摘要
目的 应用超声二维及造影参数特征构建诊断模型,预测Luminal B型乳腺癌腋窝转移淋巴结新辅助化疗(NCT)后的病理状态.方法 选择2018年5月至2023年5月于内蒙古自治区人民医院就诊且经组织病理活检证实为腋窝淋巴结转移的Luminal B型乳腺癌患者68例,均为女性,年龄32～70岁,平均年龄45.12岁;TNM分期Ⅱ期38例,Ⅲ期30例;腋窝淋巴结长径1.5～3.5 cm,平均淋巴结长径2.8 cm.根据NCT后腋窝淋巴结手术病理结果分为病理完全缓解(pCR)组和非病理完全缓解(npCR)组.回顾性分析NCT后两组病例二维及超声造影参数之间的变化值,对差异有统计学意义的超声指标采用Logistic回归分析,建立NCT后腋窝淋巴结pCR的预测模型,并绘制受试者工作特性(ROC)曲线评估模型诊断效能.结果 两组患者年龄和腋窝淋巴结最大长径(L)、最大短径(S)、短径与长径比值(S/L)及临床分期差异无统计学意义(P＞0.05);两组在NCT后腋窝淋巴结L、S、S/L较前减小,造影参数到达时间(AT)、达峰时间(TTP)高于化疗前,峰值强度(PI)、上升支斜率(AS)、曲线下面积(AUC)较化疗前减低,差异有统计学意义(P＜0.05).pCR组患者腋窝淋巴结 NCT 治疗前后变化值 ΔS、ΔS/L、ΔAT、ΔPI、ΔAS、ΔAUC 均高于 npCR 组[-7.00(1.00)vs-4.00(0.22)、-0.19(6.45)vs-0.10(2.40)、1.95(943.13)vs 0.82(27.5)、1.95(943.13)vs 0.82(27.5)、-12.17(1.00)vs-5.28(0.15)、-0.27(7.83)vs-0.10(3.10)、-1 018.24(472.03)vs-273.42(28.23).P＜0.05].采用多因素分析结果显示有差别的指标构建对于Luminal B型乳腺癌腋窝转移淋巴结pCR的预测模型Logistic(P)=-10.806+0.318ΔS-1.233 ×ΔAT+0.241 × ΔPI-11.711 × ΔAS.该预测模型的灵敏度、特异度分别为93.75％、88.57％.结论 超声造影可为Lu-minal B型乳腺癌NCT后腋窝淋巴结病理状态提供一定的影像学依据.
Abstract
Objective To establish a diagnostic model for Luminal B breast cancer by using characteristics of two-dimen-sional ultrasound and contrast parameters,and predict the pathological status of axillary metastatic lymph node after neoadju-vant chemotherapy(NCT).Methods From May 2018 to May 2023,a total of 68 female patients with Luminal B breast can-cer who were diagnosed with axillary lymph node metastasis by histopathological biopsy were enrolled,which aged 32-70 years old with mean age of 45.12 years old;38 cases of TNM stage Ⅱ and 30 of TNM stage Ⅲ;lymph node diameter was 1.5-3.5 cm with mean lymph node diameter of 2.8 cm.According to pathological results of axillary lymph node after NCT,all of them were divided into pathological complete remission(pCR)group and non-pathological complete remission(npCR)group.The changes of two-dimensional and contrast-enhanced ultrasound parameters after NCT in 2 groups were retrospectively analyzed.The Logistic regression analysis was used to establish predictive model for pCR of axillary lymph node after NCT,and receiver operating characteristic(ROC)curve was drawn to evaluate model diagnostic efficacy.Results There was no sig-nificant difference in age,maximum long diameter(L),maximum short diameter(S),ratio of short diameter to long diameter(S/L)and clinical stage of axillary lymph node between 2 groups(P＞0.05).The L,S and S/L of axillary lymph node in 2 groups after NCT were statistically significantly lower than those before NCT,the arrival time(AT)and time to peak(TTP)of contrast parameters were statistically significantly higher than those before NCT,while peak intensity(PI),ascending slope(AS)and area under curve(AUC)were statistically significantly lower than those before NCT(P＜0.05).The ΔS,ΔS/L,ΔAT,ΔPI,ΔAS and ΔAUC of axillary lymph node before and after NCT in pCR group were statistically significantly higher than those in npCR group[-7.00(1.00)vs-4.00(0.22),-0.19(6.45)vs-0.10(2.40),1.95(943.13)vs 0.82(27.5),1.95(943.13)vs 0.82(27.5),-12.17(1.00)vs-5.28(0.15),0.27(7.83)vs-0.10(3.10),-1 018.24(472.03)vs-273.42(28.23).P＜0.05].The results of multivariate analysis showed that the predictive model of pCR for axillary lymph node metastasis in Luminal B breast cancer was Logistic(P)=-10.806+0.318ΔS-1.233 × ΔAT+0.241 × ΔPI-11.711 × ΔAS.The sensitivity and specificity of prediction model were 93.75％and 88.57％,respectively.Conclusion It is demonstrated that contrast-enhanced ultrasonography could provide imaging evidence for pathological status of axillary lymph node in Luminal B type breast cancer after NCT.
基金项目
内蒙古医科大学科技百万工程联合项目(KD2020KJBWLH044)
内蒙古自治区科技计划(2021GG0125)
内蒙古自治区科技计划(2020GG0086)
NETL
NSTL
万方数据