超声联合病理指标预测乳腺癌腋窝淋巴结转移的价值
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摘要
目的:探究超声联合病理指标在预测乳腺癌腋窝淋巴结(ALN)转移中的价值。方法:选择2016年3月至2017年4月在广西医科大学第一附属医院进行手术,术中进行腋窝淋巴结分期的乳腺癌患者314例。对纳入患者的病理指标及超声特征进行单因素分析筛选腋窝淋巴结转移的危险因素,并对筛选出的危险因素按照病理组、超声组及联合组进行多因素Logistic回归分析。绘制各组受试者工作特征曲线(ROC),计算ROC曲线下面积(AUC)。结果:314例乳腺癌患者中,166例(52.87%)存在ALN转移,148例(47.13%)无ALN转移。病理组、超声组及联合组的AUC分别为0.737(95%CI:0.684~0.784)、0.783(95%CI:0.733~0.827)、0.833(95%CI:0.788~0.873)。联合组的AUC大于病理组和超声组(P<0.05)。结论:超声联合病理指标能够提高乳腺癌患者ALN转移预测的准确性。
Objective: To investigate the value of ultrasound combined with pathological factors in predicting axillary lymph node(ALN)metastasis in breast cancer patients. Methods: 314 breast cancer patients treated in our hospital from March 2016 to April 2017 were enrolled. The risks for ALN metastasis were analyzed by univariate analysis and multivariate logistic regression analysis. Receiver operating characteristic(ROC)curve was made to evaluate the value of ultrasound,pathological factors and this combination for ALN metastasis(P<0. 05).Results: Of 314 breast cancer patients,166 cases(52. 87%)had ALN metastasis. The area under the ROC curve(AUC)of ultrasound,pathological factors and the combination were 0. 737(95% CI: 0. 684-0. 784),0. 783(95% CI: 0. 733-0. 827)and 0. 833(95% CI: 0. 788-0. 873). Ultrasound combined with pathological factors had highest AUC(P<0. 05). Conclusions: Ultrasound in combination with pathological factors could elevate the accuracy for predicting ALN metastasis in breast cancer patients.
Objective: To investigate the value of ultrasound combined with pathological factors in predicting axillary lymph node(ALN)metastasis in breast cancer patients. Methods: 314 breast cancer patients treated in our hospital from March 2016 to April 2017 were enrolled. The risks for ALN metastasis were analyzed by univariate analysis and multivariate logistic regression analysis. Receiver operating characteristic(ROC)curve was made to evaluate the value of ultrasound,pathological factors and this combination for ALN metastasis(P<0. 05).Results: Of 314 breast cancer patients,166 cases(52. 87%)had ALN metastasis. The area under the ROC curve(AUC)of ultrasound,pathological factors and the combination were 0. 737(95% CI: 0. 684-0. 784),0. 783(95% CI: 0. 733-0. 827)and 0. 833(95% CI: 0. 788-0. 873). Ultrasound combined with pathological factors had highest AUC(P<0. 05). Conclusions: Ultrasound in combination with pathological factors could elevate the accuracy for predicting ALN metastasis in breast cancer patients.
引文
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[10]邹霞,李泉水,熊华花,等.超声在乳腺癌患者腋窝淋巴结转移相关因素分析中的作用[J].临床超声医学杂志,2014,16(6):392-394.
[11]郭碧萍,李艳宁,徐丽芳,等.超声弹性成像联合常规超声评分对乳腺癌腋窝淋巴结转移的诊断价值[J].广西医科大学学报,2017,34(6):832-834.
[12]胡鹏遥,尉承泽,郝晓鹏,等.B超判断乳腺癌腋窝淋巴结转移状态的临床研究[J].军事医学,2015(9):702-706,716.
[2]MERETOJA T J,HEIKKILA P S,MANSFIELD A S,et al.A predictive tool to estimate the risk of axillary metastases in breast cancer patients with negative axillary ultrasound[J].Ann Surg Oncol,2014,21(7):2229-2236.
[3]俞理,胡滨,朱家安,等.超声及其他多因素在乳腺癌腋窝淋巴结转移中的预测价值[J].中华临床医师杂志,2012,6(14):3904-3908.
[4]HE Z Y,WU S G,YANG Q,et al.Breast cancer subtype is associated with axillary lymph node metastasis:A retrospective cohort study[J].Medicine(Baltimore),2015,94(48):e2213.
[5]RAKHA E A,REIS-FILHO J S,BAEHNER F,et al.Breast cancer prognostic classification in the molecular era:the role of histological grade.Breast Cancer Res,2010,12:207.
[6]LOPEZ F,BELLOC F,LACOMBE F,et al.Modalities of synthesis of Ki67 antigen during the stimulation of lymphocytes[J].Cytometry,1991,12:42-49.
[7]INIC Z,ZEGARAC M,INIC M,et al.Difference between Luminal A and Luminal B subtypes according to Ki-67,tumor size,and progesterone receptor negativity providing prognostic information[J].Clin Med Insights Oncol,2014,8:107-111.
[8]QIU S Q,ZENG H C,ZHANG F,et al.A nomogram to predict the probability of axillary lymph node metastasis in early breast cancer patients with positive axillary ultrasound[J].Sci Rep,2016,6:21196.
[9]LEE B,LIM A K,KRELL J,et al.The efficacy of axillary ultrasound in the detection of nodal metastasis in breast cancer[J].Ajr American Journal of Roentgenology,2013,200(3):314-320
[10]邹霞,李泉水,熊华花,等.超声在乳腺癌患者腋窝淋巴结转移相关因素分析中的作用[J].临床超声医学杂志,2014,16(6):392-394.
[11]郭碧萍,李艳宁,徐丽芳,等.超声弹性成像联合常规超声评分对乳腺癌腋窝淋巴结转移的诊断价值[J].广西医科大学学报,2017,34(6):832-834.
[12]胡鹏遥,尉承泽,郝晓鹏,等.B超判断乳腺癌腋窝淋巴结转移状态的临床研究[J].军事医学,2015(9):702-706,716.