目的

研究乳腺浸润性导管癌腋窝淋巴结转移的相关因素,探讨利用乳腺及腋窝彩色多普勒超声结合肿瘤病理学检查分析预测乳腺浸润性导管癌的腋窝淋巴结转移情况。

方法

回顾性分析175 例经过病理证实的乳腺浸润性导管癌患者,所有患者术前行乳腺及腋窝彩色多普勒超声检查,术后对肿瘤行病理检查。 统计分析采用χ² 检验、Logistic 回归分析及绘制ROC 曲线。

结果

175 例病例中,病理证实腋窝淋巴结转移者107 例,肿瘤直径、肿瘤血流分级、腋窝淋巴结个数、淋巴结纵横比、淋巴结皮质最大厚度、淋巴结血流分型、肿瘤组织学分级、Ki67 抗原和c-erbB-2 阳性表达是影响腋窝淋巴结转移率的因素(P＜0.050)。 最终进入模型的因素有淋巴结纵横比、肿瘤直径、淋巴结皮质最大厚度、肿瘤组织学分级Ⅱ、Ⅲ级及Ki67 抗原阳性表达。 ROC 曲线下面积是0. 964。

结论

淋巴结纵横比小、淋巴结皮质最大厚度≥3 mm、肿瘤直径≥2 cm、肿瘤组织学分级高和Ki67 抗原阳性提示较高的腋窝淋巴结转移率。

Objective

To study related factors of axillary lymph node metastasis in breast invasive ductal carcinoma and using ultrasound and pathology exams to predict axillary lymph node metastasis status.

Methods

One hundred and seventy-five breast invasive ductal carcinoma patients confirmed pathologically were retrospectively analyzed. All patients were examined by color Doppler ultrasound to estimate breast tumor position, tumor diameter, tumor Adler grade of blood flow, number of axillary lymph node, axillary lymph node diameter,longitudinal-transverse axis ratio of axillary lymph node, cortical thickness and blood flow grade of axillary lymph node. Pathology examinations after surgery was performed to observe tumor histological grade and expression of estrogen receptor (ER), progesterone receptor(PR), Ki67 antibody and c-erbB-2. Chi-square test and univariate and multivariate logistic regression analysis were used. ROC curve was drawn and the area under the ROC curves was calculated.

Results

Of the 175 patients, 107 were proved with axillary lymph node metastasis. Breast tumor diameter, tumor Adler grade of blood flow, number of axillary lymph node, axillary lymph node diameter, longitudinal-transverse axis ratio of axillary lymph node, cortical thickness of axillary lymph node, blood flow grade of axillary lymph node, tumor histological grade, the expression of Ki67 antibody, and c-erbB-2 positive expression were correlated with axillary lymph node metastasis (P ＜0. 050). Five factors finally entered the multivariate logistic regression model,including breast tumor diameter,cortical thickness of axillary lymph node, longitudinal-transverse axis ratio of axillary lymph node, tumor histological grades II and III and Ki67 antibody positive expression. The area under the ROC curve was 0.964.

Conclusions

Low longitudinal-transverse axis ratio of axillary lymph node, the cortical thickness of axillary lymph node ≥3 mm, breast tumor diameter≥2 cm, tumor histological grades Ⅱ and Ⅲ and positive expression of Ki67 antibody predict a high rate of axillary lymph node metastasis in breast invasive ductal carcinoma.