朱芸;张书海;王小雷;杨昭;李淑华;杨丽;汤晓敏;马宜传;谢宗玉;

• 1:蚌埠医学院第一附属医院放射科
• 2:蚌埠医学院医学影像诊断学教研室

摘要(Abstract)：

目的 探讨基于MRI、钼靶影像特征联合临床病理因素构建的列线图在预测肿块型乳腺浸润性导管癌前哨淋巴结(sentinel lymph node,SLN)转移中的价值。材料与方法 回顾性分析经病理证实为浸润性导管癌患者的临床病理及影像资料312例，按3∶1随机分成训练组(234例)与验证组(78例)，两组间比较采用χ2检验或Fisher精确检验。在训练组中，SLN阴性组158例，阳性组76例，对两组患者的临床病理因素、MRI、钼靶影像特征进行分析。通过多因素Logistic回归分析筛选出独立预测因子，构建预测SLN转移的列线图模型。使用受试者操作特征(receiver operating characteristic,ROC)曲线、校准曲线、Hosmer-Lemeshow检验拟合优度对模型进行评价。结果 临床病理因素、MRI、钼靶影像特征在训练组及验证组间差异无统计学意义(P>0.05)。在训练组中，肿瘤最大径、临床T分期、淋巴结触诊、孕激素受体、人类表皮生长因子受体2、脉管浸润、MRI [肿块形状、乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)分类、腋窝淋巴结状态]、钼靶(BI-RADS分类、腋窝淋巴结状态)这11个变量在SLN阴性组和阳性组间差异有统计学意义(P<0.05)。通过多因素Logistic回归分析得到，肿瘤最大径、淋巴结触诊、MRI (腋窝淋巴结状态)、钼靶(腋窝淋巴结状态)以及脉管浸润为预测SLN转移的独立危险因素。基于这5个变量构建模型，训练组及验证组ROC曲线下面积分别为0.908和0.897;Hosmer-Lemeshow检验拟合优度P值分别为0.883和0.579 (P>0.05)。结论 基于MRI及钼靶的术前影像学特征联合临床病理因素构建的列线图模型能较好地预测肿块型浸润性导管癌患者SLN转移情况。

关键词(KeyWords)： 乳腺癌;浸润性导管癌;列线图;前哨淋巴结;磁共振成像;钼靶检查

Abstract:

Keywords:

基金项目(Foundation): 安徽省教育厅自然科学基金重点项目(编号：KJ2019A0402);; 蚌埠医学院自然科学重点项目(编号：2020byzd145)~~

作者(Authors): 朱芸;张书海;王小雷;杨昭;李淑华;杨丽;汤晓敏;马宜传;谢宗玉;

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