Feasibility Study On The Prediction Of Axillary Lymph Node Status By The Clinicopathological Features Of Breast Cancer

Objective: To investigate the relationship between the clinicopathological features of breast cancer and axillary lymph node metastasis.Materials and methods: A retrospective analysis was performed on a total of 2705 cases of female breast cancer patients who underwent surgical treatment in Fujian Medical University Union Hospital and Fujian Medical University Sanming First Hospital from January 2008 to December 2017.Collected age at diagnosis,surgical procedure,clinical tumor size,tumor location,postoperative pathological tumor size,pathological type,histological grade,clinical axillary lymph node status,ER,PR,ki67,Her-2,tumor multifocal,postoperative axillary lymph node status,tumor stage,molecular subtypes of 16 variables.According to the methods of axillary surgery,it was divided into training group(SLNB group)and Validation group(ALND group).According to whether core needle biopsy was performed preoperatively,core needle biopsy and routine paraffin sections were collected respectively.At the same time,part of pathological specimens(83 cases)were re-examined with KI67.Results: Univariate analysis was performed on 11 variables including age of diagnosis,pathological type,histological grade,pathological tumor size,clinical tumor size,hormone receptor,her-2,ki67,clinical tumor location,clinical multifocal and molecular subtypes in 1010 patients with breast cancer in the training group.Among them,9 variables including pathological type,histological grade,Clinical tumor size,pathological tumor size,hormone receptor,her-2,ki67,clinical multifocal,and molecular subtypes had statistically significant effects on axillary lymph node metastasis of breast cancer(P < 0.05).Seven variables including pathological type,histological grade,clinical tumor size,hormone receptor,her-2,ki67 and clinical multifocal were included in multivariate logistic regression analysis according to the results of univariate analysis.The analysis confirmed that pathological type,her-2,Ki67,hormone receptor,and clinical tumor size were prognostic factors for axillary lymph node metastasis of breast cancer.According to the analysis results,Nomogram for predicting the probability of axillary lymph node metastasis was made and the ROC curve of the trainingl group was drawn(AUC=0.725).The nomogram was used to calculate the transfer risk probability value of the validation group(1037 cases),and the ROC curve of the validation group(AUC=0.786)was drawn according to the probability value.Ten cut points in the prediction risk were selected,and the number of cases,sensitivity,specificity,accuracy,positive predictive value and negative predictive value of axillary lymph node metastasis were calculated respectively under the condition of different predictive risk values.It was found that this model was more accurate in predicting lymph node negative,with the negative predictive value of >90%,especially for the patients with low risk of metastasis(<10%),the prediction accuracy was higher,but the prediction efficiency for axillary lymph node positive was poor.conclusion: 1.In this study,it was found that tumor size,pathological type,ki67,hormone receptor,and her-2 were correlated with axillary lymph node metastasis,and the prediction model thus obtained had a certain predictive effect on axillary lymph node metastasis.2.For patients with clinically negative axillary lymph nodes,axillary lymph node dissection may be avoided if the tumor size is small(<20mm),the pathological type is invasive lobular carcinoma or a specific type of invasive carcinoma,and ki67 expression is low.