Analysis of factors related to non-sentinel lymph node metastasis in 296 sentinel lymph node-positive Chinese breast cancer patients

Objective: Axillary lymph node dissection(ALND) may be unnecessary in 20%–60% of breast cancer patients with sentinel lymph node(NSLN) metastasis. The aim of the present study was to review the medical records of Chinese patients with early-stage breast cancer and positive NSLN metastasis to identify clinicopathological characteristics as risk factors for non-NSLN metastasis.Methods: The medical records of 2008 early-stage breast cancer patients who received intraoperative sentinel lymph node biopsy(SLNB) between 2006 and 2016 were retrospectively reviewed. These patients were clinically and radiologically lymph nodenegative and had no prior history of receiving neoadjuvant chemotherapy or endocrinotherapy. The clinicopathological characteristics of patients with positive NSLN metastasis who underwent ALND were investigated.Results: In the present study, 296 patients with positive NSLN metastases underwent ALND. Positive non-NSLN metastases were confirmed in 95 patients(32.1%). On univariate analysis, ≥ 3 positive NSLN metastases(P <0.01), NSLN macrometastases(P =0.023), and lymphovascular invasion(P = 0.04) were associated with non-NSLN metastasis(P <0.05). In multivariate analysis, the number of positive SLNs was the most significant predictor of non-SLN metastasis. For patients with 0, 1, 2, or 3 associated risk factors, the non-SLN metastatic rates were 11.5%, 22.5%, 35.2%, and 73.1%, respectively.Conclusions: The number of positive NSLNs, NSLN macrometastases, and lymphovascular invasion were correlated with nonSLN metastasis. The number of positive SLNs was an independent predictor for non-NSLN metastasis. When 2 or 3 risk factors were present in one patient, the probability of non-NSLN was higher than that in the American College of Surgeons Oncology Group Z0011 trial(27.3%); thus, avoiding ALND should be considered carefully.

ScRNA-seq reveals the correlation between M2 phenotype of tumorassociated macrophages and lymph node metastasis of breast cancer

The process of lymphatic metastasis was proved to be associated with podoplanin-expressing macrophages in breast cancer(BC).This study aimed to investigate the role of the M2 phenotype of tumor-associated macrophages and mine the key M2 macrophages-related genes for lymph node metastasis in BC.We downloaded the GSE158399 dataset from the Gene Expression Omnibus(GEO)database,which includes transcriptomic profiles of individual cells from primary tumors,negative lymph nodes(NLNs),and positive lymph nodes(PLNs)of breast cancer patients.The cell subsets were identified by clustering analysis after quality control of the scRNA-seq using Seurat.The activation and migration capability of M2 macrophages were evaluated with R package“GSVA”.The key M2 macrophages-related genes were screened from the differential expressed genes(DEGs)and M2 macrophages activation and migration gene sets collected from MSigDB database.Our analysis identified three main cell types in primary tumors,NLNs,and PLNs:basal cells,luminal cells,and immune cell subsets.The further cell type classification of immune cell subsets indicated M2 macrophages accumulation in NLs and PLs.The GSVA enrichment scores for activation and migration capability were increased significantly in M2 macrophages from primary tumors than NLNs and PLNs(pvalue<0.001).Seven M2 macrophages activation-related and 15 M2 macrophages migration-related genes were significantly up-regulated in primary tumors than NLNs and PLNs.The proportion and GSVA enrichment scores for activation and migration of M2 macrophages may be potential markers for lymph node metastasis in breast cancer.Our study demonstrated that twenty-two up-regulated mRNA may be possible therapeutic targets for lymph node metastasis in breast cancer.

Novel eradicative high-dose rate brachytherapy for internal mammary lymph node metastasis from breast cancer

