Li Zhuoxuan, Tong Yiwei, Chen Xiaosong, Shen Kunwei
Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Front Oncol. 2022 Jul 22;12:845823. doi: 10.3389/fonc.2022.845823. eCollection 2022.
To evaluate whether changes in ultrasound features during neoadjuvant chemotherapy (NAC) could predict axillary node response in clinically node-positive breast cancer patients.
Patients with biopsy-proven node-positive disease receiving NAC between February 2009 and March 2021 were included. Ultrasound (US) images were obtained using a 5-12-MHz linear array transducer before NAC, after two cycles, and at the completion of NAC. Long and short diameter, cortical thickness, vascularity, and hilum status of the metastatic node were retrospectively reviewed according to breast imaging-reporting and data system (BI-RADS). The included population was randomly divided into a training set and a validation set at a 2:1 ratio using a simple random sampling method. Factors associated with node response were identified through univariate and multivariate analyses. A nomogram combining clinical and changes in ultrasonographic (US) features was developed and validated. The receiver operating characteristic (ROC) and calibration plots were applied to evaluate nomogram performance and discrimination.
A total of 296 breast cancer patients were included, 108 (36.5%) of whom achieved axillary pathologic complete response (pCR) and 188 (63.5%) had residual nodal disease. Multivariate regression indicated that independent predictors of node pCR contain ultrasound features in addition to clinical features, clinical features including neoadjuvant HER2-targeted therapy and clinical response, ultrasound features after NAC including cortical thickness, hilum status, and reduction in short diameter ≥50%. The nomogram combining clinical features and US features showed better diagnostic performance compared to clinical-only model in the training cohort (AUC: 0.799 vs. 0.699, P=0.001) and the validation cohort (AUC: 0.764 vs. 0.638, P=0.027).
Ultrasound changes during NAC could improve the accuracy to predict node response after NAC in clinically node-positive breast cancer patients.
评估新辅助化疗（NAC）期间超声特征的变化是否能预测临床腋窝淋巴结阳性乳腺癌患者的腋窝淋巴结反应。
纳入2009年2月至2021年3月间接受NAC且活检证实为淋巴结阳性疾病的患者。在NAC前、两个周期后以及NAC结束时，使用5-12MHz线性阵列换能器获取超声（US）图像。根据乳腺影像报告和数据系统（BI-RADS），回顾性分析转移淋巴结的长短径、皮质厚度、血管分布和门部状态。采用简单随机抽样方法，将纳入人群按2:1的比例随机分为训练集和验证集。通过单因素和多因素分析确定与淋巴结反应相关的因素。构建并验证了一个结合临床和超声（US）特征变化的列线图。应用受试者操作特征（ROC）曲线和校准图评估列线图的性能和鉴别能力。
共纳入296例乳腺癌患者，其中108例（36.5%）达到腋窝病理完全缓解（pCR），188例（63.5%）有残留淋巴结疾病。多因素回归表明，淋巴结pCR的独立预测因素除临床特征外还包括超声特征。临床特征包括新辅助HER2靶向治疗和临床反应；NAC后的超声特征包括皮质厚度、门部状态以及短径缩小≥50%。在训练队列（AUC：0.799 vs. 0.699，P = 0.001）和验证队列（AUC：0.764 vs. 0.638，P = 0.027）中，结合临床特征和US特征的列线图比仅基于临床的模型显示出更好的诊断性能。
NAC期间的超声变化可提高预测临床腋窝淋巴结阳性乳腺癌患者NAC后淋巴结反应的准确性。
