多模态超声特征列线图模型在乳腺浸润性导管癌患者Ki-67高表达中的预测价值  

Predictive value of a multimodal ultrasound-based nomogram model for high Ki-67 expression in patients with breast invasive ductal carcinoma

作　　者：尹薇薇 储小爱 汪珺莉 秦信 沈春云 孙静[1] 许导靖 强邦红 解育新 YIN Weiwei;CHU Xiaoai;WANG Junli;QIN Xin;SHEN Chunyun;SUN Jing;XU Daojing;QIANG Banghong;XIE Yuxin(Department of Ultrasound Medicine,Wuhu Hospital Affiliated to East China Normal University(Wuhu No.2 People's Hospital),Wuhu 241000,China;Department of Ultrasound Medicine,Huangshi Central Hospital,Huangshi 435000,China)

机构地区：[1]华东师范大学附属芜湖医院(芜湖市第二人民医院)超声医学科,安徽芜湖241000 [2]黄石市中心医院超声医学科,湖北黄石435000

出　　处：《分子影像学杂志》2025年第4期429-434,共6页Journal of Molecular Imaging

基　　金：湖北省自然科学基金创新发展联合基金项目(2022CFD066);芜湖市科技局重点研发与成果转化项目(2023yf123)。

摘　　要：目的探讨多模态超声特征列线图预测模型在乳腺浸润性导管癌(IDC)患者Ki-67高表达预测中的临床参考价值。方法收集2020年1月~2024年8月在我院手术后且病理证实为IDC的180例患者的多模态超声图像特征及Ki-67表达水平,根据Ki-67阳性比例是否≥20%将患者分为Ki-67高表达组(n=130)和低表达组(n=50),比较两组多模态超声参数和临床特征。单因素分析筛选有统计学意义的变量,并进一步行多因素Logistic回归探讨独立影响因素。通过LASSO和逐步回归法筛选出最终变量,并构建列线图预测模型。结果单因素及多因素Logistic回归结果显示:肿块最大径(OR=1.068,95%CI:1.022~1.115,P=0.003)、微钙化(OR=9.960,95%CI:4.183~23.715,P<0.001)、声触诊组织成像(VTI)(OR=7.937,95%CI:1.949~32.258,P=0.004)及虫噬征(OR=28.571,95%CI:4.808~166.667,P<0.001)是Ki-67高表达的独立危险因素。采用肿块最大径、微钙化、VTI评分≥4分、虫噬征变量建立Ki-67高表达列线图预测模型,结果表明该模型C-index为0.852。Bootstrap重抽样内部验证提示模型有较高的一致性,临床决策曲线分析表明该模型具有显著的临床净收益。结论肿块最大径、微钙化、VTI评分≥4分及虫噬征是IDC患者Ki-67高表达的独立影响因素,以此构建的Ki-67高表达列线图预测模型具有良好的预测效能,为IDC患者的临床决策提供了参考依据,有望改善预后。Objective To explore the clinical reference value of a nomogram prediction model based on multimodal ultrasound features in predicting high Ki-67 expression in patients with invasive ductal carcinoma(IDC)of the breast.Methods Multimodal ultrasound imaging features and Ki-67 expression levels were collected from 180 patients with pathologically confirmed IDC who underwent surgery in our hospital from January 2020 to August 2024.Patients were divided into a high Ki-67 expression group(n=130)and a low Ki-67 expression group(n=50)based on a Ki-67 positivity rate of≥20%.Multimodal ultrasound parameters and clinical characteristics were compared between the two groups.Significant variables were screened through univariate analysis,and multivariate Logistic regression was further conducted to explore independent influencing factors.The final variables were selected through LASSO and stepwise regression methods,and a nomogram prediction model was constructed.Results The results of univariate and multivariate Logistic regression showed that the maximum diameter of the mass(OR=1.068,95%CI:1.022-1.115,P=0.003),microcalcification(OR=9.960,95%CI:4.183-23.715,P<0.001),virtual touch tissue imaging(VTI)(OR=7.937,95%CI:1.949-32.258,P=0.004),and the moth-eaten sign(OR=28.571,95%CI:4.808-166.667,P<0.001)were independent risk factors for high Ki-67 expression.A nomogram prediction model for high Ki-67 expression was established using variables such as the maximum diameter of the mass,microcalcification,VTI score≥4,and the moth-eaten sign.The results showed that the C-index of this model was 0.852.Internal validation through Bootstrap resampling suggested high consistency of the model,and clinical decision curve analysis indicated that the model had significant clinical net benefit.Conclusion Maximum tumor diameter,microcalcifications,VTI score≥4,and moth-eaten sign are independent factors influencing high Ki-67 expression in IDC patients.The nomogram prediction model for high Ki-67 expression,constructed based on these factors

关 键 词：乳腺浸润性导管癌 多模态超声 KI-67 列线图 

分 类 号：R737.9[医药卫生—肿瘤]