基于乳腺癌超声特征及临床病理指标的列线图预测腋窝淋巴结转移风险  

Nomogram Based on Ultrasound Characteristics and Clinicopathological Indicators for Predicting Axillary Lymph Node Metastasis in Breast Cancer

作　　者：石丽楠 曹春莉 桑田 李文肖 曹玉文[2] 李军[1] SHI Linan;CAO Chunli;SANG Tian;LI Wenxiao;CAO Yuwen;LI Jun(Department of Ultrasound,the First Affiliated Hospital of Shihezi University,Shihezi 832008,China;不详)

机构地区：[1]石河子大学第一附属医院超声医学科,新疆石河子832008 [2]石河子大学医学院病理学教研室,新疆石河子832008

出　　处：《中国医学影像学杂志》2024年第4期332-338,共7页Chinese Journal of Medical Imaging

基　　金：国家自然科学基金(82060318,81860498,81560433);兵团财政科技计划项目(2022CB002-04);院级青年基金项目(QN202107,QN202126)。

摘　　要：目的探讨基于超声特征联合临床病理指标的列线图预测乳腺癌腋窝淋巴结转移风险的价值。资料与方法回顾性分析2014年1月—2021年10月于石河子大学第一附属医院经病理证实的1038例乳腺癌患者(共1099个肿块)的超声图像及病理资料,按检查时间分为训练组和验证组。基于多因素Logistic回归筛选与腋窝淋巴结转移相关的独立预测因素,建立回归模型并制作列线图,利用验证组数据及校准曲线验证列线图。绘制受试者工作特征曲线、决策曲线评估列线图的预测效能。结果多因素Logistic分析结果显示,乳腺癌肿块最大径(OR=1.906,95%CI 1.397~2.609,P<0.001)、纵横比(OR=0.425,95%CI 0.284~0.634,P<0.001)、边界(OR=0.373,95%CI 0.267~0.520,P<0.001)、Adler血流分级(OR=3.188,95%CI 2.049~5.107,P<0.001)、病理类型(OR=2.975,95%CI 1.759~5.267,P<0.001)及人表皮生长因子受体2表达状态(OR=1.439,95%CI 1.048~1.982,P=0.025)是预测腋窝淋巴结转移的危险因素。基于以上6个指标构建列线图预测模型,其训练组和验证组一致性指数分别为0.712和0.749,校准曲线(绝对平均误差分别为0.019、0.014)及决策曲线均提示该模型预测能力较好。结论基于乳腺癌原发病灶超声特征及临床病理指标联合构建的预测腋窝淋巴结转移风险列线图模型,可为临床诊断、后期治疗及预后评估提供参考信息。Purpose To explore the value of a nomogram based on ultrasound characteristics with clinicopathological indicators for predicting the risk of axillary lymph node metastasis in breast cancer.Materials and Methods A retrospective analysis was conducted on the ultrasonographic and clinicopathological data of 1038 breast cancer patients(1099 masses)with pathologically confirmed diagnoses,treated at the First Affiliated Hospital of Shihezi University from January 2014 to October 2021.Based on multivariate Logistic regression,the independent predictors associated with axillary lymph node metastasis were screened to establish a regression model and a nomogram.The data of validation group and calibration curve were used to verify the nomogram.The receiver operating characteristic curve and decision curve were drawn to evaluate the predictive efficacy of the nomogram.Results Multivariate Logistic analysis showed that the maximum diameter(OR=1.906,95%CI 1.397-2.609,P<0.001),aspect ratio(OR=0.425,95%CI 0.284-0.634,P<0.001),boundary(OR=0.373,95%CI 0.267-0.520,P<0.001),Adler blood flow grade(OR=3.188,95%CI 2.049-5.107,P<0.001),pathological type(OR=2.975,95%CI 1.759-5.267,P<0.001)and human epidermal growth factor receptor 2 expression status(OR=1.439,95%CI 1.048-1.982,P=0.025)were risk factors for predicting axillary lymph node metastasis.The nomogram prediction model was constructed based on the above 6 indicators,and the consistency index of the training group and the validation group was 0.712 and 0.749,respectively,the calibration curve(absolute mean error=0.019,0.014)and decision curve showed satisfactory forecasting ability.Conclusion The nomogram model for predicting axillary lymph node metastasis based on ultrasound characteristics and clinicopathological indicators of primary breast cancer can help to provide reference information for clinical diagnosis,treatment and prognosis evaluation.

关 键 词：乳腺肿瘤 淋巴转移 超声检查 病理学 外科 列线图表 

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