Objective:To investigate the risk factors of axillary lymph node metastasis(ALNM)in patients with triple-negative breast cancer(TNBC),and construct a model to predict ALNM based on full-field digital mammography(FFDM)image features.Methods:The clinicopathologic data of 227 patients with TNBC confirmed by pathological examination were retrospectively analyzed.The patients were divided into axillary lymph node metastasis group(90 cases)and non-metastatic group(137 ca-ses).All cases underwent routine breast FFDM examination before operation.The clinicopathologic features(age,menopausal status,histological grade,Ki-67 expression,pathological type)and tumor FFDM signs(glandular type,tumor maximum diameter,density,shape,margin,suspicious calcifica-tion,FFDM indicated ALNM and adjacent skin thickening or depression)were compared between the two groups of TNBC patients.Univariate analysis and binary logistic stepwise regression analysis were used to identify independent risk factors for TNBC lymph node metastasis,and a combined prediction model was constructed.Receiver operating characteristic(ROC)curve was used to evaluate the value of the model in predicting axillary lymph node metastasis.Results:Univariate analysis showed that there were significant differences in menopausal status,maximum diameter,density,shape,margin and suspicious calcification of tumors,ALNM and skin thickening or indentation indicated by FFDM be-tween two groups of TNBC patients,which were correlated with axillary lymph node metastasis(P＜0.05).Logistic regression analysis showed that tumor with spiculate margin(OR=12.362,P＜0.001),tumor with suspicious calcification(OR=4.249,P=0.001),and FFDM indicated ALNM(OR=34.428,P＜0.001)were independent risk factor for axillary lymph node metastasis in TNBC.The combined diagnostic model for predicting lymph node metastasis was established as Logit(P)=-5.349+2.515×tumor with spiculate margin+1.447×tumor with suspicious calcification+3.539× FFDM indicated ALNM.The area under the curve(AUC)of the combined prediction model was 0.880,with a coincidence rate of 81.5％,sensitivity of 86.7％,and specificity of 73.7％.Conclusion:FFDM imaging showed that tumor with spiculate margin,tumor with suspicious calcification,and FFDM indicated ALNM was a risk factor for axillary lymph node metastasis in patients with TNBC.The combined prediction model constructed based on these factors has good predictive value for TNBC lymph node metastasis.
关键词
三阴性乳腺癌/乳房X线摄影术/病理状态,体征和症状/肿瘤转移/回归分析
Key words
Triple negative breast neoplasms/Mammography/Pathological conditions,signs and symptoms/Neoplasm metastasis/Regression analysis
维普
万方数据