Predictive value of ultrasound elastography in axillary lymph node metastasis in early small breast cancer
-
摘要:目的
探讨常规超声联合弹性超声在早期小乳癌腋窝淋巴结转移中的预测价值。
方法选取女性乳腺癌患者150例, 根据术后组织病理结果将患者分为腋窝淋巴结转移组44例和腋窝淋巴结非转移组106例。对乳腺肿块及腋窝淋巴结行常规超声检查，并对肿块行弹性超声检查。分析肿块、腋窝淋巴结超声图像及肿块弹性特征与腋窝淋巴结转移的相关性。
结果单因素分析显示，乳腺肿块弹性评分、组织病理学分级、腋窝淋巴结短径、皮质厚度、血供类型以及淋巴门消失情况与淋巴结转移具有相关性(P < 0.05)。多因素Logistic回归分析显示，肿块弹性评分(P=0.007)、淋巴结皮质厚度(P < 0.001)是早期小乳癌腋窝淋巴结转移的独立影响因素。
结论常规超声结合弹性超声对早期小乳癌腋窝淋巴结转移具有重要预测价值，有利于早诊、早治，改善患者预后。
Abstract:ObjectiveTo investigate the predictive value of conventional ultrasound combined with ultrasound elastography in axillary lymph node metastasis of early small breast cancer.
MethodsA total of 150 female breast cancer patients were selected. According to the histopathological results, the patients were divided into axillary lymph node metastasis group (44 cases) and axillary lymph node non-metastatic group (106 cases). Conventional ultrasound was performed on the breast mass and axillary lymph nodes, and ultrasound elastography was performed on the mass. The correlations between the axillary lymph node metastasis and the ultrasound image of the mass and the elastic features of the mass were analyzed.
ResultsUnivariate analysis showed that breast mass elasticity score, histopathological grade, axillary lymph node minor diameter, cortical thickness, blood supply type and disappearance of lymphatic hilum were correlated with lymph node metastasis (P < 0.05). Multivariate Logistic regression analysis showed that mass elasticity score (P=0.007) and cortical lymph node thickness (P < 0.001) were independent influencing factors for axillary lymph node metastasis in early small breast cancer.
ConclusionConventional ultrasound combined with ultrasound elastography is of great value in predicting axillary lymph node metastasis of early small breast cancer, which is conducive to early diagnosis, early treatment and improvement the prognosis of patients.
-
-
![]()
图 1 56岁女性患者腋窝淋巴结转移
A: 左乳内下象限低回声肿块，形态欠规则，边缘欠光整; B: 肿块弹性评分4分，质硬; C: 左腋窝淋巴结淋巴门结构欠清晰，皮质增厚约7.5 mm; D: 淋巴结血流为边缘型。
![]()
图 2 58岁女性患者腋窝淋巴结未转移
A: 右乳内上象限低回声肿块，形态欠规则，边缘欠光整，伴点状钙化; B: 肿块弹性评分3分，质中; C: 右腋窝淋巴结淋巴门结构存在，皮质厚度小于3 mm; D: 淋巴结血流呈淋巴门型。
表 1 肿块常规超声、弹性超声参数及乳腺肿块免疫组化特征与腋窝淋巴结转移相关性(x±s)[n(%)]
参数 全组(n=150) 腋窝淋巴结未转移组(n=106) 腋窝淋巴结转移组(n=44) P 年龄/岁 — 52.3±12.06 49.86±11.06 0.250 超声测得肿块直径/mm — 18.29±8.13 19.32±7.50 0.473 距乳头距离/mm — 29.91±15.59 33.3±15.63 0.218 弹性评分/分 — 3.78±0.60 4.05±0.53 0.013 硬度比值 — 2.59±0.86 2.75±0.59 0.290 回声 低 147(98.00) 104(98.10) 43(97.73) 0.650 囊实 1(0.67) 1(0.95) 0 混合 2(1.33) 1(0.95) 1(2.27) 形态 规则 14(9.33) 8(7.54) 6(13.64) 0.243 不规则 136(90.67) 98(92.46) 38(86.36) 边缘 光整 19(12.67) 15(14.15) 4(9.10) 0.438 不光整 131(87.33) 91(85.85) 40(90.90) 钙化 无 73(48.67) 56(52.83) 17(38.63) 0.113 有 77(51.33) 50(47.17) 27(61.37) 位置 左 81(54.00) 53(50.00) 28(63.63) 0.178 右 69(46.00) 53(50.00) 16(36.37) 象限 内上 36(24.00) 27(25.47) 9(20.45) 0.295 内下 10(6.66) 9(8.49) 1(2.29) 外下 24(16.00) 14(13.20) 10(22.72) 外上 80(53.34) 56(52.84) 24(54.54) Adler血流 0级 1(0.67) 0 1(2.29) 0.076 Ⅰ级 5(3.33) 5(4.71) 0 Ⅱ级 50(33.33) 39(36.79) 11(25.00) Ⅲ级 