Clinical value of a nomogram based on pathological indexes and contrast-enhanced ultrasound parameters for predicting axillary lymph node metastasis in triple negative breast cancer
Objective To screen the independent influencing factors for predicting axillary lymph node metastasis in triple negative breast cancer(TNBC)based on pathological indexes and contrast-enhanced ultrasound parameters,and to establish a nomogram to explore its clinical application value.Methods Totally 165 patients pathologically confirmed TNBC from our hospital were divided into metastatic group(44 cases)and non-metastatic group(121 cases)according to the status of axillary lymph node metastasis.The conventional ultrasound,contrast-enhanced ultrasound and pathological examination results between metastatic and non-metastatic groups were compared.Logistic regression analysis was used to screen the independent influencing factors for predicting axillary lymph node metastasis in TNBC,and a nomogram based on above factors was established.Bootstrap self-sampling method(1000 times)was used to internally validate the nomogram and calculate the consistency index(C-index).Receiver operating characteristic(ROC)curve,calibration curve and decision curve analysis were used to evaluate the diagncstic performance,calibration degree and clinical applicability of the nomogram for predicting axillary lymph node metastasis in TNBC.Results There were significant differences in histological grade,Ki-67,tumor maximum diameter,contrast-enhanced ultrasound initiation time(IT),time to peak(TTP)and peak intensity(PI)between metastatic and non-metastatic groups(all P<0.05).Logistic regression analysis showed that the tumor diameter,histological grade,Ki-67 and PI were independent risk factors for predicting axillary lymph node metastasis in TNBC,while IT and TTP were independent protective factors(all P<0.05).A nomogram based on above independent influencing factors for predicting axillary lymph node metastasis in TNBC was established.The Bootstrap self-sampling method showed that C-index was 0.960(95％confidence interval:0.946～0.974).ROC curve analysis showed that the area under the curve was 0.940(95％confidence interval:0.927～0.953).Calibration curve showed that the predicted probability was basically consistent with the actual probability.When the decision curve showed a threshold probability of 2％～99％,the net benefit of the nomogram was higher.Conclusion Histological grade,Ki-67,tumor maximum diameter,IT,TTP and PI are independent influencing factors for predicting axillary lymph node metastasis in TNBC.The nomogram based on above factors has high clinical application value in predicting axillary lymph node metastasis in TNBC.
UltrasonographyContrast agentTriple negative breast cancerAxillary lymph node metastasisPathologyNomogram
NETL
NSTL
万方数据
