HER2~+乳腺癌超声特征预测腋窝淋巴结转移价值分析  

Evaluation of the value of and sonographic appearance in predicting axillary lymph node metastasis of HER2 over-expression breast cancer

作　　者：陈智慧 查海玲 蔡梦君 张曼琪 刘心培 杜丽雯[1] 刘晓安[2] 栗翠英[1] CHEN Zhihui;ZHA Hailing;CAI Mengjun;ZHANG Manqi;LIU Xinpei;DU Liwen;LIU Xiaoan;LI Cuiying(Department of Ultrasonography,Nanjing Medical University First Hospital,Nanjing 210029,Jiangsu Province,China;Department of Breast Surgery,Nanjing Medical University First Hospital,Nanjing 210029,Jiangsu Province,China)

机构地区：[1]南京医科大学第一附属医院超声诊断科,江苏南京210029 [2]南京医科大学第一附属医院乳腺外科,江苏南京210029

出　　处：《肿瘤影像学》2022年第4期419-424,共6页Oncoradiology

基　　金：江苏妇幼健康科研项目(F201949)。

摘　　要：目的:探讨人表皮生长因子受体2过表达(human epidermal growth factor receptor 2 over-expression,HER2^(+))乳腺癌患者肿瘤超声图像特征在提示腋窝淋巴结转移上的价值。方法:纳入2016年3月—2021年9月南京医科大学第一附属医院病理学检查证实为HER2^(+)乳腺癌的482例患者,其中153例为转移组,329例为非转移组,应用单因素及多因素logistic回归分析肿块及腋窝淋巴结超声图像特征与腋窝淋巴结转移的相关性。结果:单因素分析显示,肿块超声图像中大小、边缘、阻力指数(resistant index,RI)差异有统计学意义,腋窝淋巴结超声图像中短径S、L/S(<2)、皮质厚度(>3 mm)、淋巴门、血供类型及血流差异有统计学意义,与淋巴结转移具有相关性(P<0.05);多因素logistic回归分析显示,患者肿块超声图像中肿块边缘(OR=0.411,P=0.040)、淋巴结超声图像中皮质厚度(OR=3.082,P<0.001),淋巴门存在与否(OR=0.331,P=0.001)以及淋巴结血流(OR=0.382,P=0.001)是HER2^(+)乳腺癌腋窝淋巴结转移的独立影响因素。结论:肿块与淋巴结超声图像特点相结合对预测HER2^(+)乳腺癌腋窝淋巴结转移有重要价值,可为临床医师制订治疗方案及选择手术方式提供参考。Objective:To investigate the value of ultrasonographic features of tumor in suggesting axillary lymph node metastasis in patients with human epidermal growth factor receptor 2 over-expression(HER2^(+))breast cancer.Methods:A total of 482 female patients were enrolled with HER2^(+) breast cancer confirmed by pathology in The First Affiliated Hospital of Nanjing Medical University from March 2016 to September 2021 in this study,including lymph node metastasis group with 153 patients and nonmetastasis group with 329 patients.The correlation between ultrasonographic features of HER2^(+) breast cancer and axillary lymph node metastasis was determined by univariate and logistic regression analyses.Results:Univariate analysis showed that some parameters of the tumor,including size,margin,resistant index(RI),and of lymph node,including short axis,L/S ratio(<2),cortical thickness(>3 mm),effacement of the fatty hilum,vascular pattern and vascularity were significantly different between the two groups,which were correlated with axillary lymph node metastasis(P<0.05).Logistic regression analysis showed that margin of tumor(OR=0.411,P=0.040),cortical thickness(OR=3.082,P<0.001),effacement of the fatty hilum(OR=0.331,P=0.001),and vascularity of lymph node(OR=0.382,P=0.001)were independent risk factors for axillary lymph node metastasis in HER2^(+) breast cancer.Conclusion:Combined ultrasonographic features of mass and lymph node can predict the metastasis of axillary lymph nodes in HER2^(+) breast cancer and guide the clinical selection of axillary lymph node surgery.

关 键 词：乳腺癌 超声 人表皮生长因子受体2 腋窝淋巴结 

分 类 号：R737.9[医药卫生—肿瘤] R445.1[医药卫生—临床医学]