The Breast Tumor Strain Ratio Is a Predictive Parameter for Axillary Lymph Node Metastasis in Patients With Invasive Breast Cancer
The Breast Tumor Strain Ratio Is a Predictive Parameter for Axillary Lymph Node Metastasis in Patients With Invasive Breast Cancer
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DOI：
10.2214/ajr.14.14269
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发表时间：
2015-12-01
影响因子：
5
通讯作者：
Lee, Suck Hong
中科院分区：
文献类型：
--
作者：
Kim, Jin You;Shin, Jong Ki;Lee, Suck Hong
OBJECTIVE.本研究的目的是评估浸润性乳腺癌患者乳腺肿瘤应变率与腋窝淋巴结转移之间的关系。回顾性分析了2013年3月至2014年5月期间接受术前超声弹性成像的284例浸润性乳腺癌患者的记录。对于患有多灶性或双侧癌症的女性，包括最大的肿瘤。有经验的放射科医生使用超声设备内的专用软件进行超声弹性成像并测量应变比，应变比定义为脂肪与病变比，指示乳腺病变的相对硬度。采用单因素和多因素Logistic回归分析评估腋窝淋巴结转移与肿瘤应变率、临床和生物学变量之间的关系。284例中85例（29.9%）有腋窝淋巴结转移。有腋窝淋巴结转移的肿瘤中的应变比在统计学上显著高于无腋窝淋巴结转移的肿瘤（平均值+/- SD分别为5.19 +/- 1.28 vs 4.17 +/- 1.30; p < 0.001）。单因素分析显示，较高的应变比（> 3.89）、较大的肿瘤大小（> 2 cm）、较高的组织学分级（3级）、淋巴管浸润、可触及性和较高的Ki-67表达（>= 14%）与腋窝淋巴结转移有统计学显著相关。在多变量分析中，较高的应变比（> 3.89）（比值比[OR]，14.208; p < 0.001），存在淋巴管浸润（OR，17.437; p < 0.001），Ki-67表达更高（>= 14%）（OR = 3.744; p = 0.002）对预测腋窝淋巴结转移具有独立的意义。超声弹性成像的乳腺肿瘤应变率与浸润性乳腺癌患者腋窝淋巴结转移独立相关。
OBJECTIVE. The purpose of this study was to evaluate the association between the breast tumor strain ratio and axillary lymph node metastasis in patients with invasive breast cancer.MATERIALS AND METHODS. The records of 284 patients with invasive breast cancer who underwent ultrasound elastography before surgery between March 2013 and May 2014 were reviewed retrospectively. For women with multifocal or bilateral cancer, the largest tumor was included. An experienced radiologist performed ultrasound elastography and measured the strain ratio, which is defined as the fat-to-lesion ratio and is indicative of the relative stiffness of the breast lesion, using dedicated software within the ultrasound equipment. The associations between axillary lymph node metastasis with the tumor strain ratio and clinical and biologic variables were evaluated using univariate and multivariate logistic regression analyses.RESULTS. Among 284 tumors, 85 (29.9%) showed axillary lymph node metastasis by surgical histopathologic analysis. The strain ratio was statistically significantly higher in tumors with axillary lymph node metastasis than in those without axillary lymph node metastasis (mean +/- SD, 5.19 +/- 1.28 vs 4.17 +/- 1.30, respectively; p < 0.001). On univariate analysis, a higher strain ratio (> 3.89), larger tumor size (> 2 cm), higher histologic grade (grade 3), presence of lymphovascular invasion, palpability, and higher expression of Ki-67 (>= 14%) were statistically significantly associated with axillary lymph node metastasis. On multivariate analysis, a higher strain ratio (> 3.89) (odds ratio [OR], 14.208; p < 0.001), presence of lymphovascular invasion (OR, 17.437; p < 0.001), and higher expression of Ki-67 (>= 14%) (OR, 3.744; p = 0.002) maintained independent significance for predicting axillary lymph node metastasis.CONCLUSION. The breast tumor strain ratio on ultrasound elastography is associated independently with axillary lymph node metastasis in patients with invasive breast cancer.