Compare The Value Of Ultrasound,Mammography And Combination Of The Two Examinations In Predicting More Than Two Axillary Lymph Node Metastases In Patients With Breast Cancer

Background and:The results of the Z0011 trail have changed the clinical practice in axillary treatment for patients with early-stage breast carcinoma.The Breast Cancer Guidelines edited by Chinese Anti-Cancer Association indicated that patients with 1-2sentinel lymph node metastases may not further undergo axillary lymph node dissection.However,the false-negative rate of sentinel lymph node biopsy is approximately 4%to16.7%.To minimize the risk of underestimation of axillary disease by SLNB,the role of preoperative axillary staging should be highly regarded.Among the various imaging examinations,ultrasound and mammography are suitable for initially assessing the status of axillary lymph node.Identify the patients with less lymph node metastasis burden,which is essential for clinical decision.Objectives:First,compare the value of preoperative ultrasound,mammography and combination of the two examinations for predicting more than two axillary lymph node metastases in patients with breast cancer.Second,analyze the relative risk factors of patients with more than two axillary lymph node metastases.Methods:A retrospective study of 394 patients with breast cancer from January 2016 to October 2017 was performed.According to the image examination report to determine whether the axillary lymph node was suspicious.The pathological diagnostic results were as gold standard.Patients were divided into two groups based on the number of lymph node metastasis?group1:?2 lymph node metastasis;group2:>2 lymph node metastases?.SPSS19.0 software was used for statistical analysis.The accuracy of the diagnostic method was evaluated by receiver operating characteristic?ROC?curve and the area under the ROC curve?AUC?.Multivariate logistic regression was used to analyze the relative risk factors.A logistic regression predictive model was established.P<0.05 indicated statistically significant.Results:1.A total of 394 patients were enrolled in this study.All of the patients were female with an average age of 52 years?range from 27 to 90 years old?.All patients underwent preoperative breast and axillary ultrasound,and 185 patients received mammography before surgery.There were 256 cases without axillary lymph node metastasis,64 cases with 1-2 axillary lymph node metastases,and 74 cases with more than two axillary lymph node metastases.2.In predicting patients with more than two axillary lymph node metastases:the sensitivity,specificity,NPV,NLR,PPV,PLR,coincidence rate and Youden index of ultrasound were 82.4%,84.7%,95.4%,0.21,56.0%,5.50,84.0%and 0.67,respectively.The AUC of ultrasound,mammography and the combination of the two examinations were 0.849,0.645,and 0.831,respectively.3.Independent impact factors of breast cancer with more than two lymph node metastases include young age,large tumor size and axillary lymph node suspicious detected by ultrasound.The Logistic regression model equation:?P?=-3.596-0.746X₁+1.523X₂+3.345X₃?X₁ was age,X₂ was T stage,and X₃ was the result of ultrasound?.The AUC of logistic regression predictive model was 0.905.Conclusions:1.In predicting patients with more than two axillary lymph node metastases,ultrasound is obviously better than mammography,and the combination of the two examinations can't improve the diagnostic efficiency.2.Ultrasound is a reliable examination to exclude the patients with more than two axillary lymph node metastases.3.Independent predictors of patients with more than two lymph node metastases include young age,large tumor size and axillary lymph node suspicious detected by ultrasound.The Logistic regression model can improve predictive accuracy theoretically.