超声监测定位腋窝淋巴结对乳腺癌患者新辅助治疗疗效的预测研究

目的：联合超声和腋窝转移定位淋巴结，建立风险评估模型，预测临床淋巴结阳性（clinically LN-positive，cN+）乳腺癌患者新辅助治疗（neoadjuvant systemic therapy，NST）后腋窝病理完全缓解（pathologic complete response，pCR）的情况。方法： 选取88例患者按7∶3的比例随机分配到测试组或验证组。所有患者于NST前，选取超声图像上最可疑且由病理活检证实为转移的淋巴结，在超声引导下置入1枚定位钛夹。对测试组进行单因素和多因素Logistic回归分析，根据多因素分析结果建立风险评分模型。结果：腋窝pCR率为48%（42/88）。以NST前激素受体状态、超声提示异常淋巴结的分级和分级的变化、定位淋巴结皮质厚度变化为独立因素，建立危险评分模型。在-13~-9分和1~10分时，测试组腋窝pCR率分别为100%和0。测试组和验证组的受试者工作特征曲线下面积分别为0.931（95%CI=0.868~0.994）和0.762（95%CI=0.576~0.947）。结论：基于超声和定位淋巴结的风险评分模型准确预测了cN+的乳腺癌患者NST后的腋窝淋巴结状态。危险评分-13~-9时腋窝淋巴结转移假阴性率为0%，这部分患者能够避免腋窝淋巴结清扫及一系列并发症。

Monitoring of clipped axillary lymph node by ultrasound to predict response of breast cancer to neoadjuvant systemic therapy

Objective：Combined ultrasound and axillary metastatic clipped lymph nodes was developed a model to predict the pathological complete response（pCR）of axillary lymph nodes in clinically lymph node - positive（cN +）breast cancer patients after neoadjuvant systemic therapy（NST）. Methods：Eighty-eight patients were randomly assigned to the testing or validation set at a ratio of 7∶3. Before NST，the lymph nodes most suspicious on ultrasound images and confirmed as metastatic by pathological biopsy were selected and marked with a titanium clip under ultrasound guidance. Univariate and multivariate logistic regression analyses of the testing set were performed. A risk score model was developed based on the results of multivariate analysis. Results：The axillary pCR rate was 48%（42/88）. Hormone receptor status，N grade and changes in the number of abnormal lymph nodes were determined by ultrasonography，and changes in cortical thickness of the clipped lymph nodes were identified as independent factors and established the risk score model. In the score range of-13 to-9 and 1 to 10，the axillary pCR rate of the testing set was 100% and 0% ， respectively. The area under the receiver operating characteristic curves of the testing and validation sets were 0.931（95% CI：0.868- 0.994）and 0.762（95% CI：0.576-0.947），respectively. Conclusion：The risk score model based on ultrasound and clipped lymph nodes accurately predicte the axillary lymph node status of breast cancer patients with cN + after NST. When the risk score was between -13 and -9，the false-negative rate of axillary lymph node metastasis was 0%，allowing these patients to avoid axillary lymph node dissection and a series of complications.