Value of nomogram based on ultrasound in prediction of papilla-areola complex involvement in patients with breast cancer
Objective To investigate the detection rate of nipple-areola complex(NAC)involvement in patients with breast cancer,and to construct a nomogram predictive model based on conventional ultrasound and contrast-enhanced ultrasound(CEUS)signs to guide preoperative evaluation.Methods A total of 108 patients with breast cancer who were pathologically diagnosed and eligible for mastectomy in Shaanxi Nuclear Industry 215 Hospital from October 2022 to October 2023 were retrospectively summarized.They were(44.8±10.4)years old.They were divided into an NAC positive group(35 cases)and an NAC negative group(73 cases)according to the postoperative routine pathological results.Before the operation,conventional two-dimensional color Doppler ultrasound was used to measure the tumor maximum diameter,tumor to nipple distance(TND),tumor location,type,shape,direction,edge,boundary,echo pattern,internal uniformity,blood vessels,microcalcification,and echo pattern extending from lesion to catheter.CEUS was used to measure the maximum tumor diameter,TND,catheter enhancement extension to nipple(DEEN),focal nipple enhancement,enhanced uniformity,edge enhancement,contour enhancement,sequence of enhancement,perfusion defect,and extent of enhancement.The independent-sample t test andx2 were used to compared tha data between the groups.Multivariate logistic regression was used to screen the risk factors of NAC involvement and establish a nomogram model.The predictive performance was verified by the receiver operating characteristic curves(ROC),calibration,and decision analysis(DCA).Results Compared with the negative group,the positive group showed increases of peripheral tumors,microcalcifications,ductal echo extending from lesion,as well as CEUS measurements of DEEN and focal nipple enhancement,while the TND measured by two-dimensional ultrasound and CEUS were significantly shorter(all P＜0.05).The regression analysis showed that ductal echo extending from lesion(full course:OR=2.452,95％CI 1.590-3.782,P＜0.001;segmental:OR=1.992,95％CI 1.252-3.169,P＜0.001),DEEN(OR=1.385,95％CI 1.018-1.885,P=0.003),and focal nipple enhancement(OR=3.435,95％CI 1.654-7.135,P＜0.001)were the main risk factors of NAC involvement.After establishing the nomogram using the R software,the AUC calculated by ROC was 0.876(95％CI 0.811-0.935,P＜0.001),indicating good predictive accuracy of the model.The calibration and DCA curves showed good agreement and clinical net benefit ratio of the model.Conclusion The nomogram model developed by conventional ultrasound and CEUS typical signs has important potential for predicting the risk of NAC involvement in patients with breast cancer taking breast conserving resection.
Breast cancerBreast conserving resectionNipple-areola complexContrast-enhanced ultrasoundNomogram
万方数据
维普
