一种经过验证的基于超声的乳腺癌腋窝转移风险分层评分系统：AX-RADS（腋窝影像报告和数据系统）。

A Validated Ultrasound-Based Scoring System to Stratify Risk of Axillary Metastasis in Breast Cancer: AX-RADS (Axillary Imaging Reporting and Data System).

作者信息

Van Decar Spencer G, Barbera Elizabeth L, Adams Alexandra M, Shore Jason M, Dragusin Iulian B, Davis Erika A, Tork Craig A, Krell Robert, Graybeal Troy B, Clifton Katherine, Buckley Arianna, Travis Clifton G

机构信息

Brooke Army Medical Center, San Antonio, Texas, USA.

Cancer Vaccine Development Program, San Antonio, Texas, USA.

出版信息

J Surg Oncol. 2025 Jul;132(1):28-34. doi: 10.1002/jso.28159. Epub 2025 May 20.

DOI:10.1002/jso.28159

PMID:40392181

Abstract

INTRODUCTION

Ultrasound is the imaging modality of choice for evaluation of axillary involvement in breast cancer, but is associated with variable sensitivity and specificity. Understanding the risk of axillary lymph node metastasis (ALNM) based on ultrasonographic and clinical features will inform treatment decisions. Our group aimed to create a scoring system to quantify the risk of ALNM based on ultrasound characteristics in breast cancer patients. We validated the model and tested it among different Memorial Sloan Kettering Breast Cancer Sentinel Lymph Node Metastasis Nomogram (MSK) subgroups.

METHODS

The ultrasound score was developed using data collected at a single institution from 2019 to 2021 by allocating points based on the regression coefficients of variables found to significantly predict ALNM. We validated the test statistics of our score at an outside institution. The index and validation cohorts were combined: 358 pooled patients were stratified by predicted ALNM positivity according to a validated nomogram based on primary tumor characteristics.

RESULTS

Between 2019 and 2021, in the validation cohort, the NPV for low risk (0-1) scores was 87%, while the PPV for high-risk (5 +) scores was 71%. Overall, in the combined cohort, 241 (67%) patients had low-risk (0-1) axillary ultrasound scores and 33 (9%) had high risk (5 +) scores. In this combined cohort, NPV was 84% (203/241 low-risk score patients were node negative), while PPV for high-risk scores was 85% (28/33 high-risk score patients were node positive). When stratified via the Memorial Sloan Kettering Breast Cancer Nomogram: Sentinel Lymph Node Metastasis predicted ALNM rates, the NPV of low-risk scores was 87%-89% for patients with < 50% predicted ALNM positivity. For patients with > 50% predicted ALNM positivity, the PPV of high-risk scores was 82%.

CONCLUSIONS

A scoring system to predict ALNM among biopsy-proven breast cancer patients undergoing upfront surgery was successfully developed from a multivariate model based on axillary ultrasound characteristics. Combining the axillary US scoring system with an additional validated nomogram based on primary tumor and patient characteristics may help foster better communication about ALNM risk to inform treatment decisions.

摘要

引言

超声是评估乳腺癌腋窝受累情况的首选成像方式，但其敏感性和特异性存在差异。基于超声和临床特征了解腋窝淋巴结转移（ALNM）的风险将有助于指导治疗决策。我们团队旨在创建一个评分系统，根据乳腺癌患者的超声特征量化ALNM风险。我们对该模型进行了验证，并在不同的纪念斯隆凯特琳乳腺癌前哨淋巴结转移列线图（MSK）亚组中进行了测试。

方法

超声评分是利用2019年至2021年在单一机构收集的数据开发的，根据发现能显著预测ALNM的变量的回归系数来分配分数。我们在外部机构验证了评分的检验统计量。将索引队列和验证队列合并：根据基于原发肿瘤特征的有效列线图，将358名合并患者按预测的ALNM阳性情况进行分层。

结果

在2019年至2021年期间，在验证队列中，低风险（0 - 1）评分的阴性预测值（NPV）为87%，而高风险（5分及以上）评分的阳性预测值（PPV）为71%。总体而言，在合并队列中，241名（67%）患者腋窝超声评分为低风险（0 - 1），33名（9%）患者为高风险（5分及以上）。在这个合并队列中，NPV为84%（203/241名低风险评分患者淋巴结阴性），而高风险评分的PPV为85%（28/33名高风险评分患者淋巴结阳性）。当通过纪念斯隆凯特琳乳腺癌列线图分层时：前哨淋巴结转移预测ALNM发生率，对于预测ALNM阳性率<50%的患者，低风险评分的NPV为87% - 89%。对于预测ALNM阳性率>50%的患者，高风险评分的PPV为82%。