AIM: To develop a method of delivering an eradicative high radiotherapeutic dose safely preserving the surrounding skin in the treatment of internal mammary lymph node metastasis (IMLNM) of breast cancer. METHODS: We report a 38-year-old female patient with a solo IMLNM showing no response to 60 Gy in 2.5 Gy fractions of external beam radiotherapy. To eradicate this tumor, a boost brachytherapy plan was created after percutaneous insertion of an applicator needle into the IMLNM lesion avoiding the pleura and vessels under ultrasound monitoring. According to the dose distribution, the required thickness of a spacer between the skin and the tumor was determined, and hyaluronic gel was injected up to this thickness under ultrasound monitoring. We evaluated skin doses, target doses and clinical outcome. RESULTS: All procedures were performed easily. Sixteen Gy (34.7 Gy equivalent in 2 Gy fractions calculated by the linear quadratic model at α/β = 10: EQD2, α/β = 10, cumulative total was 101.9 Gy EQD10) to 100% of the target volume was irradiated with cumulative maximum skin dose of 70 Gy EQD2, α/β = 3 which was 98.7 Gy EQD2, α/β = 3 without spacer. No procedure related- or late complications and no local recurrence at the treated site were observed for three years until expiration. CONCLUSION: We consider that this procedure will provide an eradicative high-dose irradiation to IMLNM of breast cancer, preserving skin from overdose complications.

A meta-analysis of the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis versus patients with stage Ⅲb/c or Ⅳ breast cancer

Objective:To systematically evaluate the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis (SLNM) versus patients with stage Ⅲb/c or Ⅳ breast cancer,so as to provide evidence for clinical practice and research.Methods:Computer retrieval from PubMed,Cochrane Libratory,CNKI (China National Knowledge Infrastructure),CBM and Wanfang Database with the assistance of other retrieval tools.All the studies evaluating the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis versus patients with stage Ⅲb/c or Ⅳ breast cancer were collected.Quality assessment was performed for the included data based on the quality assessment criteria appropriate for this study.Meta-analysis was performed using RevMan 5.3 software.Results:A total of four references (1277 patients) were included.Assessment of influences on prognosis:As compared to the stage Ⅲb/c group,the 5-year survival rate was slightly lower in the SLNM group (relative risk (RR) 0.79; 95％ confidence interval (CI) 0.59-1.06; Z =1.55,P =0.12),but there was no statistical significance; in contrast,the 5-year survival rate was significantly increased in the SLNM group as compared to the stage Ⅳ group (RR =2.70; 95％CI:1.36-5.37; Z =2.84,P =0.005).As compared to the stage Ⅲb/c group,the 5-year disease-free survival rate was lower in the SLNM group (RR =0.65; 95％CI:0.40-1.05; Z =1.75,P =0.08); however,there was no statistical significance.Conclusions:In patients with advanced breast cancer receiving combined therapy,the prognosis in patients with breast cancer with ipsilateral SLNM was significantly better than in those with stage Ⅳ breast cancer,and slightly worse than those with stage Ⅲb/c breast cancer.However,with the scarcity and poor quality of these observational studies,the long-term prognosis remains to be further verified in large-sample,high-quality studies.

Development and validation of a nomogram for predicting survival of breast cancer patients with ipsilateral supraclavicular lymph node metastasis

Background:Breast cancer patients with ipsilateral supraclavicular lymph node metastasis(ISLNM)but without distant metastasis are considered to have a poor prognosis.This study aimed to develop a nomogram to predict the overall survival(OS)of breast cancer patients with ISLNM but without distant metastasis.Methods:Medical records of breast cancer patients who received surgical treatment at the Affiliated Cancer Hospital of Zhengzhou University,Jiyuan People’s Hospital and Huaxian People’s Hospital between December 21,2012 and June 30,2020 were reviewed retrospectively.Overall,345 patients with pathologically confirmed ISLNM and without evidence of distant metastasis were identified.They were further randomized 2:1 and divided into training(n=231)and validation(n=114)cohorts.A nomogram to predict the probability of OS was constructed based on clinicopathologic variables identified by the univariable and multivariable analyses.The predictive accuracy and discriminative ability were measured by calibration plots,concordance index(C-index),and risk group stratification.Results:Univariable analysis showed that estrogen receptor-positive(ER+),progesterone receptor-positive(PR+),human epidermal growth factor receptor 2-positive(HER2+)with Herceptin treatment,and a low axillary lymph node ratio(ALNR)were prognostic factors for better OS.PR+,HER2+with Herceptin treatment,and a low ALNR remained independent prognostic factors for better OS on multivariable analysis.These variables were incorporated into a nomogram to predict the 1-,3-,and 5-year OS of breast cancer patients with ISLNM.The C-indexes of the nomogram were 0.737(95%confidence interval[CI]:0.660–0.813)and 0.759(95%CI:0.636–0.881)for the training and the validation cohorts,respectively.The calibration plots presented excellent agreement between the nomogram prediction and actual observation for 3 and 5 years,but not 1 year,OS in both the cohorts.The nomogram was also able to stratify patients into different risk groups.Conclusions:In this study,we established and validated a novel nomogram for predicting survival of patients with ISLNM.This nomogram may,to some extent,allow clinicians to more accurately estimate prognosis and to make personalized therapeutic decisions for individual patients with ISLNM.

