| Background The treatment of breast cancer is based on surgery.The earliest and most common metastatic site of breast cancer is the axillary lymph node system.The axillary lymph node status of breast cancer is an independent factor that predicts and affects the postoperative prognosis and treatment of patients.When breast cancer is accompanied by axillary lymph node metastasis,the main surgical methods used are breast cancer radical surgery,modified radical surgery,modified nipple-preserving radical mastectomy and breast-conserving surgery.Conventional axillary lymph node dissection is indispensable;for no axillary lymph nodes In patients with metastatic breast cancer,in addition to the above surgical methods,axillary lymph node dissection is not necessary.Axillary lymph node dissection often brings a series of postoperative complications,such as shoulder pain,movement disorders,edema,numbness,and axillary net syndrome,which seriously affects the quality of life of patients after surgery.Triple negative breast cancer(Triple Negative Breast Cancer,TNBC)refers to a special type of negative expression of estrogen receptor(ER),progesterone receptor(PR)and human epidermal growth factor receptor2(HER-2)Breast cancer.Studies have reported that triple-negative breast cancer often shows signs similar to benign masses on ultrasound images,but because of its higher tumor aggressiveness,it is more prone to axillary lymph node metastasis.Compared with NTNBC(non-three-negative breast cancer),TNBC is more like ultrasound images of benign tumors(maximum diameter ?20mm,morphological rules and clear boundaries,prone to axillary lymph node metastasis,higher tissue aggressiveness and The prognosis is poor.Ultrasound is the preferred imaging method for breast and axillary examination.For breast masses,the diagnostic efficiency of ultrasound examination is recognized.Although ultrasound can detect enlarged axillary lymph nodes,due to the dense anatomy of axillary fat and fascia Structure,the detection of metastatic lymph nodes still has great challenges.Some scholars have reported that the accuracy of ultrasound detection of breast cancer axillary lymph node metastasis is about 64% to67.9%.In order to be able to predict early whether triple negative breast cancer is accompanied by axillary Lymph node metastasis,reduce unnecessary axillary lymph node dissection,provide clinical imaging for patients with early axillary lymph node metastasis and evaluate the status of patients with axillary lymph nodes before surgery.This study aims to determine the triple negative breast cancer Ultrasound signs,pathological types and histological grades to predict the presence or absence of axillary lymph Transfer.Objective To explore the relationship between the ultrasonographic features,pathological types and histological grades of triple negative breast cancer and lymph node metastasisMethods Collected the medical records of 1190 inpatients with breast cancer in the Thyroid and Breast Surgery Department of the First Affiliated Hospital of Chongqing Medical University 18 patients underwent ultrasound examination,22 patients were dissatisfied with the image,10 patients were unable to obtain specific values due to the huge mass.50 patients were not included in this study,and the remaining 53 patients with TNBC had complete clinical pathology and ultrasound examination data.The patients were all women,aged 33 to 71 years old,with an average age of(51.17±9.271)years old,and the largest diameter of the mass was 6mm to39 mm,with an average of(22.96 ± 7.493)mm.According to the pathological results of postoperative patients with or without axillary lymph node metastasis,they were divided into a metastatic group(36 cases,67.9%)and a non-metastatic group(17 cases,32.1%).The ultrasound features,pathological types,and histological grades of the primary lesions were compared and analyzed.The relationship between pathological types?histological grades and axillary lymph node metastasis,and the risk factors affecting axillary lymph node metastasis in patients with TNBC were screened out.Retrospective analysis of 53 cases of triple-negative breast cancer primary ultrasound features,including the location of the primary focus(outer upper quadrant and other quadrants),size(maximum diameter?20mm and maximum diameter> 20mm),shape(regular and irregular),length/width ration(> 1 and <1),spiculated margin(with or without),echo pattern(hypoechoic and isoechoic),posterior acoustic features(shadowing,enhancement and no posterior acoustic features),whether there are high echo halo around,calcification(with or without)and blood flow classification(grade 0 ~ 1,grade 2 ~ 3).The pathological types include:non-special types of invasive breast cancer,invasive lobular carcinoma,carcinoma with medullary features,metaplastic carcinoma.Histological grades include: I,?,?.Statistical methods used The statistical method uses SPSS21.0 software to analyze the data.The count data is expressed as frequency(rate),and the measurement data is expressed as average((?)