Résumé
Objective:To construct a diagnostic model based on the multimodal ultrasound imaging, and to predict the axillary lymph node (ALN) status of breast cancer patients after neoadjuvant chemotherapy (NAC).Methods:A total of 204 female breast cancer patients with ALN metastasis who had undergone puncture biopsy of aspiration in the Second Affiliated Hospital and Harbin Medical University Cancer Hospital between July 2017 to May 2021 were included. According to the pathological results of ALN surgery after NAC, the cases were divided into pathologically complete response (pCR) group and non-pCR group. The ultrasound images, immunohistochemistry and blood routine index were collected and compared between the two groups, the indexes whose P<0.02 were selected. In terms of logistic regression algorithm, a predictive model for the pathological state of axillary lymph nodes in breast cancer patients was established after NAC, and ROC curve was plotted to evaluate the performance of the model. Results:The P values for comparison between the two groups of the breast tumor size, blood flow resistance index (RI), elasticity score, lymph hilum structure, maximum cortical thickness, blood flow distribution, blood flow RI, and immunohistochemical detection indicators including estrogen receptor(ER), progesterone receptor(PR), human epidermal growth factor 2(HER-2), Ki67 molecular expressions were <0.20 by t test, Mann-Whitney U test, and χ 2 test analysis; in the multiple logistic regression analysis, tumor size, lymphatic hilum structure, maximum cortical thickness, lymph node blood flow distribution and blood flow resistance index, PR and HER-2 molecular expressions were the independent factors predicting the pathological status of axillary lymph nodes in breast cancer patients after NAC ( P<0.05). The performance of the predictive model was 0.870 (95% confidence interval: 0.819-0.922, P<0.05), with sensitivity of 86.82% and specificity of 70.67%. Conclusions:The model for predicting the pathological state of ALN in breast cancer patients after NAC using multi-modal ultrasound characteristic and immunohistochemical indexes achieves good diagnostic performance providing more objective evidence for the formulation of clinical treatment plans and prognostic evaluation.
Résumé
Objective To investigate the correlation of DCEGMRI findings with pathologic tumor response to neoadjuvant chemotherapy for patients with tripleGnegative breast cancer (TNBC).Methods SixtyGnine patients with TNBC were enrolled,who underwent DCEG MRI before neoadj uvant chemotherapy,then completed neoadjuvant chemotherapy and surgery.Patterns of tumor volume reduction were divided into two types.Univariate and multivariate Logistic regression analyses were performed to detect the independent predictors of pathological tumor response.Results 30.4% (21/69)patients achieved a pathologic complete response.Multivariate Logistic regression analysis showed that homogenous enhancement on preGneoadj uvant chemotherapy MRI (OR＝1 0.87 ,9 5%CI＝2.94－48.3 1 ,P＜0.00 1 )and concentric shrinkage pattern on postGneoadj uvant chemotherapy (OR＝1 3.04,9 5%CI＝2.0 1－54.1 1 ,P＜0.00 1 )were the independent predictors of pathologic complete response.Conclusion Homogeneous enhancement on preGneoadj uvant chemotherapy MRI and the presence of concentric shrinkage pattern are correlated with pathologically complete response in patients with TNBC.