Which Lymph Nodes Should Be Exactly Removed during Breast Cancer Surgery to Prevent Metastasis?

The aim of the study was to identify the relationship between molecular subtypes of breast cancer (BC) and the morphological characteristics of axillary lymph nodes (ALN) and metastatic risk in BC patients to clarify danger degree and justification of removal before metastases appear. Material and methods. Tumor molecular subtypes of 116 female BC patients aged 24 - 75 (53.9 ± 0.8) were determined by tumor tissue immunohistological examination (obtained by tru-cut biopsy), and the BC was classified as Luminal A, Luminal B/HER2−, Luminal B/HER2+, TNBC, and HER2+ subtypes. To interpret the results for the BC receptor status, immunohistochemical analysis was performed and interpreted according to the Allred scale. Lymph node size, shape, structure and conglomerates availability were recorded according to ultrasonography (USG) examination evaluated on “LOGIQ C5-Premium” (2012). Blood CA-15-3 levels were analyzed using a COBAS-e 411 automated analyzer. Statistical analysis of the obtained results was carried out using the SPSS-26 software package, and based on the t-Student-Bonferroni and H-Kruskal-Wallis criteria. The sensitivity and specificity of the indicators studied were determined using ROC statistical analysis. Results showed a significant association of some subtypes, as well as receptor expression, with tumor metastasis to ALN. Conclusion: 1) The HER2+ subtype is the most aggressive in terms of ALN metastasis. Although TNBC is the most aggressive subtype in general, it is characterized by fewer metastases to the ALN than the HER2+ subtype. 2) Metastatic ALNs can be distinguished based on their cortical structure before tumor tissue biopsy, which is economically profitable. These LNs can be removed without biopsy.

Prospective study found that peripheral lymph node sampling reduced the false-negative rate of sentinel lymph node biopsy for breast cancer

Background:Although sentinel lymph node biopsy(SLNB) can accurately predict the status of axillary lymph node(ALN) metastasis,the high false?negative rate(FNR) of SLNB is still the main obstacle for the treatment of patients who receive SLNB instead of ALN dissection(ALND).The purpose of this study was to evaluate the clinical significance of SLNB combined with peripheral lymph node(PLN) sampling for reducing the FNR for breast cancer and to discuss the effect of "skip metastasis" on the FNR of SLNB.Methods:At Shandong Cancer Hospital Affiliated to Shandong University between March 1,2012 and June 30,2015,the sentinel lymph nodes(SLNs) of 596 patients with breast cancer were examined using radiocolloids with blue dye tracer.First,the SLNs were removed;then,the area surrounding the original SLNs was selected,and the visible lymph nodes in a field of 3–5 cm in diameter around the center(i.e.,PLNs) were removed,avoiding damage to the structure of the breast.Finally,ALND was performed.The SLNs,PLNs,and remaining ALNs underwent pathologic examination,and the relationship between them was analyzed.Results:The identification rate of SLNs in the 596 patients was 95.1%(567/596);the metastasis rate of ALNs was 33.7%(191/567);the FNR of pure SLNB was 9.9%(19/191);and after the SLNs and PLNs were eliminated,the FNR was 4.2%(8/191),which was significantly decreased compared with the FNR before removal of PLNs(P Aected number(N) of SLNs,the patients were divided into four groups of N = 0.028).ccording to the det= 1,2,3,and ≥4;the FNR in these groups was 19.6,9.8,7.3,and 2.3%,respectively.For the patients with removal of PLNs was significantly decreased compared with that before remo≤2 or val of P≤3 detected SLNs,the FNR afterLNs(N 3:12.2% vs.4.7%,P ≤ 2:14.0% vs.4.7%,P = 0.019;N ≤ nt(P = 0.021),whereas for patients with ≥4 detected SLNs,the decrease in FNR was not statistically significa= 1.000).In the entire cohorts,the "skip metastasis" rate was 2.5%(15/596);the FNR caused by "skip metastasis" was 2.1%(4/191).Conclusions:The FNR of SLNB was associated with the number of SLNs.For patients with mpling can reduce the FNR of SLNB to an acceptable level of less than 5%.Because of the≤3 detected SLNs,PLN sa existence of the "skip metastasis" and distinct metastasis patterns,the FNR of SLNB cannot be completely eliminated.

