Abstract:

Objective To analyze the breast cancer-related parameters and the ultrasonic features of positive axillary lymph nodes， to discuss the risk factors for axillary lymphnode metastatic burden， and to provide basis for preoperative evaluation of breast cancer patients. Methods The ultrasonic and clinicopathological data of 574 breast cancer patients with axillary lymph node metastasis confirmed by surgery and pathology were retrospectively analyzed. According to the status of axillary lymphnode metastasis， the patients were divided into low nodal burden （LNB） group （n=283） and high nodal burden （HNB） group （n=291）. The affected side， tumor quadrant， distance to skin， maximum diameter， internal echogenicity， shape， margin， calcification， blood supply， posterior echo， lymphnode long diameter， lymphnode short diameter， lymphnode aspect ratio， number of suspicious metastases， intranodal blood supply， lymphnode hilum morphology， age， pathological type， histological grade， molecular subtype， and the expressions of estrogen receptor （ER）， progesterone receptor （PR）， Ki-67， human epidermal growth factor receptor 2 （HER2）， and P53 were compared between two groups. Logistic regression was used to analyze the risk factors for axillary lymph node metastatic burden in the breast cancer patients； receiver operating characteristic （ROC） curve and area under the curve （AUC） were used to evaluate the predictive value. Results The univariate analysis results showed that there were statistically significant differences in tumor quadrant， distance to skin， molecular subtype， HER2 positive expression， lymphnode long diameter， lymph node short diameter， lymph node aspect ratio， number of suspicious metastases， and lymphnode hilum morphology between two groups （P<0.05）. The multivariate Logistic regression analysis results showed that tumor located in the upper outer quadrant （OR=0.648， P=0.021）， distance to skin <5 mm （OR=0.283， P=0.016）， Luminal A （OR=1.564， P=0.044）， lymphnode long diameter ≥20 mm （OR=2.050， P<0.01）， lymphnode short diameter ≥8.6 mm （OR=2.430， P<0.01）， lymph node aspect ratio <2 （OR=1.585， P<0.01）， and indistinct lymphnode hilum structure （OR=2.092， P<0.01） were the independent risk factors for axillary lymphnode metastatic burden. The ROC curve analysis results showed that compared with the ultrasonic features of positive axillary lymph nodes， the AUC of the combination of breast cancer-related parameters and ultrasonic features of positive axillary lymphnodes was larger （Z=2.72， P=0.006 5）， and it had higher predictive value for axillary lymphnode metastatic burden. Conclusion The tumor quadrant， distance to skin， molecular subtype， lymphnode long diameter， lymph node short diameter， lymphnode aspect ratio， and lymphnode hilum structure are the independent risk factors for axillary lymphnode metastatic burden， and they have certain predictive value for axillary lymphnode metastatic burden.

Key words: Breast neoplasms, Lymphnodes, Lymphnode metastatic burden, Ultrasonic features, Clinicopathology