超声预测乳腺癌腋窝淋巴结转移的多因素分析  

Multivariate analysis in predicting axillary lymph node metastasis in breast cancer

作　　者：王丰[1] 张锐[1] 肖芳[1] 唐熙[1] 

机构地区：[1]怀化市第一人民医院超声科,湖北省418000

出　　处：《中华临床医师杂志（电子版）》2011年第8期2201-2206,共6页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探寻预测乳腺癌腋窝淋巴结转移的超声相关因素,建立超声预测乳腺癌腋窝淋巴结转移的多因素Logistic回归模型。方法利用乳腺和腋窝超声观察227例病理证实的乳腺癌患者,分析影响腋窝淋巴结转移率的超声相关因素,将这些因素引入单因素及多因素Logistic回归模型,计算回归模型ROC曲线下面积及准确度等评价指标。结果肿瘤大小、肿瘤边界、肿瘤血流分级、超声检出淋巴结数目、淋巴结皮质最大厚度、淋巴结血流分型和淋巴结纵横比是影响乳腺癌腋窝淋巴结转移率的因素(P<0.05),多因素Logistic回归模型显示肿瘤大小≥2cm、淋巴结皮质最大厚度≥3mm、淋巴结血流Ⅲ型和较小的淋巴结纵横比是乳腺癌腋窝淋巴结转移的危险因素。多因素回归模型ROC曲线下面积为0.847,准确度、敏感度、特异度、阳性预测值和阴性预测值分别为79.3%、85.9%、68.2%、81.9%和74.4%,较单因素回归模型在没有明显降低敏感度基础上显著提高了特异度,避免了过多假阴性出现。结论多因素Logistic回归模型能够较好地预测乳腺癌腋窝淋巴结转移情况。Objective To estimated the related factor of axillary lymph node metastasis in breast cancer patients.The multivariate logistic regression model was established for predicting axillary lymph node metastasis.Methods Breast and axillary ultrasound were recorded in 227 breast cancer patients diagnosed by pathology.To analyse the relationship between ultrasonographic characteristics and axillary lymph node metastasis rate in breast cancer patients.Use univariate and multivariate logistic regression analysis to calculate which ultrasonographic characteristics related to axillary lymph node metastasis,and ROC curve was drawn to appraise the value of logistic regression,then evaluated accuracy for each logistic regression.Results Breast tumor diameter,edge of tumor,Adler grade of tumor blood flow,number of axillary lymph node found by ultrasound,cortical thickness of axillary lymph node,blood flow form of axillary lymph node and longitudinal transverse axis ratio of axillary lymph node were correlated with axillary lymph node metastasis(P<0.05),and multivariate logistic regression analysis showed breast tumor diameter,cortical thickness of axillary lymph node,blood flow form Ⅲ of axillary lymph node and longitudinal transverse axis ratio of axillary lymph node were risk factors of axillary lymph node metastasis in breast cancer patients.The area under the ROC curve of multivariate logistic regression model was 0.847,the accuracy,sensitivity,specificity,positive predictive value and negative predictive value were 79.3%,85.9%,68.2%,81.9%,74.4%.Specificity was improved significantly than univariate logistic analysis,meanwhile the sensitivity only slightly descended in multivariate logistic regression model.Many of false negative patients were avoided by using the multivariate logistic regression model.Conclusions The multivariate logistic regression model can be helpful for predicting axillary lymph node metastasis in breast cancer.

关 键 词：超声检查 乳腺肿瘤 淋巴转移 腋 

分 类 号：R737.9[医药卫生—肿瘤]