超声造影特征联合NLR、TSR诊断乳腺癌腋窝淋巴结转移的价值

The value of ultrasound contrast features combined with NLR and TSR in diagnosing axillary lymph node metastasis of breast cancer

摘要:

目的 探讨超声造影特征联合中性粒细胞与淋巴细胞比值（NLR）和肿瘤-间质比（TSR）在诊断乳腺癌腋窝淋巴结转移中的价值。方法 选取宁波大学附属第一医院2021年6月—2024年7月收治的186例乳腺癌患者作为研究对象。其中，87例确诊为腋窝淋巴结转移（腋窝淋巴结转移组），99例为无腋窝淋巴结转移组。所有患者接受超声造影检查，并测定NLR和TSR。采用多因素逐步Logistic回归模型分析乳腺癌腋窝淋巴结转移的影响因素；绘制受试者工作特征（ROC）曲线评估超声造影特征、NLR、TSR对腋窝淋巴结转移的诊断价值。结果 腋窝淋巴结转移组患者的血流分级Ⅱ、Ⅲ级，周边声晕，周边汇聚，增强后范围扩大，最大皮质厚度> 3 cm，峰值强度，NLR和TSR均高于无腋窝淋巴结转移组（P <0.05），达峰时间短于无腋窝淋巴结转移组（P <0.05）。多因素逐步Logistic回归分析结果显示，血流分级Ⅱ、Ⅲ级［O^R =12.075（95% CI：1.730，84.305）］、周边声晕［O^R =26.857（95% CI：2.805，257.147）］、周边汇聚［O^R =18.616（95% CI：2.220，156.131）］、增强后范围扩大［O^R =10.496（95% CI：1.629，67.652）］、最大皮质厚度> 3 cm［O^R =32.729（95% CI：3.575，299.671）］、达峰时间短［O^R =0.502（95% CI：0.345，0.731）］、峰值强度高［O^R =2.866（95% CI：1.527，5.379）］、NLR高［O^R =20.495（95% CI：1.194，351.666）］、TSR高［O^R =1.255（95% CI：1.093，1.441）］均为乳腺癌腋窝淋巴结转移的危险因素（P <0.05）。超声造影特征、NLR和TSR对乳腺癌腋窝淋巴结转移的诊断敏感性分别为92.0%（95% CI：0.841，0.967）、71.3%（95% CI：0.606，0.805）和62.1%（95% CI：0.510，0.723），特异性分别为97.0%（95% CI：0.914，0.994）、71.7%（95% CI：0.618，0.803）和77.8%（95% CI：0.683，0.855），曲线下面积分别为0.976、0.754和0.731。当超声造影特征、NLR和TSR联合时，敏感性和特异性分别为93.1%（95% CI：0.856，0.974）和98.0%（95% CI：0.929，0.998），曲线下面积为0.991。结论 超声造影特征联合NLR和TSR可以有效提高乳腺癌腋窝淋巴结转移的诊断准确性，对乳腺癌的分期和预后评估具有重要临床意义。

Abstract:

Objective To explore the value of contrast-enhanced ultrasound (CEUS) features combined with the Neutrophil-to-Lymphocyte Ratio (NLR) and Tumor-Stroma Ratio (TSR) in diagnosing axillary lymph node metastasis in breast cancer patients.Methods A total of 186 breast cancer patients treated at Ningbo University Medical College from June 2021 to July 2024 were selected as the study subjects. Among them, 87 were diagnosed with axillary lymph node metastasis, forming the axillary lymph node metastasis group, and 99 were in the non-axillary lymph node metastasis group. All patients underwent ultrasound contrast examination and had their NLR and TSR measured. Multivariate logistic regression analysis was used to explore the risk factors for axillary lymph node metastasis in breast cancer. ROC curve was plotted to evaluate the diagnostic value of ultrasound contrast features, NLR, TSR in axillary lymph node metastasis.Results In the axillary lymph node metastasis group, blood flow grade Ⅱ to Ⅲ, peripheral halo, peripheral convergence, post-enhancement range expansion, maximum cortical thickness > 3 cm, peak intensity, NLR, and TSR were higher than those in the non-axillary lymph node metastasis group(P < 0.05), while the time to peak was shorter than in the non-axillary lymph node metastasis group (P < 0.05). Multivariate logistic regression analysis showed that blood flow grade Ⅱ to Ⅲ [O^R = 12.075 (95% CI: 1.730, 84.305)], peripheral halo [O^R = 26.857 (95% CI: 2.805, 257.147)], peripheral convergence [O^R = 18.616 (95% CI: 2.220, 156.131)], post-enhancement range expansion [O^R = 10.496 (95% CI: 1.629, 67.652)], maximum cortical thickness > 3 cm [O^R = 32.729 (95% CI: 3.575, 299.671)], low time to peak [O^R = 0.502 (95% CI: 0.345, 0.731)], high peak intensity [O^R = 2.866 (95% CI: 1.527, 5.379)], NLR [O^R = 20.495 (95% CI: 1.194, 351.666)], and TSR [O^R = 1.255 (95% CI: 1.093, 1.441)] were all risk factors for axillary lymph node metastasis in breast cancer (P < 0.05). The diagnostic sensitivities of CEUS features, NLR, and TSR for axillary lymph node metastasis in breast cancer were 92.0% (95% CI: 0.841, 0.967), 71.3% (95% CI: 0.606, 0.805), and 62.1% (95% CI: 0.510, 0.723), respectively, and the specificities were 97.0% (95% CI: 0.914, 0.994), 71.7% (95% CI: 0.618, 0.803), and 77.8% (95% CI: 0.683, 0.855), respectively, with AUC values of 0.976, 0.754, and 0.731, respectively. When CEUS features, NLR, and TSR were combined, the diagnostic sensitivity and specificity were 93.1% (95% CI: 0.856, 0.974) and 98.0% (95% CI: 0.929, 0.998), respectively, with an AUC value of 0.991.Conclusion The combination of contrast-enhanced ultrasound features with NLR and TSR can effectively improve the diagnostic accuracy of axillary lymph node metastasis in breast cancer. This approach holds significant clinical importance for breast cancer staging and prognosis assessment, demonstrating substantial value in clinical applications.