基于多模态超声参数的列线图预测乳腺癌新辅助化疗后腋窝淋巴结病理完全缓解的价值  

Value of nomogram based on multimodal ultrasound parameters in predicting axillary lymph node pathological complete response after neoadjuvant chemotherapy for breast cancer

作　　者：葛红军 张子宁[1] 周菊英[1] 朱莉华 陆琳 GE Hongjun;ZHANG Zining;ZHOU Juying;ZHU Lihua;LU Lin(Department of Ultrasound Medicine,Jiangyin Hospital of Traditional Chinese Medicine,Jiangsu 214400,China)

机构地区：[1]江苏省江阴市中医院南京中医药大学江阴附属医院超声医学科,214400

出　　处：《临床超声医学杂志》2023年第12期996-1000,共5页Journal of Clinical Ultrasound in Medicine

基　　金：无锡市卫生健康委科研项目(Z202203)。

摘　　要：目的基于多模态超声定量参数构建预测乳腺癌新辅助化疗(NAC)后腋窝淋巴结病理完全缓解(pCR)的列线图模型,探讨其临床应用价值。方法选取在我院行NAC的乳腺癌患者150例,依据腋窝淋巴结是否pCR分为pCR组43例和非pCR组107例,比较两组二维超声、弹性成像和超声造影检查结果的差异。应用多因素二元Logistic回归分析筛选乳腺癌患者NAC后腋窝淋巴结pCR的独立影响因素,并构建列线图模型。绘制受试者工作特征(ROC)曲线分析模型的预测效能;采用校准曲线评价模型的拟合优度;临床决策曲线分析模型的临床适用性。结果pCR组阻力指数(RI)、收缩期峰值流速(PSV)、搏动指数(PI)、AUC、最大径变化率均大于非pCR组,病灶最大径和弹性评分均小于非pCR组,差异均有统计学意义(均P<0.001)。多因素二元Logistic回归分析显示,RI是乳腺癌患者NAC后腋窝淋巴结pCR的独立保护因素(P<0.05),弹性评分是独立危险因素(P<0.05)。以RI和弹性评分构建预测乳腺癌患者NAC后腋窝淋巴结pCR的列线图模型,ROC曲线分析显示,该模型预测乳腺癌患者NAC后腋窝淋巴结pCR的曲线下面积为0.930(95%可信区间:0.863~1.000);校准曲线显示模型拟合度较好(χ^(2)=6.966,P=0.540);临床决策曲线显示模型具有较好的临床适用性。结论基于多模态超声定量参数构建的列线图模型在预测乳腺癌患者NAC后腋窝淋巴结pCR中具有较好的临床应用价值。Objective To estabilish a nomogram model based on multimodal ultrasound quantitative parameters in predicting axillary lymph node pathological complete remission(pCR)after neoadjuvant chemotherapy(NAC)for breast cancer,and to explore its clinical application value.Methods A total of 150 breast cancer patients who underwent NAC in our hospital were selected and divided into pCR group(n=43)and non-pCR group(n=107)according to whether axillary lymph nodes were pCR or not.The differences in the results of two-dimensional ultrasound,elastography and contrast-enhanced ultrasound were compared between the two groups.Multivariate binary Logistic regression analysis was used to screen the independent influencing factors of axillary lymph node pCR after NAC in breast cancer patients,and the nomogram was established.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficacy of the model.Calibration curve was used to evaluate the goodness of fit of the model,and the clinical decision curve was used to analyze the clinical applicability of model.Results The resistance index(RI),systolic peak flow velocity(PSV),pulsation index(PI),area under the curve(AUC)and the change rate of maximum diameter in pCR group were significantly higher than those in non-pCR group,and the lesion maximum diameter and elasticity score in pCR group were significantly lower than those in non-pCR group,with statistical significances(all P<0.05)Multivariate binary Logistic regression analysis showed that RI was an independent protective factor for axillary lymph node pCR after NAC in breast cancer patients(P<0.05),and elasticity score was an independent risk factor(P<0.05).RI and elasticity score were used to establish a nomogram model for predicting axillary lymph node pCR after NAC in breast cancer patients.ROC curve analysis showed that the area under the curve of the model for predicting axillary lymph node pCR after NAC in breast cancer patients was 0.930(95%confidence interval:0.863~1.000).Calibration curve showed a g

关 键 词：超声检查 造影剂 弹性成像 乳腺癌 腋窝淋巴结 新辅助化疗 病理完全缓解 列线图 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]