基于乳腺MRI及腋窝超声的列线图预测早期乳腺癌前哨淋巴结转移风险的价值  

The application value of a nomogram based on breast MRI and axillary ultrasonography for predicting sentinel lymph node metastasis of early-stage breast cancer

作　　者：马微妹 李姣 何妮[1] 陈洁婷 伍尧泮[1] Ma Weimei;Li Jiao;He Ni;Chen Jieting;Wu Yaopan(Department of Radiology,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;Department of Radiology,the Eighth Affiliated Hospital,Sun Yat-sen University,Shenzhen 518033,China)

机构地区：[1]中山大学肿瘤防治中心影像科,广州510060 [2]中山大学附属第八医院影像科,深圳518033

出　　处：《中华放射学杂志》2020年第7期694-701,共8页Chinese Journal of Radiology

摘　　要：目的探讨基于术前乳腺MRI及腋窝超声的列线图预测早期乳腺癌(EBC)前哨淋巴结(SLN)转移风险的价值。方法回顾性分析2007年5月至2017年12月在中山大学肿瘤防治中心经手术病理证实为原发性单侧侵犯性EBC女性患者的临床和影像资料。共入组397例患者,年龄25~81(48±11)岁。根据SLN活检的病理结果,分为SLN阴性组(n=200)和SLN阳性组(n=197)。分析2组患者临床病理资料、MRI检查、腋窝超声检查的差异。使用logistic回归分析筛选出独立危险因素,构建预测模型并制作列线图,以视化预测因素和SLN状态之间的关系。模型的拟合优度评估使用Hosmer-Lemeshow检验,使用受试者操作特征(ROC)曲线评估列线图的预测性能,并通过Bootstrap重采样进行内部验证。结果年龄、脉管浸润、孕激素受体(PR)、人类表皮生长因子受体2(HER2)、分子亚型、MRI表现(肿瘤大小;肿块边缘;淋巴结长径、短径和长径/短径;淋巴结边缘;淋巴结门;双侧腋窝淋巴结对称性)、腋窝超声表现(淋巴结皮髓质分界;淋巴结皮质增厚;淋巴结门)在SLN阴性组和阳性组间差异有统计学意义(P<0.05)。通过logistic回归分析,患者年龄、MRI表现(淋巴结边缘、淋巴结门、双侧腋窝淋巴结对称性)、腋窝超声表现(皮质是否增厚)以及病理因素(脉管浸润、PR状态、HER2状态)被确定为SLN转移的预测因子。基于患者年龄和上述影像学特征构建的预测SLN转移风险的列线图的预测效能较好,其ROC曲线下面积为0.778;而联合病理参数的列线图的预测能力显著提高,其ROC曲线下面积为0.866。结论基于乳腺MRI及腋窝超声构建的列线图可作为一种无创性量化工具预测早期乳腺癌SLN的转移风险,并有利于术前腋窝治疗策略的制定。Objective To explore the clinical application values of a nomogram based on preoperative breast MRI and axillary ultrasonography imaging parameters for predicting the risk of sentinel lymph node(SLN)metastasis in early-stage breast cancer patients.Methods Three hundred and ninty-seven female patients(mean age 48.0±10.7 years old,range 25-81 years old)who admitted to Sun Yat-sen University Cancer Center from May 2007 to December 2017 were enrolled in this study.All patients were diagnosed as primary unilateral invasive early-stage breast cancer confirmed by surgical pathology.Preoperative breast MRI,axillary ultrasonography and clinical pathological data of enrolled patients were retrospectively analyzed.According to the pathological results of sentinel lymph node biopsy(SLNB),the cases were divided into negative SLN group(n=200)and positive SLN group(n=197).Clinicopathologic data,MRI and axillary ultrasound features were analyzed and compared between two groups.Logistic regression analysis was used to select independent risk factors.Then a predictive model was constructed and a nomogram was made for visualizing the associations between the predictive factors and SLN metastasis.Goodness-of-fit of the model was evaluated by using the Hosmer-Lemeshow test.Predictive performance was assessed based on the receiver operating characteristic(ROC)curves.Bootstrap resampling was performed for internal validation.Results Significant differences were found in patient age,lymphovascular invasion status,PR status,HER2 status and molecular subtype between negative and positive SLN groups(all P<0.05);MRI features including tumor size,mass margin,long and short diameter,as well as the ratio of long to short diameter of LNs,LN margin,presence or absence of LN hilum,and axillary LNs symmetry were found significantly different between negative and positive SLN groups(all P<0.05);as for the axillary LN ultrasonography parameters,the interface between cortex and medulla,presence or absence of cortical thickening,and LN hilum were sig

关 键 词：乳腺肿瘤 列线图 前哨淋巴结活组织检查 磁共振成像 超声检查 

分 类 号：R737.9[医药卫生—肿瘤] R445[医药卫生—临床医学]