常规超声联合超声造影预测乳腺癌腋窝淋巴结转移的价值  

The value of conventional ultrasound combined with contrast⁃enhanced ultrasound for predicting axillary lymph node metastasis of breast cancer

作　　者：李文肖[1] 刘燕 曹春莉 吴芳[1] 曹玉文[2] 成静[1] 李军[1,3] LI Wenxiao;LIU Yan;CAO Chunli;WU Fang;CAO Yuwen;CHENG Jing;LI Jun(Department of Ultrasound,the First Affiliated Hospital of Medical College of Shihezi University,Shihezi 832008,China;不详)

机构地区：[1]石河子大学医学院第一附属医院超声科,新疆石河子832008 [2]石河子大学医学院病理教研室,新疆石河子832008 [3]国家卫健委中亚高发病防治重点实验室,新疆石河子832008

出　　处：《实用医学杂志》2022年第18期2272-2278,共7页The Journal of Practical Medicine

基　　金：国家自然科学基金(编号:82060318,81860498,81560433);中国医学科学院中央级公益性科研院所基本科研业务费专项资金资助(编号:2020⁃PT330⁃003);兵团科技攻关项目(编号:2019DB012);石河子大学医学院第一附属医院青年基金项目(编号:QN202126,QN202107)。

摘　　要：目的探讨常规超声联合超声造影预测乳腺癌腋窝淋巴结转移的价值。方法回顾性收集119个乳腺癌原发病灶的常规超声特征及超声造影特征,根据术后病理结果将患者分为转移组及未转移组,通过单因素及多因素logistic回归分析,筛选出与腋窝淋巴结转移相关的危险因素,建立logistic回归预测模型并绘制受试者工作特征(ROC)曲线。结果单因素分析结果显示,肿块最大径线、Alder血流分级、边缘毛刺征、增强后边缘放射状汇聚和增强后范围变化比较两组间差异有统计学意义(P<0.05)。多因素分析结果显示,乳腺癌原发病灶最大径线>2 cm、增强后有灌注缺损和增强后范围增大是腋窝淋巴结转移的独立危险因素(P<0.05),以上三种超声特征单独预测腋窝淋巴结转移的AUC分别为0.699、0.616、0.664,联合以上三种超声特征构建预测模型,预测腋窝淋巴结转移的AUC为0.791,大于所有单一特征参数(P<0.05)。一致性检验结果表明该预测模型具有较好的预测效能(Kappa值=0.607)。结论最大径线>2 cm,增强后有灌注缺损及增强后范围增大是乳腺癌腋窝淋巴结发生转移的独立危险因素,且联合上述三种指标预测腋窝淋巴结转移价值较高。Objective To explore conventional ultrasound combined with contrast⁃enhanced ultrasound(CEUS)in predicting axillary lymph node metastasis of breast cancer.Methods Conventional ultrasound and CEUS features of breast cancer tumors(n=119)were retrospectively collected.According to the postoperative pathological results,the patients were divided into the group with and without axillary lymph node metastasis(ALNM).And the methods of univariate and multivariate Logistic regression analysis were used to screen out the risk factors associated with ALNM in breast cancer.Logistic regression prediction model was established,and the receiver operating characteristic(ROC)curve was drawn.Results Univariate analysis showed that there were significant differences between the two groups in maximum diameter of breast cancer,alder blood flow grade,edge burr sign,radial convergence of enhanced edge and range change after enhancement(P<0.05).Multivariate analysis showed that the maximum diameter of breast cancer>2 cm,enhancement of perfusion defect and enhancement of the larger rangewere independent risk factors for ALNM(P<0.05).The AUC of these three ultrasound features predicting the ALNM were 0.699,0.616 and 0.664 respectively.The prediction model of the above indicators combined with AUC was 0.791,whichwas greater than that of breast cancer>2 cm,enhancement of perfusion defect and enhance⁃ment of the larger range alone(P<0.05).The prediction model had a better prediction efficacy through the consis⁃tency test(Kappa value=0.607).Conclusion The maximum diameter of breast cancer>2 cm,enhancement of perfusion defect and enhancement of the larger range were independent risk factors for ALNM in breast cancer,and the value of combined use of them had a higher predictive value for ALNM.

关 键 词：乳腺癌 淋巴结转移 常规超声 超声造影 

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