多参数磁共振Kaiser评分系统联合多模态超声对乳腺癌腋窝淋巴结转移的预测价值分析

Predictive value of the multiparametric MRI Kaiser scoring system combined with multimodal ultrasound for axillary lymph node metastasis in breast cancer

摘要:

目的 探究多参数磁共振Kaiser评分系统与多模态超声两种方法及联合应用在乳腺癌腋窝淋巴结转移中的预测价值。方法 回顾性选取2022年1月—2025年6月于秦皇岛市中医医院经病理确诊的108例乳腺癌患者，根据是否发生腋窝淋巴结转移分为转移组（34例）和未转移组（74例）。所有患者进行多模态超声检查和多参数磁共振检查，依据检查结果进行Kaiser评分。收集并比较两组患者的临床特征、多模态超声特征及Kaiser评分。采用多因素一般Logistic回归模型分析乳腺癌腋窝淋巴结转移的危险因素，绘制受试者工作特征曲线分析多参数磁共振Kaiser评分系统、多模态超声及两者联合应用对乳腺癌腋窝淋巴结转移的预测价值。结果 转移组与未转移组年龄、体质量指数、绝经率、组织学分类构成、肿瘤位置构成、ER阳性率和PR阳性率比较，差异均无统计学意义（P >0.05）。转移组肿瘤最大径>20 mm占比、微钙化阳性率、汇聚征阳性率、Adler血流分级Ⅱ、Ⅲ级占比、Kaiser评分≥6分占例均高于未转移组（P <0.05）。多因素一般Logistic回归分析显示，肿瘤最大径>20 mm［O^R =6.084（95% CI：1.595，23.204）］、微钙化阳性［O^R =3.618（95% CI：1.175，11.136）］，汇聚征阳性［O^R =3.347（95% CI：1.155，9.701）］和Kaiser评分≥6分［O^R =8.562（95% CI：2.854，25.687）］均为乳腺癌患者发生腋窝淋巴结转移的危险因素（P <0.05）。上述指标联合预测时，敏感性为82.4%（95% CI：0.655，0.932），特异性为81.1%（95% CI：0.703，0.893）。结论 肿瘤最大径>20 mm、微钙化阳性、汇聚征阳性及Kaiser评分≥6分是预测乳腺癌腋窝淋巴结转移的独立影像学指标。多模态超声与Kaiser评分联合应用可提升预测效能，优于单一方法，为术前无创精准评估提供了有效策略。

Abstract:

Objective To investigate the predictive value of the multiparametric magnetic resonance imaging Kaiser scoring system, multimodal ultrasound, and their combination for axillary lymph node metastasis in breast cancer.Methods A total of 108 patients with pathologically confirmed breast cancer admitted to Qinhuangdao Municipal Hospital of Traditional Chinese Medicine from January 2022 to June 2025 were retrospectively enrolled. According to the presence or absence of axillary lymph node metastasis, the patients were divided into a metastasis group (n = 34) and a non-metastasis group (n = 74). All patients underwent multimodal ultrasound and multiparametric MRI examinations, and Kaiser scores were calculated based on the imaging findings. Clinical characteristics, multimodal ultrasound features, and Kaiser scores were compared between the two groups. Multivariate logistic regression analysis was used to identify risk factors for axillary lymph node metastasis. Receiver operating characteristic curves were plotted to evaluate the predictive value of the Kaiser scoring system, multimodal ultrasound, and their combination.Results There were no significant differences between the two groups in age, body mass index, menopausal status, histological classification, tumor location, estrogen receptor positivity, or progesterone receptor positivity (P > 0.05). The proportions of patients with a maximum tumor diameter > 20 mm, positive microcalcification, positive convergence sign, Adler blood flow grades Ⅱ-Ⅲ, and Kaiser score ≥ 6 were significantly higher in the metastasis group than in the non-metastasis group (P < 0.05). Multivariate logistic regression analysis showed that maximum tumor diameter > 20 mm [O^R = 6.084, 95% CI: 1.595, 23.204], positive microcalcification [O^R = 3.618, 95% CI: 1.175， 11.136], positive convergence sign [O^R = 3.347, 95% CI: 1.155, 9.701], and Kaiser score ≥ 6 [O^R = 8.562, 95% CI: 2.854, 25.687] were independent risk factors for axillary lymph node metastasis in patients with breast cancer (P < 0.05). The combined model yielded a sensitivity of 82.4% (95% CI: 0.655, 0.932) and a specificity of 81.1% (95% CI: 0.703, 0.893).Conclusion Maximum tumor diameter > 20 mm, positive microcalcification, positive convergence sign, and Kaiser score ≥ 6 are independent imaging indicators for predicting axillary lymph node metastasis in breast cancer. The combined application of multimodal ultrasound and the Kaiser scoring system improves predictive performance and is superior to either method alone, providing an effective noninvasive strategy for accurate preoperative evaluation.