ABSTRACT
Objective:
To investigate whether ultrasound features, mammographic features and immunohistochemical
indicators show any
association with rates of axillary
pathologic complete response(
pCR) in cN 1
breast cancer patients receiving
neoadjuvant chemotherapy(NAC), and to construct prediction models of axillary
pCR to predict axillary
lymph nodes (ALN) status, so as to select suitable
patients for less invasive axillary
surgery after NAC.
Methods:
This
retrospective study evaluated 134 consecutive cN 1
breast cancer patients with ALN
metastasis who underwent NAC in the Second Affiliated
Hospital and
Tumor Hospital of Harbin Medical
University from July 2020 to July 2022. According to the pathological results of ALN
surgery after NAC, the cases were divided into
pCR and non pathologic complete respose(
npCR) groups. The ultrasound images, mammographic images and immunohistochemical
indicators of the two groups were compared. In terms of
logistic regression algorithm, the model A(the ultrasound model), the model B(the ultrasound combined with
mammography model), the model C(the ultrasound combined with
immunohistochemistry model) and the model D(the ultrasound combined with
mammography and
immunohistochemistry model) were respectively established for predicting the pathological
state of axillary
lymph nodes in
breast cancer patients,
ROC curves were plotted to evaluate the performance of the models, and the diagnostic
efficiency of different models was compared by Delong′s test. The model with the best predictive performance was shown in a
nomogram.
Results:
①The P values between two groups of the short diameter of ALN, the ratio of long/short diameter of ALN, fatty hilum and central hilar vascularity, mammographic spiculation,
estrogen receptor(ER),
progesterone receptor(PR),
human epidermal growth factor receptor 2(HER2) were <0.05 by the t test and χ 2 test
analysis. ②The ratio of long/short diameter and fatty hilum in the model A were independent factors for predicting the pathological status of ALN after NAC. The independent predictors of model B and Model C were respectively added with mammographic spiculation and immunohistochemical
indicators (ER, PR) on the basis of model A. In the model D, the ratio of long/short diameter, short diameter, fatty hilum, mammographic spiculation, and immunohistochemical
indicators (ER, PR) remained significant independent predictors associated with axillary
pCR. ③The area under
ROC curve (
AUC) of the model A, B, C, D was 0.78, 0.84, 0.84 and 0.89, respectively. The
sensitivity was 0.71, 0.80, 0.78 and 0.86, the
specificity was 0.76, 0.74, 0.76 and 0.80, and the accuracy was 0.73, 0.76, 0.77 and 0.83, respectively. ④Delong′s test showed the model D had an improved
AUC of 0.89(0.89 vs 0.78, 0.84, 0.84, all P<0.05).
Conclusions:
The prediction models combining bi-modal imaging and immunohistochemical
indicators show good prediction
ability and can provide reference for selecting suitable
patients for less invasive axillary
surgery after NAC.