Application Of Ultrasonographic Features In The Prediction Of Axillary Lymph Node Metastasis In Breast Cancer

Objective(s):1.By discussing the ultrasonic imaging features of primary breast cancer,the application of ultrasonic imaging features of breast cancer in predicting axillary lymph node metastasis was explored.2.By analyzing the ultrasonic features of primary breast cancer,the ultrasonic features most related to axillary lymph node metastasis were screened out,and the Logistic regression model and ROC curve were constructed to study its value in predicting axillary lymph node metastasis,so as to effectively improve the accuracy of diagnosis of axillary lymph node metastasis.Methods: The clinical,ultrasonic and pathological data of 247 breast cancer patients who visited our hospital from October 2021 to June,2022 and confirmed by operation and histology were retrospectively analyzed.247 breast cancer patients were examined by conventional gray-scale ultrasound before operation,and 10 kinds of ultrasound imaging features related to breast masses were analyzed.These ultrasound imaging features were recorded one by one,including location,size,shape,direction,edge,boundary,internal echo,calcification,posterior echo and blood flow.Single factor analysis was used to screen the ultrasonic features related to axillary lymph node metastasis,and the related ultrasonic features were analyzed by binary Logistic regression,so as to screen out the independent risk factors of axillary lymph node metastasis and establish a Logistic regression model.Then,the ROC curve of the subjects was drawn,and the area under the curve(AUC)was used for risk prediction and efficacy evaluation.The difference was statistically significant(P < 0.05).Results: A total of 280 patients underwent breast ultrasound examination in our hospital from October 2021 to June 2022 were collected.In the end,247 patients met the inclusion criteria,with a total of 247 breast masses.Ten ultrasonic imaging features of breast masses,including location,size,shape,direction,edge,boundary,internal echo,calcification,posterior echo and blood flow,were analyzed by single factor.It was found that the direction,calcification and blood flow were related to axillary lymph node metastasis.Multivariate analysis showed that vertical orientation,microcalcification and abundant blood flow were independent risk factors for axillary lymph node metastasis.OR values are 2.871,2.834 and 3.020,respectively.ROC analysis was carried out with axillary lymph node metastasis as the state variable and logistic regression model,direction,calcification and blood flow as the test variables.The results showed that the AUC area of logistic regression model for predicting the risk of axillary pathological metastasis was 0.716(0.652,0.780),the specificity was0.758,the sensitivity was 0.605 and the Jordan index was 0.363.The AUC area,specificity,sensitivity and Jordan’s index for predicting the risk of axillary pathological metastasis are 0.579(0.508,0.651),0.789,0.370 and 0.159 respectively.The AUC area of microcalcification for predicting the risk of axillary pathological metastasis is 0.621(0.551,0.691),the specificity is 0.680,the sensitivity is 0.563,and the Jordan index is 0.243.The AUC area for predicting the risk of axillary pathological metastasis by blood flow is 0.624(0.554,0.694),the specificity is 0.500,the sensitivity is 0.748,and the Jordan index is 0.248.Conclusion(s): 1.It is feasible to predict the status of axillary lymph nodes by ultrasonic imaging features of primary breast cancer.Vertical orientation,microcalcification and rich blood flow are independent risk factors for axillary lymph node metastasis;2.The risk of axillary lymph node metastasis is high when the breast lesions have microcalcification,vertical direction and blood flow grade II-III.Multivariate regression analysis combining the three factors can better predict the status of axillary lymph nodes than single factor analysis;3.By analyzing the ultrasonic image characteristics of primary breast cancer,it provides more diagnostic information for ultrasonic diagnosis of axillary lymph nodes,which has certain reference value.