Department of Breast Surgery, Ninewells Hospital and Medical School, Level 6, Dundee, UK.
Department of Radiology, Ninewells Hospital and Medical School, Level 6, Dundee, UK.
Br J Radiol. 2020 Apr;93(1108):20190711. doi: 10.1259/bjr.20190711. Epub 2020 Jan 28.
A number of pre-operative factors predicting nodal burden in females with breast cancer have recently been identified. The aim of this study is to assess if these factors independently influence nodal burden in females with a positive axillary core biopsy.
All node positive patients detected on axillary core biopsy were identified in our cancer audit database. Mode of presentation, age, core tumour grade, core tumour type, ER and HER2 status were evaluated. Tumours were assessed for ultrasound size, distance of tumour-to-skin, presence of invasion of skin and diffuse skin thickening. Axillary lymph nodes were assessed for cortical thickness and presence of ultrasound replaced nodes. Statistical significance was ascertained using univariate logistic regression. A predictive model was produced following a multiple logistic regression model incorporating cross-validation and assessed using receiving operating characteristic curve.
115 patients' data were analysed. Patients referred because of symptoms (70% 38%, = 0.005), and those with ultrasound skin thickening (87% 59%, = 0.055) have higher nodal burden than those referred from screening or without skin thickening. These factors were significant after multivariate analysis. The final predictive model included mode of presentation, ultrasound tumour size, cortical thickness and presence of ultrasound skin thickening. The area under curve is 0.77.
We have shown that mode of presentation and ultrasound skin thickening are independent predictors of high nodal burden at surgery. A model has been developed to predict nodal burden pre-operatively, which may lead to avoidance of axillary node clearance in patients with lower nodal burden.
Method of presentation and skin involvement/proximity to skin by the primary tumour are known to influence outcome and nodal involvement respectively but have not been studied with regard to nodal burden. We have shown that mode of presentation and skin thickening at ultrasound are independent predictors of high nodal burden at surgery.
最近已经确定了一些预测乳腺癌女性淋巴结受累的术前因素。本研究旨在评估这些因素是否独立影响腋窝核心活检阳性女性的淋巴结受累程度。
在我们的癌症审计数据库中，确定了所有在腋窝核心活检中检测到的淋巴结阳性患者。评估了发病方式、年龄、核心肿瘤分级、核心肿瘤类型、ER 和 HER2 状态。评估了肿瘤的超声大小、肿瘤与皮肤的距离、皮肤侵犯和弥漫性皮肤增厚的情况。评估了腋窝淋巴结的皮质厚度和超声替代淋巴结的存在。使用单变量逻辑回归确定统计学意义。在包含交叉验证的多元逻辑回归模型之后生成预测模型，并使用接收操作特征曲线进行评估。
分析了 115 名患者的数据。因症状就诊的患者（70%比 38%， = 0.005）和超声皮肤增厚的患者（87%比 59%， = 0.055）的淋巴结受累程度高于因筛查就诊或无皮肤增厚的患者。这些因素在多变量分析后仍然具有统计学意义。最终的预测模型包括发病方式、超声肿瘤大小、皮质厚度和超声皮肤增厚的存在。曲线下面积为 0.77。
我们已经表明，发病方式和超声皮肤增厚是手术时高淋巴结受累的独立预测因素。已经开发了一种模型来预测术前的淋巴结受累程度，这可能导致在淋巴结受累程度较低的患者中避免腋窝淋巴结清扫。
发病方式和肿瘤对皮肤的侵犯/接近皮肤程度分别已知会影响预后和淋巴结受累，但尚未针对淋巴结受累进行研究。我们已经表明，发病方式和超声皮肤增厚是手术时高淋巴结受累的独立预测因素。