Immunohistochemical study on angiogenesis of axillary lymph node metastasis in human invasive breast carcinoma

Objective: To study angiogenesis of the axillary lymph node metastases including micrometastases in breast carcinoma and the relationship between microvessel density (MVD) and metastasis. Methods: Thirty-seven breast cancer tissues and 121 metastatic axillary lymph nodes were collected from the patients and studied immuno-histochemically. MVD was counted by means of microvideo system under 100 magnification. The diameter of each micrometastasis was measured with a micrometer. Results: The mean diameter of 13 micrometastatic foci was 210±37 mm. No blood vessel formation was found. MVD of the primary tumor and that of metastatic tumor in the axillary lymph node were 93.8±21.8 and 89.3±18.4, respectively (P<0.05). The distribution of microvessels of the metastatic tumor in the lymph node and that of the primary tumor was similar, being higher at the periphery than at the center. Conclusion: Micrometastatic foci of breast carcinoma in the axillary lymph node do not have new blood vessel formation. Their further growth, however, depends on neo-angiogenesis. Treatment based on inhibition of angiogenesis may be efficacious in the prevention of micrometastatic foci from developing into metastatic tumor in lymph node.

Genome-wide 5-Hydroxymethylcytosine Profiling Analysis Identifies MAP7D1 as A Novel Regulator of Lymph Node Metastasis in Breast Cancer

Although DNA 5-hydroxymethylcytosine(5 hmC)is recognized as an important epigenetic mark in cancer,its precise role in lymph node metastasis remains elusive.In this study,we investigated how 5 hmC associates with lymph node metastasis in breast cancer.Accompanying with high expression of TET1 and TET2 proteins,large numbers of genes in the metastasis-positive primary tumors exhibit higher 5 hmC levels than those in the metastasis-negative primary tumors.In contrast,the TET protein expression and DNA 5 hmC decrease significantly within the metastatic lesions in the lymph nodes compared to those in their matched primary tumors.Through genomewide analysis of 8 sets of primary tumors,we identified 100 high-confidence metastasis-associated5 hmC signatures,and it is found that increased levels of DNA 5 hmC and gene expression of MAP7 D1 associate with high risk of lymph node metastasis.Furthermore,we demonstrate that MAP7 D1,regulated by TET1,promotes tumor growth and metastasis.In conclusion,the dynamic5 hmC profiles during lymph node metastasis suggest a link between DNA 5 hmC and lymph node metastasis.Meanwhile,the role of MAP7 D1 in breast cancer progression suggests that the metastasis-associated 5 hmC signatures are potential biomarkers to predict the risk for lymph node metastasis,which may serve as diagnostic and therapeutic targets for metastatic breast cancer.

Tumor deposits in axillary adipose tissue in patients with breast cancer:Do they matter?

Tumor deposits(TDs)are defined as discrete,irregular clusters of tumor cells lying in the soft tissue adjacent to but separate from the primary tumor,and are usually found in the lymphatic drainage area of the primary tumor.By definition,no residual lymph node structure should be identified in these tumor masses.At present,TDs are mainly reported in colorectal cancer,with a few reports in gastric cancer.There are very few reports on breast cancer(BC).For TDs,current dominant theories suggest that these are the result of lymph node metastasis of the tumor with complete destruction of the lymph nodes by the tumor tissue.Even some pathologists classify a TD as two lymph node metastases for calculation.Some pathologists also believe that TDs belong to the category of disseminated metastasis.Therefore,regardless of the origin,TDs are an indicator of poor prognosis.Moreover,for BC,sentinel lymph node biopsy is generally used at present.Whether radical axillary lymph node dissection should be adopted for BC with TDs in axillary lymph nodes is still inconclusive.The present commentary of this clinical issue has certain guiding significance.It is aimed to increase the awareness of the scientific community towards this under-recognized problem in BC pathology.