94(62.67) 62(58.50) 32(72.71) 组织学分级 Ⅰ级 17(11.33) 16(15.09) 1(2.29) 0.049 Ⅱ级 79(52.66) 55(51.88) 24(54.54) Ⅲ级 54(36.01) 35(33.03) 19(43.17) ER 阴 27(18.00) 21(19.81) 6(13.63) 0.370 阳 123(82.00) 85(80.19) 38(86.37) PR 阴 50(33.33) 37(34.90) 13(29.54) 0.526 阳 100(66.67) 69(65.10) 31(70.46) Her-2 阴 116(77.33) 81(76.41) 35(79.55) 0.677 阳 34(22.67) 25(23.59) 9(20.45) Ki-67 阴 35(23.33) 27(25.47) 8(18.18) 0.337 阳 115(76.67) 79(74.53) 36(81.82) 分子分型 Luminal A 33(22.00) 25(23.59) 8(18.18) 0.583 Luminal B 94(62.66) 63(59.43) 31(70.45) 三阴性 10(6.66) 7(6.60) 3(6.83) Her-2过表达型 13(8.68) 11(10.38) 2(4.54) ER: 雌激素受体; PR: 孕激素受体; Her-2: 人表皮生长因子受体2; Ki-67: 增殖细胞核抗原。 
下载: 导出CSV
表 2 淋巴结超声特征与腋窝淋巴结转移相关性(x±s)[n(%)]
参数 全组(n=150) 腋窝淋巴结未转移组(n=106) 腋窝淋巴结转移组(n=44) P 长径/mm — 15.00±5.57 16.20±5.77 0.234 短径/mm — 5.11±1.33 6.35±2.43 0.001 长径/短径 ＜2 17(11.33) 9(8.49) 8(18.18) 0.088 ≥2 133(88.67) 97(91.51) 36(81.82) 皮质厚度 ＞3 mm 21(14.00) 4(3.77) 17(38.63) ＜0.001 ≤3 mm 129(86.00) 102(96.23) 27(61.37) 淋巴门 存在 145(96.67) 105(99.05) 40(90.90) 0.026 消失 5(3.33) 1(0.95) 4(9.10) 淋巴结血流 门型 141(94.00) 106(100.00) 35(79.53) ＜0.001 边缘型 1(0.67) 0 1(2.29) 混合型 8(5.33) 0 8(18.18)
下载: 导出CSV
表 3 预测腋窝淋巴结转移的logistic回归分析结果
变量 β SE Wald χ2 P 弹性评分 1.048 0.388 7.302 0.007 皮质厚度 0.682 0.178 14.609 ＜0.001 常数 -6.499 1.668 15.184 ＜0.001
下载: 导出CSV
-
[1] SIEGEL R L, MILLER K D, JEMAL A. Cancer statistics, 2018[J]. CA Cancer J Clin, 2018, 68(1): 7-30. doi: 10.3322/caac.21442
[2] MAESHIMA Y, SAKAI T, OGIYA A, et al. Assessment of axillary node status by ultrasound after neoadjuvant chemotherapy in patients with clinically node-positive breast cancer according to breast cancer subtype[J]. Sci Rep, 2021, 11(1): 10858. doi: 10.1038/s41598-021-89738-8
[3] 陈智慧, 查海玲, 蔡梦君, 等. HER2+乳腺癌超声特征预测腋窝淋巴结转移价值分析[J]. 肿瘤影像学, 2022, 31(4): 419-424. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYX202204010.htm [4] 熊朝月, 周敏, 何小芳, 等. 基于超声特征联合临床资料的预测模型对早期乳腺癌患者腋窝淋巴结转移的评估价值[J]. 实用临床医药杂志, 2022, 26(12): 14-18, 22. doi: 10.7619/jcmp.20220195 [5] 笪霞, 纪璟, 朱春花, 等. 乳腺癌患者保乳术联合腔镜腋窝淋巴结清扫术的临床研究[J]. 实用临床医药杂志, 2022, 26(8): 49-53. doi: 10.7619/jcmp.20214131 [6] D'ORSI C, MORRIS E, MENDELSON E, et al. ACR BIRADS Atlas, Breast Imaging Reporting and Data System[M]. Reston: American College of Radiology, 2013: 121-140.
[7] ADLER D D, CARSON P L, RUBIN J M, et al. Doppler ultrasound color flow imaging in the study of breast cancer: preliminary findings[J]. Ultrasound Med Biol, 1990, 16(6): 553-559. doi: 10.1016/0301-5629(90)90020-D
[8] ITOH A, UENO E, TOHNO E, et al. Breast disease: clinical application of US elastography for diagnosis[J]. Radiology, 2006, 239(2): 341-350. doi: 10.1148/radiol.2391041676
[9] ELSTON C W, ELLIS I O. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up[J]. Histopathology, 2010, 19(5): 403-410.
[10] HAMMOND M E, HAYES D F, DOWSETT M, et al. American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer[J]. J Clin Oncol, 2010, 28(16): 2784-2795. doi: 10.1200/JCO.2009.25.6529
[11] SCHNITT S J. Will molecular classification replace traditional breast pathology?[J]. Int J Surg Pathol, 2010, 18(3 Suppl): 162S-166S.
