基于超声造影的列线图模型预测乳腺癌患者HER-2表达的临床价值  

Clinical value of nomogram model based on contrast-enhanced ultrasound for predicting human epidermal growth factor receptor 2 expression in breast cancer patients

作　　者：林燕霞 吴才标 王小霞 LIN Yanxia;WU Caibiao;WANG Xiaoxia(Department of Ultrasound Medicine,the Fourth People’s Hospital of Haikou,Haikou 571100,China)

机构地区：[1]海口市第四人民医院超声医学科,571100

出　　处：《临床超声医学杂志》2024年第8期678-683,共6页Journal of Clinical Ultrasound in Medicine

摘　　要：目的基于超声造影(CEUS)构建预测乳腺癌患者人表皮生长因子受体2(HER-2)表达的列线图模型,探讨其临床应用价值。方法选取我院经病理确诊的乳腺癌患者79例,根据HER-2表达分为HER-2阳性组42例和HER-2阴性组37例,比较两组CEUS检查结果的差异。应用多因素Logistic回归分析预测乳腺癌患者HER-2表达的独立影响因素,并构建列线图模型;绘制受试者工作特征(ROC)曲线,采用ROC曲线下面积、一致性指数(C-index)评价模型的区分度;校准曲线评价模型的校准度;决策曲线评价模型的临床适用性。结果HER-2阳性组充盈缺损及穿支血管征占比均高于HER-2阴性组,差异均有统计学意义(均P<0.05);两组增强强度、增强后范围、增强病灶边缘比较差异均无统计学意义。HER-2阳性组达峰时间(PT)低于HER-2阴性组,曲线下面积(AUC)、上升支斜率(K)均高于HER-2阴性组,差异均有统计学意义(均P<0.05);两组峰值强度比较差异无统计学意义。多因素Logistic回归分析显示,穿支血管征、PT、AUC、K均为预测乳腺癌患者HER-2表达的独立影响因素(OR=22.015、0.381、1.629、4.010,均P<0.05);基于独立影响因素构建的列线图模型预测乳腺癌患者HER-2表达的C-index为0.946,ROC曲线下面积为0.946(95%可信区间:0.897~0.996),特异度为84.62%,灵敏度为97.30%;校准曲线显示,列线图模型预测可能性绝对误差为0.016;决策曲线显示,当模型概率阈值>17%时对乳腺癌患者进行临床干预后获益最大。结论基于CEUS的列线图模型可有效预测乳腺癌患者HER-2表达。Objective To construct a nomogram model based on contrast-enhanced ultrasound(CEUS)for predicting human epidermal growth factor receptor 2(HER-2)expression in breast cancer patients,and to explore its clinical application value.Methods A total of 79 cases of breast cancer diagnosed by pathological examination in our hospital were selected and divided into HER-2 positive group(42 cases)and HER-2 negative group(37 cases)according to the expression of HER-2,and the differences of CEUS examination results between the two groups were compared.Multivariate Logistics regression analysis was used to analyze the independent influencing factors for predicting HER-2 expression in breast cancer patients,and nomogram model was constructed.Receiver operating characteristic(ROC)curve was drawn,and area under the ROC curve and consistency index(C-index)were used to evaluate the differentiation of the model.Calibration curve was used to evaluate the calibration degree of the model.Decision curve was used to analyze the clinical applicability of the model.Results The proportion of filling defects and perforator vessels in HER-2 positive group were higher than those in HER-2 negative group,and the differences were statistically significant(both P<0.05).There were no significant difference in enhancement intensity,post-enhancement range and enhancement lesion margin between the two groups.The peak time(PT)in HER-2 positive group was lower than that in HER-2 negative group,the area under the curve(AUC)and the rising slope(K)were higher than those in HER-2 negative group,the difference were statistically significant(all P<0.05),and the peak intensity between the two groups was not statistically different.Multivariate Logistic regression analysis showed that perforator vessel,PT,AUC and K were independent influencing factors for predicting HER-2 expression in breast cancer patients(OR=22.015,0.381,1.629,4.010,all P<0.05).The C-index of HER-2 expression in breast cancer patients was 0.946 by constructing a nomogram model based on the in

关 键 词：超声检查 造影剂 乳腺肿瘤 人表皮生长因子受体2 

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]