基于双模态超声的乳腺癌患者术前淋巴结转移负荷模型构建分析

Construction and analysis of preoperative lymph node metastasis load model of breast cancer patients based on dual-mode ultrasound

目的构建基于双模态超声的乳腺癌患者术前淋巴结转移负荷风险模型,以识别淋巴结高转移负荷人群,并为手术方案的制定提供参考。方法选取2021年5月—2023年5月湖州市中心医院接受手术治疗的乳腺癌患者168例作为研究对象。术前行双模态超声检查并根据淋巴结转移状态分为高转移负荷组62例(≥3个转移淋巴结)和低转移负荷组106例(≤2个转移淋巴结)。通过LASSO-logistic回归进一步筛选变量构建基于双模超声的乳腺癌患者术前淋巴结高转移负荷列线图预测模型并验证模型效能。结果经过LASSO回归分析10倍交叉验证最终筛选出脉管侵犯、导管扩张、Adler血流分级、弹性应变率4个代表性特征。多因素logistic分析显示:存在脉管侵犯(OR=2.250,95%CI:1.012~5.002)、Adler血流分级为Ⅱ/Ⅲ级(OR=2.929,95%CI:1.256~6.827)、导管扩张(OR=2.548,95%CI:1.066~6.093)、弹性应变率高(OR=4.167,95%CI:2.486~6.982)均为乳腺癌患者术前淋巴结转移高负荷危险因素(P<0.05)。列线图显示预测乳腺癌患者术前淋巴结高转移负荷相关因素的C-index为0.834(95%CI:0.771~0.898)且校正曲线显示实测值与预测值基本相符。结论基于常规二维超声、剪切波弹性成像超声图像构建的模型结合了多种模态的特点,使其信息互补,有助于提高乳腺癌术前淋巴结转移负荷定性及定位分析的准确性。

Objective To construct a risk model using dual-mode ultrasound to identify breast cancer patients with a high lymph node metastasis load.This model provides references for the formulation of surgical protocols.Methods The study included 168 breast cancer patients who underwent surgical treatment at Huzhou Central Hospital between May 2021 and May 2023.Preoperative dual-mode ultrasonography was performed and the patients were divided into two groups based on the status of lymph node metastasis:high metastatic load group(62 cases,≥3 metastatic lymph nodes)and low metastatic load group(106 cases,≤2 metastatic lymph nodes).LASSO-logistic regression was used to screen variables and construct a prediction model for preoperative high metastatic load of lymph nodes in breast cancer patients based on dual-mode ultrasound.The effectiveness of the model was also verified.Results Four representative characteristics,namely vascular invasion,catheter dilation,Adler blood flow grading and elastic strain rate were selected through LASSO regression analysis with 10-fold cross-validation.Multivariate logistic analysis revealed that vascular invasion(OR=2.250,95%CI 1.012-5.002),Adler blood flow grade Ⅱ/Ⅲ(OR=2.929,95%CI:1.256-6.827),catheter dilation(OR=2.548,95%CI:1.066-6.093)and high elastic strain rate(OR=4.167,95%CI:2.486-6.982)were identified as risk factors for preoperative high burden of lymph node metastasis in breast cancer patients(P<0.05).The C-index for factors predicting preoperative high metastatic load of lymph nodes in breast cancer patients was 0.834(95%CI:0.771-0.898),and the calibration curve demonstrated good agreement between measured and predicted values.Conclusion The model constructed using conventional two-dimensional ultrasound and shear-wave elastography ultrasound images combines the characteristics of multiple modes to make their information complementary.This is helpful in improving the accuracy of qualitative and localization analysis of lymph node metastasis load before breast cancer.