常规超声及弹性评分联合免疫组化指标预测乳腺癌腋窝淋巴结转移的价值

Value of Routine Ultrasound and Elastic Score Combined with Immunohistochemical Index in Predicting Axillary Lymph Node Metastasis of Breast Cancer

摘要: 目的：探讨乳腺癌肿块超声特征及弹性评分联合免疫组化指标预测腋窝淋巴结转移的价值。方法：选取2021年1月~2023年8月青岛大学附属医院市南院区手术治疗的乳腺癌患者156例，肿块183个；依据淋巴结状态分为转移组与未转移组，观察两组间乳腺癌肿块的常规超声特征、弹性成像评分，并检测免疫组化指标ER、PR、HER-2、Ki-67、p53的表达情况，用单因素分析及多因素Logistic回归分析法获得两组间统计学具有差异的参数，建立回归模型。结果：单因素分析结果显示，血流II~III级、钙化(+)、HER2(+)和弹性评分 > 3分在腋窝淋巴结转移组占比显著更高(P < 0.05)；多因素回归分析结果显示各变量曲线下面积(AUC)从小到大依次为弹性评分、钙化情况、血流、HER2，各变量的ROC曲线下面积均显著大于0.5，即认为模型具有一定的预测效果。结论：乳腺癌患者肿块的血流分级、钙化情况、HER-2表达和弹性评分在腋窝淋巴结是否转移方面有一定的预测价值。

Abstract: Objective: To investigate the value of ultrasound features and elastic score combined with immuno-histochemical indexes in predicting axillary lymph node metastasis in breast cancer. Methods: 156 patients with breast cancer (183 lumps) were selected from January 2021 to August 2023 in Shinan District, Affiliated Hospital of Qingdao University; according to the lymph node status, the patients were divided into metastatic group and non metastatic group. The conventional ultrasonic charac-teristics and elastography scores of breast cancer masses between the two groups were observed, and the expression of immunohistochemical indicators ER, PR, HER-2, Ki-67, and p53 were detected. The parameters with statistical differences between the two groups were obtained by single factor analysis and multivariate logistic regression analysis, and the regression model was established. Result: Univariate analysis showed that blood flow levels II~III, calcification (+), HER2 (+), and elas-ticity score > 3 were significantly higher in the axillary lymph node metastasis group (P < 0.05); the results of multiple factor regression analysis showed that the area under the curve (AUC) of each variable, from small to large, followed by elastic score, calcification, blood flow, HER2. The area un-der the ROC curve of each variable was significantly greater than 0.5, indicating that the model has a certain predictive effect. Conclusion: The blood flow grade, calcification, HER-2 expression and elasticity score of the tumor in breast cancer patients have a certain predictive value in whether ax-illary lymph node metastasis.