Preoperative prediction of lymph node metastasis using deep learning-based features

Lymph node involvement increases the risk of breast cancer recurrence.An accurate non-invasive assessment of nodal involvement is valuable in cancer staging,surgical risk,and cost savings.Radiomics has been proposed to pre-operatively predict sentinel lymph node(SLN)status;however,radiomic models are known to be sensitive to acquisition parameters.The purpose of this study was to develop a prediction model for preoperative prediction of SLN metastasis using deep learning-based(DLB)features and compare its predictive performance to state-of-the-art radiomics.Specifically,this study aimed to compare the generalizability of radiomics vs DLB features in an independent test set with dissimilar resolution.Dynamic contrast-enhancement images from 198 patients(67 positive SLNs)were used in this study.Of these subjects,163 had an in-plane resolution of 0.7×0.7 mm^(2),which were randomly divided into a training set(approximately 67%)and a validation set(approximately 33%).The remaining 35 subjects with a different in-plane resolution(0.78×0.78 mm^(2))were treated as independent testing set for generalizability.Two methods were employed:(1)conventional radiomics(CR),and(2)DLB features which replaced hand-curated features with pre-trained VGG-16 features.The threshold determined using the training set was applied to the independent validation and testing dataset.Same feature reduction,feature selection,model creation procedures were used for both approaches.In the validation set(same resolution as training),the DLB model outperformed the CR model(accuracy 83%vs 80%).Furthermore,in the independent testing set of the dissimilar resolution,the DLB model performed markedly better than the CR model(accuracy 77%vs 71%).The predictive performance of the DLB model outperformed the CR model for this task.More interestingly,these improvements were seen particularly in the independent testing set of dissimilar resolution.This could indicate that DLB features can ultimately result in a more generalizable model.

Factors predicting upstaging from clinical N0 to pN2a/N3a in breast cancer patients

BACKGROUND With sentinel node metastasis in breast cancer(BC)patients,axillary lymph node(ALN)dissection is often omitted from cases with breast-conserving surgery.Omission of lymph node dissection reduces the invasiveness of surgery to the patient,but it also obscures the number of metastases to non-sentinel nodes.The possibility of finding≥4 lymph nodes(pN2a/pN3a)preoperatively is important given the ramifications for postoperative treatment.AIM To search for clinicopathological factors that predicts upstaging from N0 to pN2a/pN3a.METHODS Patients who were sentinel lymph node(SLN)-positive and underwent ALN dissection between September 2007 and August 2018 were selected by retrospective chart review.All patients had BC diagnosed preoperatively as N0 with axillary evaluation by fluorodeoxyglucose(FDG) positron emission tomography/computed tomography and ultrasound (US)examination. When suspicious FDG accumulation was found in ALN, the presence of metastasiswas reevaluated by second US. We examined predictors of upstaging from N0 to pN2a/pN3a.RESULTSAmong 135 patients, we identified 1-3 ALNs (pN1) in 113 patients and ³4 ALNs (pN2a/pN3a) in22 patients. Multivariate analysis identified the total number of SLN metastasis, the maximaldiameter of metastasis in the SLN (SLNDmax), and FDG accumulation of ALN as predictors ofupstaging to pN2a/pN3a.CONCLUSIONWe identified factors involved in upstaging from N0 to pN2a/pN3a. The SLNDmax and numberof SLN metastasis are predictors of ≥ 4 ALNs (pN2a/pN3a) and predictors of metastasis to nonsentinelnodes, which have been reported in the past. Attention should be given to axillaryaccumulations of FDG, even when faint.

Clinical Pathological Analysis in 104 Ductal Breast Cancer Cases

Ductal breast cancer is a clinically heterogeneous disease;we investigate the correlation between tumor size, comedo necrosis, number of cell mitoses and axillary lymph node metastasis in ductal breast cancer. In this study, 104 ductal breast cancer specimens were collected and divided into 3 groups: T1 group (tumor size ≤ 2 cm), T2 group (2 5.0 cm). Among those specimens, 95 cases were diagnosed with invasive ducted carcinoma, and 9 cases were ductal carcinoma in-situ (DCIS). Results show that T3 group has a higher rate of axillary lymph node metastasis than T2 group and T1 group;T2 group has a higher rate of lymph node metastasis than T1 group. The patients with the number of cell mitoses (≥10) were also has a higher rate of axillary lymph node metastasis (P = 0.0139) than the patients with the number of cell mitoses (<10). No significance was found between comedo necrosis lesions and axillary lymph node metastasis, though the frequency of comedo necrosis lesions in patients with axillary lymph node metastasis was higher than those in non-metastatic patients. It is concluded that the tumor size and the number of cell mitoses were risk factors for axillary lymph node involvement in ductal breast cancer.

