性质。

Objective To explore the diagnostic efficacy of percutaneous lymphatic contrast ultrasound(LCEUS)combined with clinicopathological features in the diagnosis of breast cancer sentinel lymph node(SLN).Methods A total of 135 breast cancer patients who underwent sentinel lymph node biopsy and axillary lymph node radical resection were prospectively collected in the Affiliated Hospital of Nanjing University of Chinese Medicine from July 2018 to June 2021,and the breast masses and SLNs were evaluated by routine ultrasound,contrast-enhanced ultrasound and LCEUS within one week before surgery.The surgeons recorded the patients′clinical characteristics before surgeries,and the pathology of the masses and SLNs were recorded after surgeries.Univariate analysis and multivariate Logistic regression analysis were used to explore the correlation between ultrasound clinicopathological features of breast cancer and SLN metastasis,then to establish a model,and evaluate the diagnostic efficacy of the model.Results Univariate analysis showed that SLN metastasis of breast cancer was associated with age,axillary palpation of enlarged lymph nodes,pathological type of mass,clear hilum of lymph nodes,cortical thickening of lymph nodes,marginal blood flow in lymph nodes,and the appearances of LCEUS(all P<0.05).Multivariate Logistic regression analysis showed age,palpation of axillary lymph nodes and the appearances of LCEUS were independent predictors of SLN properties,the OR values were 6.90(P=0.030),16.06(P<0.001)and 12.71(P<0.001),respectively.The regression equation was Logit(P)=0.887+1.932×axillary lymph node palpation+2.776×marginal blood flow+2.542×LCEUS.Conclusions LCEUS combined with marginal blood flow in lymph nodes and palpation of axillary lymph nodes can help to determine the SLN state.