A Retrospective Study Of Risk Factors Associated With Axillary Lymph Node Metastasis In Breast Cancer

Objective:To analyse the relationship between clinical and pathological features and ultrasound characteristics of masses and axillary lymph node metastasis in breast cancer patients,and to develop a diagnostic model to improve the accuracy of predicting axillary lymph node metastasis in breast cancer patients.Methods:One hundred and twenty-seven breast cancer patients attending our hospital from April 2019 to December 2020 were collected as study subjects,and their preoperative ultrasound features,clinical data and postoperative pathological findings were retrospectively analyzed.The pathological findings after lymph node biopsy of patients were used as the gold standard to determine whether axillary lymph node metastasis was present.Ultrasound features(mass size,morphology,echogenicity,margins,growth direction,posterior echogenicity,calcification,colour Doppler flow signal),clinical and pathological features(patient’s age,mass location,ER,PR,HER-2,Ki-67,P53,CK5/6,molecular typing,histological grade)were screened by univariate analysis for any differences with the presence or absence of axillary lymph node metastasis.Risk factors were screened and statistically modelled by binary logistic regression,and their diagnostic efficacy was analysed.Results:1.A total of 127 patients were included in this study,of whom 59(46.46%)had axillary lymph node metastases and 68(53.54%)had no axillary lymph node metastases.2.Univariate analysis: Of all the factors included,a total of 7 factors differed in a statistically significant manner.Among the ultrasound features,statistically significant differences were found between tumour size,tumour shape,colour Doppler blood flow signal and whether axillary lymph nodes metastasised(P < 0.05);among the pathological features,statistically significant differences were found between HER-2,Ki-67,molecular typing,histological grade and whether axillary lymph nodes metastasised(P < 0.05).3.Binary logistic regression analysis was performed to screen out the closely related risk factors and establish a logistic regression model with Logit(P)=-3.238 +2.704*tumour histological grade + 0.854*HER-2 + 1.652*blood flow signal.Accordi ng to the OR,the 3 risk factors were blood flow signal > histological grade >HER-2 in that order.4.The area under the ROC curve for blood flow signal,tumour histological grade,HER-2 and logistic regression model were 0.776,0.645,0.659 and 0.588 respectively.Conclusions:1.Patients with higher colour Doppler flow imaging grading of breast masses,higher histological grade and HER-2 positive are more likely to have lymph node metastasis,and ultrasound imaging provides a promising tool for predicting axillary lymph node metastasis in breast cancer patients.2.The logistic regression model developed in this study can better analyze the importance of each factor in the diagnosis and predict axillary lymph node metastasis,which has some clinical value.