基于常规超声和剪切波弹性成像的列线图预测乳腺癌淋巴结转移的临床价值  

Clinical value of nomogram based on conventional ultrasound and shear wave elastography for predicting lymph node metastasis in breast cancer

作　　者：周伟 王燕 ZHOU Wei;WANG Yan(Department of Ultrasound Medicine,Liu’an Hospital Affiliated to Anhui Medical University,Anhui 237000,China)

机构地区：[1]安徽医科大学附属六安医院超声医学科,安徽省六安市237000

出　　处：《临床超声医学杂志》2024年第11期932-938,共7页Journal of Clinical Ultrasound in Medicine

摘　　要：目的 基于常规超声和剪切波弹性成像(SWE)构建列线图,探讨其在预测乳腺癌淋巴结转移的临床价值。方法 选取我院经手术病理确诊的乳腺癌患者221例,按照7∶3的比例将其中2021年7月至2023年12月155例乳腺癌患者设为训练集(淋巴结转移组和无淋巴结转移组分别为50例、105例),2024年1~8月66例乳腺癌患者设为验证集(淋巴结转移组和无淋巴结转移组分别为19例、47例),比较训练集中淋巴结转移组与无淋巴结转移组常规超声和SWE检查结果的差异;采用Logistic回归分析筛选预测乳腺癌淋巴结转移的独立影响因素,并基于此构建列线图模型;绘制受试者工作特征(ROC)曲线、校准曲线、临床决策曲线评估列线图模型预测训练集和验证集中乳腺癌淋巴结转移的区分度、校准度及临床适用性。结果 训练集中淋巴结转移组脉管侵犯、形态不规则、钙化占比及杨氏模量弥散度(Esd)、平均值(Emean)、最大值(Emax)均高于无淋巴结转移组,差异均有统计学意义(均P<0.05)。Logistic回归分析显示,脉管侵犯、形态不规则、钙化、Esd、Emean及Emax均为预测乳腺癌淋巴结转移的独立影响因素(OR=5.239、2.669、4.700、1.220、1.040、1.040,均P<0.05)。基于此构建列线图模型,ROC曲线分析显示,模型预测训练集和验证集中乳腺癌淋巴结转移的曲线下面积分别为0.899(95%可信区间:0.848~0.951)、0.867(95%可信区间:0.758~0.975);校准曲线显示,模型对训练集和验证集中乳腺癌淋巴结转移的预测概率与实际概率基本一致,训练集和验证集中预测结果与真实结果之间符合度的平均绝对误差分别为0.030、0.050;临床决策曲线显示,当模型概率阈值分别为1%~92%、1%~100%时,其预测训练集和验证集中乳腺癌淋巴结转移的净获益均较高。结论 基于常规超声和SWE的列线图在预测乳腺癌淋巴结转移中有一定的临床价值。Objective To construct a nomogram based on conventional ultrasound and shear wave elastography(SWE),and to explore its clinical value in predicting lymph node metastasis in breast cancer.Methods A total of 221 breast cancer patients confirmed by surgical pathology in our hospital were selected.According to a ratio of 7∶3,the patients diagnosed from July 2021 to December 2023 were assigned to the training set(totally 155 cases,including 50 cases in the lymph node metastasis group and 105 cases in the lymph node non-metastasis group),and the patients diagnosed from January to August 2024 were assigned to the validation set(totally 66 cases,including 19 cases in the lymph node metastasis group and 47 cases in the lymph node non-metastasis group).The differences in conventional ultrasound and SWE findings between the lymph node metastasis and non-metastasis groups in the training set were analyzed.Logistic regression analysis was used to identify the independent predictive factors for lymph node metastasis in breast cancer,and a nomogram model was constructed based on these factors.The discrimination,calibration,and clinical applicability of the nomogram model in predicting lymph node metastasis in the training and validation sets were evaluated by receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis.Results The lymph node metastasis group in the training set showed a higher proportion of vascular invasion,irregular shape,calcification,and higher dispersibility,mean,maximum of Young’s modulus(Esd,Emean,Emax)than those in the non-metastasis group(all P<0.05).Logistic regression analysis showed that vascular invasion,irregular shape,calcification,Esd,Emean and Emax were independent predictive factors for lymph node metastasis in breast cancer(OR=5.239,2.669,4.700,1.220,1.040,1.040,all P<0.05).Based on these factors,a nomogram model was constructed.ROC curve analysis showed that the area under the curve(AUC)of the nomogram model for predicting lymph node metastasis in the trainin

关 键 词：超声检查 剪切波弹性成像 乳腺癌 淋巴结转移 列线图模型 

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]