Xing Yue, Li Yanbo, Wang Jiahui, Liu Liangsheng, Li Fangfang, Lu Hong
Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
Quant Imaging Med Surg. 2025 Jun 6;15(6):5126-5136. doi: 10.21037/qims-24-1257. Epub 2025 Jun 3.
The early detection of axillary lymph node metastasis (ALNM) is a critical prognostic factor in breast cancer (BC). The objective of this study was to establish and validate a nomogram to predict the upgrade in the diagnosis of axillary lymph nodes (ALNs) in BC via ultrasonography (US)-guided core-needle biopsy (CNB) in combination with related factors.
This study included a total of 304 patients who underwent preoperative US-guided CNB and were diagnostically negative for ALNM. According to the postoperative pathological results, 103 patients were placed into an ALNM group and 201 patients into a non-ALNM group. A case-control study was conducted between the two groups. We assessed the rate of false-negative results from CNB of ALN. We further evaluated and determined the relationships between an upgrade in diagnosis and related factors by performing univariate analysis and multivariate logistic regression analysis. The relevant factors included clinicopathologic features, primary imaging features, ALN involvement, and ALN scoring according to the Node Reporting and Data System 1.0 (Node-RADS 1.0).
In the multivariate logistic regression analysis, histological grades II and III, luminal B, triple-negative breast cancer (TNBC), human epidermal growth factor receptor 2 (HER2), presence of lymphovascular invasion, and Node-RADS 1.0 score ≥4 were independent risk factors for an upgrade in diagnosis. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of preoperative US-guided CNB of ALNs combined with related factors were 85.6%, 71.8%, 80.9%, 85.6%, and 71.8%, respectively. The nomogram achieved good discriminative performance, with an area under the curve value of 0.879.
The nomogram based US-guided CNB, clinicopathological data, and Node-RADS 1.0 score can predict an upgrade in the diagnosis of ALNs in BC.
腋窝淋巴结转移（ALNM）的早期检测是乳腺癌（BC）的关键预后因素。本研究的目的是建立并验证一种列线图，以通过超声（US）引导下的粗针活检（CNB）结合相关因素来预测BC腋窝淋巴结（ALN）诊断的升级。
本研究共纳入304例接受术前US引导下CNB且ALNM诊断为阴性的患者。根据术后病理结果，103例患者被纳入ALNM组，201例患者被纳入非ALNM组。在两组之间进行病例对照研究。我们评估了ALN的CNB假阴性结果率。我们通过单因素分析和多因素逻辑回归分析进一步评估并确定诊断升级与相关因素之间的关系。相关因素包括临床病理特征、主要影像学特征、ALN受累情况以及根据淋巴结报告和数据系统1.0（Node-RADS 1.0）进行的ALN评分。
在多因素逻辑回归分析中，组织学II级和III级、管腔B型、三阴性乳腺癌（TNBC）、人表皮生长因子受体2（HER2）、存在淋巴管侵犯以及Node-RADS 1.0评分≥4是诊断升级的独立危险因素。术前US引导下ALN的CNB结合相关因素的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为85.6%、71.8%、80.9%、85.6%和71.8%。该列线图具有良好的鉴别性能，曲线下面积值为0.879。
基于US引导下CNB、临床病理数据和Node-RADS 1.0评分的列线图可以预测BC中ALN诊断的升级。
