Predictive Value of Multimodal Ultrasonography in Lymph Node Pathologically Complete Response After Neoadjuvant Chemotherapy in Invasive Breast Cancer
Objective To explore the predictive value of multimodal ultrasonography in lymph node pathologically complete response(pCR)after neoadjuvant chemotherapy(NAC)in invasive breast cancer.Methods 148 patients,including 112 in the training set and 36 in the testing set,with breast cancer before NAC,who underwent routine ultrasound,percutaneous contrast-enhanced ultrasound(pCEUS)and shear wave elastography(SWE)of axillary lymph nodes,were collected.T staging and molecular typing of breast cancer and the short diameter,long short diameter ratio,hilum structure,parenchymal thickness,parenchymal echo,boundary,color doppler flow imaging(CDFI)grade,contrast-enhanced mode of lymph nodes,lymphatic continuity,lymph nodes average elasticity(Emean),maximum elastic modulus(Emax),minimum elastic modulus(Emin),standard deviation(SD)and elastic modulus ratio(Eratio)were collected.According to the pathological results after axillary lymph node dissection,axillary lymph nodes were divided into pCR group and non-pathologically complete response(npCR)group.The influencing factors related to axillary lymph node pCR were analyzed and a logistic regression model was established.In the testing set,the predictive performance of the model was comprehensively evaluated using receiver operating characteristic(ROC)curves,Hosmer-Lemeshow goodness of fit tests,calibration curves,and decision curves.Results Among the 112 patients in the training set,49 axillary lymph nodes were pCR and 63 were still positive.Univariate analysis showed that there were statistically significant differences in molecular typing of breast cancer,hilar structure,parenchymal thickness,Emean,Emax,Emin,SD,Eratio,contrast-enhanced type,and lymphatic continuity between pCR group and npCR group(P＜0.05).The results of multivariate analysis showed that HER 2+,parenchymal thickness 0.38 cm,Emax＜10.0 kPa and homogeneous/circular contrast enhancement were the protective factors of axillary lymph node pCR(P＜0.05).The regression model was constructed for axillary lymph nodes pCR,and area under curve was 0.831(95％CI:0.749-0.923,P＜0.05),with a sensitivity of 87.8％and a specificity of 70.9％.The results of the Hosmer-Lemeshow goodness-of-fit test,calibration curves,and decision curves all indicated that the predictive model performed well in all aspects of accuracy,discrimina-tion,calibration,and clinical benefit.Conclusion Multimodal ultrasound of axillary lymph nodes can effectively recognize the cases of lymph nodes pCR after NAC.It can offer the reliable evidence in the choice of axillary lymph nodes surgical methods in patients with clinical N 1 breast cancer after NAC.
万方数据
维普
