Dual-modal Ultrasonic Diagnosis And Relevant Factors Analysis Of Axillary Lymph Node Metastasis In Invasive Breast Cancer

Part 1 Application of Dual-modal Ultrasound in the Diagnosis of Axillary Lymph Node Metastasis in Invasive Breast CancerObjectiveTo compare the value of conventional ultrasound and contrast-enhanced ultrasound in the diagnosis of axillary lymph node metastasis of invasive breast cancer,and to evaluate the application value in clinic of dual-mode ultrasound which is combined with conventional ultrasound and contrast-enhanced ultrasound in the diagnosis of axillary lymph node metastasis of invasive breast cancer.Methods135 patients with invasive breast cancer in our hospital from June 2018 to December 2018 were selected.A conventional ultrasound and a contrast enhanced ultrasound examination of axillary lymph nodes were performed in all patients and then they underwent breast surgery.the diagnostic results were determined by two doctors independently and blindly.Taking the postoperative histopathological results as the gold standard,the receiver operating characteristic curves with conventional ultrasound,contrast-enhanced ultrasound and combined diagnosis were drawn.Areas under the curve were compared.The sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio and coincidence rate of these diagnostic methods were respectively calculated.The difference was statistically significant with P<0.05.ResultsThe pathological results of axillary lymph nodes showed that 57 of 135 cases had lymph node metastasis and 78 of 135 cases had no lymph node metastasis.The sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio and coincidence rate of conventional ultrasound in the diagnosis of axillary lymph node metastasis were 70.2%,83.3%,75.5%,79.3%,4.21,0.36 and 77.8%,respectively.The sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio and coincidence rate of combined conventional ultrasound and contrast-enhanced ultrasound diagnosis were 89.5%,79.5%,76.1%,91.2%,4.36,0.13 and 83.7%,respectively.The area under the ROC curve of conventional ultrasound and combined diagnosis was 0.768 and 0.845,respectively.The difference was statistically significant?Z=2.706,P=0.007?.With postoperative pathology as the gold standard,the difference of diagnostic coincidence rate between enhancement pattern of type??integral homogeneous enhancement?and type??centralized limited filling defect?was statistically significant??²=8.294,P=0.004?.The two doctors had good consistency in diagnosis(Kappa_ultrasound=0.826,P_ultrasound<0.001;Kappa_CEUS=0.785,P_CEUS<0.001).ConclusionsBoth conventional ultrasound and contrast-enhanced ultrasound are valuable in the diagnosis of axillary lymph node metastasis of breast cancer.What is more,the combined diagnosis of them can improve the diagnostic efficiency of preoperative diagnosis of axillary lymph node.The pattern of localized filling defect in the central of contrast-enhanced ultrasound has a slightly lower diagnostic efficacy in non-metastatic lymph nodes.Part 2 Analysis of Related Factors of Axillary Lymph Node Metastasis in Invasive Breast CancerObjective To investigate the correlation between axillary lymph node metastasis and clinical and pathological features in patients with invasive breast cancer,and to screen the risk factors of axillary lymph node metastasis.Methods 238 patients with invasive breast cancer admitted to our hospital from March 2018 to September 2018 were selected.All the patients were received surgical treatment in our hospital.Taking the postoperative histopathological results as the gold standard,the patients were divided into axillary lymph node metastasis group and axillary lymph node non-metastasis group.The clinical and pathological data were collected,which including age,tumor location,tumor size,tumor aspect ratio,histological grade,vascular invasion,molecular classification,expression of ER,PR,HER2 and Ki-67.The expression of d2-40 in tumor tissue incisions was detected by immunofluorescence assay and the lymphatic vessel density was counted.Univariate and multivariate analysis were used to screen the Factors significantly related to axillary lymph node metastasis.Results The pathological results of axillary lymph nodes showed that 99 of 238 cases of lymph node metastasis and 139 of 238 cases of no metastasis.Univariate analysis showed that the maximum diameter of tumor?P<0.001?,vascular invasion?P<0.001?,HER2 expression?P=0.017?and molecular classification of breast cancer?P=0.039?were correlated with axillary lymph node metastasis.Binary logistic regression analysis showed that the maximum diameter of tumor?P=0.009?and vascular invasion?P<0.001?were significantly correlated with axillary lymph node metastasis.Conclusions Axillary lymph node metastasis of invasive breast cancer is correlated with clinicopathological features of the patients.The maximum diameter of tumor greater than 2cm and vascular tumor embolus are independent risk factors for axillary lymph node metastasis.