PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an Shaanxi, 710061, China.
BMC Cancer. 2023 Oct 24;23(1):1028. doi: 10.1186/s12885-023-11498-7.
The accurate assessment of axillary lymph node metastasis (LNM) in early-stage breast cancer (BC) is of great importance. This study aimed to construct an integrated model based on clinicopathology, ultrasound, PET/CT, and PET radiomics for predicting axillary LNM in early stage of BC.
124 BC patients who underwent 18 F-fluorodeoxyglucose (18 F-FDG) PET/CT and whose diagnosis were confirmed by surgical pathology were retrospectively analyzed and included in this study. Ultrasound, PET and clinicopathological features of all patients were analyzed, and PET radiomics features were extracted to establish an ultrasound model (clinicopathology and ultrasound; model 1), a PET model (clinicopathology, ultrasound, and PET; model 2), and a comprehensive model (clinicopathology, ultrasound, PET, and radiomics; model 3), and the diagnostic efficacy of each model was evaluated and compared.
The T stage, US_BIRADS, US_LNM, and PET_LNM in the positive axillary LNM group was significantly higher than that of in the negative LNM group (P = 0.013, P = 0.049, P < 0.001, P < 0.001, respectively). Radiomics score for predicting LNM (RS_LNM) for the negative LNM and positive LNM were statistically significant difference (-1.090 ± 0.448 vs. -0.693 ± 0.344, t = -4.720, P < 0.001), and the AUC was 0.767 (95% CI: 0.674-0.861). The ROC curves showed that model 3 outperformed model 1 for the sensitivity (model 3 vs. model 1, 82.86% vs. 48.57%), and outperformed model 2 for the specificity (model 3 vs. model 2, 82.02% vs. 68.54%) in the prediction of LNM. The AUC of mode 1, model 2 and model 3 was 0.687, 0.826 and 0.874, and the Delong test showed the AUC of model 3 was significantly higher than that of model 1 and model 2 (P < 0.05). Decision curve analysis showed that model 3 resulted in a higher degree of net benefit for all the patients than model 1 and model 2.
The use of a comprehensive model based on clinicopathology, ultrasound, PET/CT, and PET radiomics can effectively improve the diagnostic efficacy of axillary LNM in BC.
This study was registered at ClinicalTrials Gov (number NCT05826197) on 7th, May 2023.
准确评估早期乳腺癌（BC）腋窝淋巴结转移（LNM）具有重要意义。本研究旨在构建一种基于临床病理、超声、PET/CT 和 PET 放射组学的综合模型，用于预测早期 BC 的腋窝 LNM。
回顾性分析了 124 例接受 18F-氟脱氧葡萄糖（18F-FDG）PET/CT 检查且经手术病理证实的 BC 患者，并将其纳入本研究。分析所有患者的超声、PET 和临床病理特征，并提取 PET 放射组学特征，建立超声模型（临床病理和超声；模型 1）、PET 模型（临床病理、超声和 PET；模型 2）和综合模型（临床病理、超声、PET 和放射组学；模型 3），评估和比较每个模型的诊断效能。
腋窝 LNM 阳性组的 T 分期、US_BIRADS、US_LNM 和 PET_LNM 明显高于 LNM 阴性组（P=0.013、P=0.049、P<0.001、P<0.001，分别）。预测 LNM 的放射组学评分（RS_LNM）在 LNM 阴性和阳性组之间有统计学意义（-1.090±0.448 vs. -0.693±0.344，t=-4.720，P<0.001），AUC 为 0.767（95%CI：0.674-0.861）。ROC 曲线显示，在 LNM 预测方面，模型 3 的敏感性（模型 3 与模型 1，82.86% vs. 48.57%）优于模型 1，特异性（模型 3 与模型 2，82.02% vs. 68.54%）优于模型 2。模型 1、模型 2 和模型 3 的 AUC 分别为 0.687、0.826 和 0.874，Delong 检验显示模型 3 的 AUC 明显高于模型 1 和模型 2（P<0.05）。决策曲线分析表明，模型 3 为所有患者带来的净获益程度均高于模型 1 和模型 2。
基于临床病理、超声、PET/CT 和 PET 放射组学的综合模型的使用可以有效提高 BC 腋窝 LNM 的诊断效能。
本研究于 2023 年 5 月 7 日在 ClinicalTrials Gov 注册（注册号 NCT05826197）。
