Quantitative imaging in medicine and surgery · 2025
Preoperative ultrasonography-guided core-needle biopsy-based factors for predicting the upgrade of axillary lymph nodes in breast cancer.
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Xing Yue, Li Yanbo, Wang Jiahui, Liu Liangsheng, Li Fangfang, Lu Hong
Аннотация
BACKGROUND: The early detection of axillary lymph node metastasis (ALNM) is a critical prognostic factor in breast cancer (BC). The objective of this study was to establish and validate a nomogram to predict the upgrade in the diagnosis of axillary lymph nodes (ALNs) in BC via ultrasonography (US)-guided core-needle biopsy (CNB) in combination with related factors.
METHODS: This study included a total of 304 patients who underwent preoperative US-guided CNB and were diagnostically negative for ALNM. According to the postoperative pathological results, 103 patients were placed into an ALNM group and 201 patients into a non-ALNM group. A case-control study was conducted between the two groups. We assessed the rate of false-negative results from CNB of ALN. We further evaluated and determined the relationships between an upgrade in diagnosis and related factors by performing univariate analysis and multivariate logistic regression analysis. The relevant factors included clinicopathologic features, primary imaging features, ALN involvement, and ALN scoring according to the Node Reporting and Data System 1.0 (Node-RADS 1.0).
RESULTS: In the multivariate logistic regression analysis, histological grades II and III, luminal B, triple-negative breast cancer (TNBC), human epidermal growth factor receptor 2 (HER2), presence of lymphovascular invasion, and Node-RADS 1.0 score ≥4 were independent risk factors for an upgrade in diagnosis. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of preoperative US-guided CNB of ALNs combined with related factors were 85.6%, 71.8%, 80.9%, 85.6%, and 71.8%, respectively. The nomogram achieved good discriminative performance, with an area under the curve value of 0.879.
CONCLUSIONS: The nomogram based US-guided CNB, clinicopathological data, and Node-RADS 1.0 score can predict an upgrade in the diagnosis of ALNs in BC.
METHODS: This study included a total of 304 patients who underwent preoperative US-guided CNB and were diagnostically negative for ALNM. According to the postoperative pathological results, 103 patients were placed into an ALNM group and 201 patients into a non-ALNM group. A case-control study was conducted between the two groups. We assessed the rate of false-negative results from CNB of ALN. We further evaluated and determined the relationships between an upgrade in diagnosis and related factors by performing univariate analysis and multivariate logistic regression analysis. The relevant factors included clinicopathologic features, primary imaging features, ALN involvement, and ALN scoring according to the Node Reporting and Data System 1.0 (Node-RADS 1.0).
RESULTS: In the multivariate logistic regression analysis, histological grades II and III, luminal B, triple-negative breast cancer (TNBC), human epidermal growth factor receptor 2 (HER2), presence of lymphovascular invasion, and Node-RADS 1.0 score ≥4 were independent risk factors for an upgrade in diagnosis. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of preoperative US-guided CNB of ALNs combined with related factors were 85.6%, 71.8%, 80.9%, 85.6%, and 71.8%, respectively. The nomogram achieved good discriminative performance, with an area under the curve value of 0.879.
CONCLUSIONS: The nomogram based US-guided CNB, clinicopathological data, and Node-RADS 1.0 score can predict an upgrade in the diagnosis of ALNs in BC.