Risk factors for non-sentinel lymph node metastases in breast cancer patients with positive sentinel lymph nodes

The presence or absence of metastases in the axillary lymph nodes has remained the most powerful prognostic factor in breast carcinoma. Axillary lymph node dissection （ALND） is the standard procedure for obtaining this information. However, postoperative complications are common. Sentinel lymph node （SLN） biopsy has been proposed as a potential alternative to ALND for staging breast carcinoma. This technique has been shown to be sensitive and specific for predicting the status of the axillary lymph nodes. Furthermore, it has the potential advantage of decreasing the morbidity associated with ALND.

Genomic mutation signatures in primary breast cancer and their axillary metastatic lymph nodes

Breast cancer is one of the most common malignant tumors in women all over the world.Metastasis represents a major adverse progression of breast cancer,resulting in poor survival duration.Axillary lymph node metastasis is often the first step of systemic metastasis process of breast cancer.However,themechanismof lymph node metastasis and the genomic signatures of primary breast tumors and lymph node metastasis are still under exploration.Whole exome sequencing was applied to primary breast cancer,axillary metastatic lymph nodes,andwhite blood cells from10Chinesewomen patients in our study.Single nucleotide variants(SNVs)and copynumber variants(CNVs)were compared between primary tumors and lymph nodes for individual patients.There are somatic SNVs(average 5.58±2.56 per megabase)in primary breast cancers and somatic SNVs(average 5.46±2.66 per megabase)in axillary metastatic lymph nodes were identified,which is corresponding to a semblable mutation burden in two malignant sites(P=0.81).No difference was found in CNVs(P=0.33).In primary breast cancer,somatic SNVs(48.12±13.80%)and CNVs(61.72±35.00%)were overlapping with somatic SNVs(49.43±12.30%)and CNVs(72.01±24.31%)in axillary metastatic lymph nodes.Nine genes were screened for significant specificmutations in primary tumors,and 15 genes were significantly mutated in metastatic lymph nodes.Using MutSigCV screening,it was found that HRNR and AHNAK2 are lymph node metastasis-specific genes.In our study,primary breast tumors are directly related to axillary lymph node metastases together and there are most SNVs and CNVs which were overlapping in primary andmetastatic sites.These variants which are overlapping is closely related to themetastatic process of tumor invasion with early genetic variability.This is the first timeto prove the concept of polyclonalmetastaticmodel and in thismodelmore than one clonemigrates establish the metastases to axillary lymph nodes.This study was approved by the institutional review board(IRB)of the Cancer Hospital,Chinese Academy of Medical Sciences,and Peking Union Medical College,China(approval No.NCC2016G-030)on March 3,2016.

Overexpression of leptin and leptin receptors in breast cancer positively correlates with clinicopathological features

Obesity has been reported to increase postmenopausal breast cancer risk by 30% to 50%, and obese breast cancer patients have been shown to present more aggressive breast cancer pathological features As most breast cancers are sex hormone-dependent, adipocytokines derived from adipose tissue, such as leptin, may account for the positive association between obesity and breast cancer. Leptin, a 16-kDa protein product of the obese gene, was initially regarded as a neuroendocrine factor in the hypothalamus to maintain homeostasis of body weight by regulating food intake and energy expenditure.

乳腺癌患者腋窝淋巴结转移的危险因素及行X线摄影与CT检查的诊断效能分析

目的:探讨乳腺癌患者腋窝淋巴结转移的危险因素及X线与CT检查的诊断效能比较。方法:选取2021年1月至2023年5月在我院治疗的乳腺癌患者112例,分析发生和未发生腋窝淋巴结转移患者临床资料差异;同时分析X线、CT检查诊断腋窝淋巴结转移的价值。结果:112例患者中,腋窝淋巴结转移患者32例,腋窝淋巴结转移率为28.57%;发生腋窝淋巴结转移患者组织低分化比例、组织类型为浸润性癌比例、有脉管浸润比例、肿瘤直径≥5cm比例、组织Ki-67表达≥14%比例分别为68.75%、90.63%、28.13%、31.25%和84.38%,明显高于未发生腋窝淋巴结转移患者(P<0.05);Logistic回归分析显示:分化程度、病灶组织类型、脉管浸润、Ki-67表达是乳腺癌患者发生腋窝淋巴结转移的影响因素(P<0.05);X线诊断腋窝淋巴结转移与病理结果一致性Kappa值为0.500,P<0.05,一致性较差;CT诊断腋窝淋巴结转移与病理结果一致性Kappa值为0.825,P<0.05,一致性较好;CT诊断腋窝淋巴结转移的准确性、灵敏性和阴性预测值分别为92.86%、87.50%和95.00%,明显高于X线检查(P<0.05)。结论:乳腺癌患者腋窝淋巴结转移受分化程度、病灶组织类型、脉管浸润、Ki-67表达的影响;相较于X线,CT诊断腋窝淋巴结转移的价值较高。