[12] 张曼琪, 查海玲, 刘心培, 等. 超声检查评估乳腺癌新辅助化疗疗效的准确性及影响因素分析[J]. 实用临床医药杂志, 2022, 26(13): 45-49, 54. doi: 10.7619/jcmp.20220387 [13] 解松刚, 梁成通, 周丽娟, 等. 乳腺癌肺转移患者预后危险因素的分析及诺模图的构建[J]. 实用临床医药杂志, 2022, 26(18): 48-56. doi: 10.7619/jcmp.20220717 [14] 周敏, 朱峰, 王小燕, 等. 乳腺癌早期诊断中乳腺超声检查的漏诊、误诊病例特征及影响因素的回顾性分析[J]. 实用临床医药杂志, 2021, 25(24): 35-38. doi: 10.7619/jcmp.20213648 [15] HAN P, YANG H P, LIU M, et al. Lymph node predictive model with in vitro ultrasound features for breast cancer lymph node metastasis[J]. Ultrasound Med Biol, 2020, 46(6): 1395-1402.
[16] KEYKHAEI M, ASHRAF H, RASHEDI S, et al. Differences in the 2020 ESC versus 2015 ESC and 2014 ACC/AHA guidelines on the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation[J]. Curr Atheroscler Rep, 2021, 23(12): 77.
[17] CHANG J M, SHIN H J, CHOI J S, et al. Imaging protocol and criteria for evaluation of axillary lymph nodes in the NAUTILUS trial[J]. J Breast Cancer, 2021, 24(6): 554-560.
[18] 伍锦凤, 桂照华, 闫红. 乳腺浸润性癌组织人表皮生长因子受体-2基因扩增状态与蛋白表达的比较及其与临床病理特征的相关性[J]. 实用临床医药杂志, 2021, 25(13): 40-44. doi: 10.7619/jcmp.20211659 [19] CHANG J M, LEUNG J W T, MOY L, et al. Axillary nodal evaluation in breast cancer: state of the art[J]. Radiology, 2020, 295(3): 500-515.
[20] RUKANSKIENE D, VEIKUTIS V, JONAITIENE E, et al. Preoperative axillary ultrasound versus sentinel lymph node biopsy in patients with early breast cancer[J]. Medicina (Kaunas), 2020, 56(3): 127.
[21] LIM G H, TEO S Y, ALLEN J C Jr, et al. Determining whether high nodal burden in early breast cancer patients can be predicted preoperatively to avoid sentinel lymph node biopsy[J]. J Breast Cancer, 2019, 22(1): 67-76.
[22] 周雪雁, 潘晓芳, 王坤, 等. 三维剪切波弹性成像定量参数预测乳腺癌腋窝淋巴结转移的价值[J]. 肿瘤影像学, 2022, 31(3): 269-274. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYX202203009.htm [23] YI C B, DING Z Y, DENG J, et al. Combining the ultrasound features of primary tumor and axillary lymph nodes can reduce false-negative rate during the prediction of high axillary node burden in BI-RADS category 4 or 5 breast cancer lesions[J]. Ultrasound Med Biol, 2020, 46(8): 1941-1948.
[24] XU H, XU G L, LI X D, et al. Correlation between the contrast-enhanced ultrasound image features and axillary lymph node metastasis of primary breast cancer and its diagnostic value[J]. Clin Transl Oncol, 2021, 23(1): 155-163.
[25] 徐燕军, 邓一帆, 胡兵, 等. 二维超声联合实时组织弹性成像鉴别诊断乳腺癌腋窝淋巴结转移的价值[J]. 声学技术, 2021, 40(3): 370-375. https://www.cnki.com.cn/Article/CJFDTOTAL-SXJS202103012.htm [26] 张娜娜, 沈滨, 陈晰, 等. 微小核糖核酸在乳腺癌中的研究进展[J]. 实用临床医药杂志, 2021, 25(4): 106-110, 115. doi: 10.7619/jcmp.20201506 [27] 吴延琴, 赵巧玲, 辛亚军. 超声诊断乳腺癌腋窝淋巴结转移的影像学表现及其临床效果观察[J]. 影像研究与医学应用, 2022, 6(3): 53-55. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYY202203018.htm [28] LIU H, WAN J, XU G. Conventional US and 2-D shear wave elastography of virtual touch tissue imaging quantification: correlation with immunohistochemical subtypes of breast cancer[J]. Ultrasound Med Biol, 2019, 45(10): 2612-2622.
[29] EVANS A, RAUCHHAUS P, WHELEHAN P, et al. Does shear wave ultrasound independently predict axillary lymph node metastasis in women with invasive breast cancer[J]. Breast Cancer Res Treat, 2014, 143(1): 153-157.
[30] 王修军, 易君, 张欢欢. 基于多维度指标建立预测模型在乳腺癌病人腋窝淋巴结转移的应用价值[J]. 蚌埠医学院学报, 2022, 47(8): 1066-1069, 1073. https://www.cnki.com.cn/Article/CJFDTOTAL-BANG202208018.htm
计量
- 文章访问数: 186
- HTML全文浏览量: 57
- PDF下载量: 17
苏公网安备 32100302010246号
