Page 109 - 南京医科大学自然版

第44卷第6期 南京医科大学学报（自然科学版）
2024年6月 Journal of Nanjing Medical University（Natural Sciences） ·845 ·

·临床研究·

超声监测定位腋窝淋巴结对乳腺癌患者新辅助治疗疗效的预

测研究

刘心培 ，查海玲 ，平洁怡 ，张曼琪 ，刘 薇 ，陈 锐 ，王 珏 ，查小明 ，栗翠英 1*
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南京医科大学第一附属医院超声诊断科，乳腺外科，江苏 南京 210029
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［摘 要］ 目的：联合超声和腋窝转移定位淋巴结，建立风险评估模型，预测临床淋巴结阳性（clinically LN⁃positive，cN+）乳腺
癌患者新辅助治疗（neoadjuvant systemic therapy，NST）后腋窝病理完全缓解（pathologic complete response，pCR）的情况。方法：
选取88例患者按7∶3的比例随机分配到测试组或验证组。所有患者于NST前，选取超声图像上最可疑且由病理活检证实为转
移的淋巴结，在超声引导下置入1枚定位钛夹。对测试组进行单因素和多因素Logistic回归分析，根据多因素分析结果建立风
险评分模型。结果：腋窝pCR率为48%（42/88）。以NST前激素受体状态、超声提示异常淋巴结的分级和分级的变化、定位淋
巴结皮质厚度变化为独立因素，建立危险评分模型。在-13~-9分和1~10分时，测试组腋窝pCR率分别为100%和0。测试组
和验证组的受试者工作特征曲线下面积分别为0.931（95%CI=0.868~0.994）和0.762（95%CI=0.576~0.947）。结论：基于超声和
定位淋巴结的风险评分模型准确预测了cN+的乳腺癌患者NST后的腋窝淋巴结状态。危险评分-13~-9时腋窝淋巴结转移假
阴性率为0%，这部分患者能够避免腋窝淋巴结清扫及一系列并发症。
［关键词］ 乳腺癌；新辅助治疗；超声；腋窝淋巴结
［中图分类号］ R737.9 ［文献标志码］ A ［文章编号］ 1007⁃4368（2024）06⁃845⁃08
doi：10.7655/NYDXBNSN231208

Monitoring of clipped axillary lymph node by ultrasound to predict response of breast
cancer to neoadjuvant systemic therapy
1 1 1 1 1 2 2 2
LIU Xinpei ，ZHA Hailing ，PING Jieyi ，ZHANG Manqi ，LIU Wei ，CHEN Rui ，WANG Jue ，ZHA Xiaoming ，LI
Cuiying 1*
1 Department of Ultrasonography，Department of Breast Surgery，the First Affiliated Hospital of Nanjing Medical
2
University，Nanjing 210029，China

［Abstract］ Objective：Combined ultrasound and axillary metastatic clipped lymph nodes was developed a model to predict the
pathological complete response（pCR）of axillary lymph nodes in clinically lymph node⁃positive（cN+）breast cancer patients after
neoadjuvant systemic therapy（NST）. Methods：Eighty⁃eight patients were randomly assigned to the testing or validation set at a ratio of
7∶3. Before NST，the lymph nodes most suspicious on ultrasound images and confirmed as metastatic by pathological biopsy were
selected and marked with a titanium clip under ultrasound guidance. Univariate and multivariate logistic regression analyses of the
testing set were performed. A risk score model was developed based on the results of multivariate analysis. Results：The axillary pCR
rate was 48%（42/88）. Hormone receptor status，N grade and changes in the number of abnormal lymph nodes were determined by
ultrasonography，and changes in cortical thickness of the clipped lymph nodes were identified as independent factors and established
the risk score model. In the score range of - 13 to - 9 and 1 to 10，the axillary pCR rate of the testing set was 100% and 0% ，
respectively. The area under the receiver operating characteristic curves of the testing and validation sets were 0.931（95% CI：0.868-
0.994）and 0.762（95% CI：0.576-0.947），respectively. Conclusion：The risk score model based on ultrasound and clipped lymph
nodes accurately predicte the axillary lymph node status of breast cancer patients with cN + after NST. When the risk score was
between -13 and -9，the false⁃negative rate of axillary lymph node metastasis was 0%，allowing these patients to avoid axillary lymph

［基金项目］ 江苏省人民医院临床能力提升工程医疗项目（JSPH⁃MB⁃2022⁃5）
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通信作者（Corresponding author），E⁃mail：lynx_ko@163.com