二维超声结合临床特征预测乳腺癌腋窝淋巴结转移的单中心前瞻性研究

Two-Dimensional Breast Ultrasound in Combination with Clinical Features to Predict Axillary Lymph Node Metastasis in Breast Cancer:A Single-Center Prospective Study

目的探讨二维超声结合临床特征对乳腺癌患者腋窝淋巴结(ALN)转移的预测价值,并分析乳腺癌ALN转移的危险因素。方法前瞻性收集2022年5月至2023年8月四川大学华西医院乳腺疾病中心收治的335例资料齐全且首次治疗的浸润性乳腺癌患者作为研究对象,收集所有患者术前的ALN临床特征、乳腺超声检查结果、术前穿刺活检结果,分析乳腺癌患者ALN转移的危险因素,并初步建立乳腺癌患者ALN转移的预测模型。结果335例乳腺癌患者中159例有ALN转移,176例无ALN转移。单因素分析结果显示,淋巴结形态、淋巴结边缘形态(清楚/模糊)、皮质厚度、皮质厚度不均匀等均为ALN转移的危险因素;多因素分析结果显示,激素受体为HR+、肿瘤浸润乳腺后间隙、淋巴结短径>8 mm、淋巴结长径/短径≤2、淋巴结皮髓质分界模糊为乳腺癌ALN转移的独立影响因素;二维超声结合临床特征的预测模型预测ALN状态的AUC为0.870(95%CI:0.832~0.908,P<0.001)。结论乳腺癌激素受体为HR+、肿瘤浸润乳腺后间隙、淋巴结短径>8 mm、淋巴结长径/短径≤2、淋巴结皮髓质分界模糊可能是判断乳腺癌ALN转移的重要指标;联合应用可较好预测乳腺癌ALN转移的状态。

Objective 1.To investigate the predictive value of combining clinical and ultrasonographic characteristics for the assessment of axillary lymph node(ALN)metastatic status in breast cancer patients.2.To analyze the risk factors associated ALN metastasis in breast cancer.Methods A prospective cohort of 335 patients with first-time treatment for invasive breast cancer,who were admitted to the Breast Disease Center of West China Hospital,Sichuan University,from May 2022 to August 2023 with complete data,was selected as the study subjects.Preoperative clinical characteristics of ALN,breast ultrasonography findings,and preoperative biopsy results were collected for all patients.Univariate and multivariate analyses were conducted to identify risk factors related to the status of ALN in breast cancer patients.And a preliminary predictive model for the metastasis of ipsilateral ALN in invasive breast cancer was established.Results Among the 335 breast cancer patients,159 had ALN metastasis,while 176 did not exhibit ALN metastasis.Univariate analysis indicated statistically significant differences in lymph node shape,clarity/blurriness of lymph node margins,cortical thickness,and heterogeneity of cortical thickness(P<0.05).Multivariate analysis revealed that molecular subtype HR(+),tumor infiltration into the retro-mammary space,lymph node short axis>8 mm,lymph node long to short axis ratio≤2,and blurry lymph node cortex-medulla boundary(P<0.05)were independent predictors of ALN metastasis in invasive breast cancer.ROC curve analysis of the ultrasonography combined with clinical characteristics model for predicting the status of ALN yielded an AUC of 0.870(95%CI 0.832-0.908,P<0.001).Conclusion The molecular subtype of the breast tumor being HR(+),tumor infiltration into the retro-mammary space,lymph node short axis>8 mm,lymph node long to short axis ratio≤2,and a blurry lymph node cortex-medulla boundary are significant indicators for determining ipsilateral ALN metastasis in invasive breast cancer.The combined use of these indicators can more accurately predict the status of ALN metastasis in invasive breast cancer.