基于数字化乳腺X线影像组学预测浸润性乳腺癌腋窝淋巴结转移的多中心研究

目的:探讨基于多中心数字化乳腺X线影像组学预测浸润性乳腺癌腋窝淋巴结转移的临床应用价值。方法:回顾性搜集728例经病理证实的浸润性乳腺癌患者,按照7:3的比例将皖南医学院第一附属医院弋矶山医院413例浸润性乳腺癌患者随机拆分为训练组289例(淋巴结转移阴性197例,淋巴结转移阳性92例)和验证组124例(淋巴结转移阴性85例,淋巴结转移阳性39例),将阜阳市人民医院和太和县人民医院浸润性乳腺癌患者共计315例(淋巴结转移阴性221例,淋巴结转移阳性94例)作为外部测试组。对比分析双乳内外斜位(MLO)和头尾位(CC)图像,选取病变面积较大的数字化乳腺X线图像使用深睿医疗多模态科研平台进行图像分割及影像组学特征提取,采用特征间线性相关性分析与最小绝对收缩和选择算法(LASSO)对组学特征进行降维并使用支持向量机(SVM)分类器构建影像组学预测模型。采用受试者工作特征(ROC)曲线和决策曲线分析(DCA)评价模型性能。结果:最终筛选出8个影像组学特征构建预测模型用于预测浸润性乳腺癌腋窝淋巴结转移,该模型的预测效能在训练组、验证组和外部测试组分别为0.807、0.790和0.753,敏感度、特异度分别为84.8%和61.4%、79.5%和69.4%、44.7%和92.8%。决策曲线证实了该模型的临床实用性。结论:基于数字化乳腺X线影像组学对浸润性乳腺癌腋窝淋巴结转移的预测具有较高效能,对患者制定个性化的治疗方案和预后评估有着重要的临床应用价值。

芪贞归脾汤辅助治疗对食管癌伴锁骨上淋巴结转移患者细胞E-cadherin表达的影响

目的探讨芪贞归脾汤辅助治疗对食管癌伴锁骨上淋巴结转移患者细胞钙黏素(E-cadherin)表达的影响。方法选取2016年1月—2021年1月食管癌伴锁骨上淋巴结转移病例96例,随机编号方法分两组,各48例,对照组采用常规放疗;在此基础上,观察组采用芪贞归脾汤辅助治疗,持续治疗8周。治疗前后评价中医证候积分、匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)、免疫功能、细胞角蛋白19片段(cytokeratin 19 fragment,CYFRA21-1)、癌胚抗原(carcinoembryonic antigen,CEA)、癌抗原(cancer antigen 125,CA125)、E-cadherin和不良反应情况。结果观察组治疗后咽下困难、胸闷不舒、形体消瘦、气短乏力等积分低于对照组,差异有统计学意义(均P<0.05)。观察组治疗后睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能障碍等评分低于对照组,差异有统计学意义(均P<0.05)。观察组治疗后CD^(+)_(3)、CD^(+)_(4)、CD^(+)_(4)/CD^(+)_(8)高于对照组,CD^(+)_(8)低于对照组,差异有统计学意义(均P<0.05)。观察组治疗后血清CYFRA21-1、CEA、CA125低于对照组,差异有统计学意义(均P<0.05)。观察组治疗后E-cadherin阳性率72.92%高于对照组54.17%,差异有统计学意义(P<0.05)。两组放射性皮炎、恶心呕吐、白细胞减少、肝功能异常、神经毒性等不良反应比较,差异无统计学意义(均P>0.05)。结论芪贞归脾汤辅助治疗可以提高食管癌伴锁骨上淋巴结转移患者的免疫功能和睡眠质量,降低肿瘤标志物及E-cadherin的表达,安全性高。