±s).When more than 20% of the cells in the R × C table are less than 5 Fisher's exact probability method was used.In other cases,the R × C table was tested by chi-square test to calculate the P value.P <0.05 was considered statistically significant.Multi-factor Logistic regression analysis was used to analyze the risk factors of axillary lymph node metastasis.Results The relationship between the primary ultrasonographic features of TNBC and axillary lymph node metastasis1.Quadrant: Of the 53 patients with triple-negative breast cancer,32 were in the outer upper quadrant(60.4%),including 26 with axillary lymph node metastasis(81.2%)and 6 without metastasis(18.8%);21 were in the remaining quadrant(39.6%),including axillary There were 10 patients with lymph(47.6%)node metastasis and 11 patients without metastasis(52.4%);the P value was 0.010 <0.05,which was statistically significant.2.Size: Among 53 cases of triple negative breast cancer,20 cases(37.7%)had a maximum primary diameter ?20 mm,including 17 cases with axillary lymph node metastasis(85.0%)and 3 cases without metastasis(15.0%);33 cases(62.3%)had a maximum diameter> 20 mm,Among them,19 patients with axillary lymph node metastasis(57.6%)and14 patients without metastasis(42.4%);the P value was 0.038 <0.05,which was statistically significant.3.Shape: Of the 53 patients with triple-negative breast cancer,32 had regular primary shape(60.4%),including 17 with axillary lymph node metastasis(53.1%)and 15 without metastasis(46.9%);21 with irregular shape(39.6%),including 19 with axillary lymph node metastasis(90.5%)and 2 cases without metastasis(9.5%);the P value was 0.004 <0.05,which was statistically significant.4.Length/width ratio: Of 53 patients with triple-negative breast cancer,11(20.8%)had a primary length/width ratio of> 1,including 9 with lymph node metastasis(81.8%)and 2 without metastasis(18.2%);42(79.2%)had an length/width ratio of ?1,of which There were 27 cases of axillary lymph node metastasis(64.3%)and 15 cases without metastasis(35.7%);the P value was 0.469> 0.05,which was not statistically significant.Although the Length/width ratio of the lesion has no statistical significance with axillary lymph node metastasis,the rate of axillary lymph node metastasis manifested by ultrasound as benign lesions is higher.5.Spiculatd margin: Of 53 patients with triple-negative breast cancer,22 had spiculatd margin(41.5%),including 12 with axillary lymph node metastases(54.5%)and 10 without metastases(45.5%);31 had no spiculatd margin(58.5%)with axillary lymph node metastases 24 cases(77.4%)and7 cases without metastasis(22.6%);the P value was 0.079> 0.05,there was no statistical significance.Although the primary spiculatd margin and axillary lymph node metastasis were not statistically significant,the marginal burr-free axillary lymph node metastasis rate was higher than that of burr.6.Echo pattern: Of the 53 patients with triple negative breast cancer,50(94.3%)had hypoechoic pattern,of which 34 had metastatic axillary lymph node metastases(68.0%)and 16 had no metastases(32.0%).Echo pattern was isoechoic in 3 cases,accounting for 5.7%,there were 2 cases with axillary lymph node metastasis(66.7%)and 1 case without metastasis(33.3%);the P value of the two was 1.000> 0.05,which was not statistically significant.Although the echo pattern and axillary lymph node metastasis are not statistically significant,the axillary lymph node rate of the primary hypoechoic pattern is higher than those of isoechoic.7.Posterior acoustic features: Of the 53 patients with triple-negative breast cancer,15 patients(28.3%)had no change in the posterior echo features of the primary focus,including 10 patients with axillary lymph node metastasis(66.7%)and 5 patients without metastasis(33.3%);16patients(30.2%)had posterior echo features attenuated,there were 9 cases of lymph node metastasis(56.3%),7 cases without metastasis(43.7%);22cases(41.5%)with posterior echo enhancement,17 cases with axillary lymph node metastasis(77.3%),and 5 cases without metastasis(22.7%);the comparison of the three values was 0.388> 0.05,which was not statistically significant.Although the characteristics of the posterior acoustic features of the lesion are not statistically significant with the axillary lymph node metastasis,the rate of enhanced posterior echo axillary lymph node metastasis is higher than that of the posterior echo without change and attenuation.8.Hyperechoic halo: Of the 53 patients with triple-negative breast cancer,6 cases(11.3%)had hyperechoic halo around the primary lesion, including 2 cases with axillary lymph node metastasis(33.3%)and 4 cases without metastasis(66.7%);47 cases(88.7%)without hyperechoic halo around.There were 34 cases of axillary lymph node metastasis(72.3%)and13 cases without metastasis(27.7%);the P value of the two was 0.076>0.05,which was not statistically significant.Although there is no statistical significance between hyperechoic halo and axillary lymph node metastasis around the lesion,the rate of axillary lymph node metastasis without hyperechoic halo is higher than that with hyperechoic halo.9.Calcification: Of the 53 patients with triple-negative breast cancer,19 had primary calcification(35.8%),including 11 with axillary lymph node metastasis(57.9%)and 8 without metastasis(42.1%);34 had no calcification(64.2%),including 25 with axillary lymph node metastasis(73.5%)and 9 cases without metastasis(26.5%);the P value was0.242> 0.05,there was no statistical significance.But the rate of lymph node metastasis without calcification was higher than those with calcification.10.Blood flow grade: Among 53 patients with triple-negative breast cancer,22 cases(41.5%)had primary blood flow grade 0 ~ 1,including 11 cases with axillary lymph node metastasis(50.0%)and 11 cases without metastasis(50.0%);31 cases(58.5%)with grade 2 ~ 3.There were 25 cases with axillary lymph node metastasis(80.6%)and 6 cases without metastasis(19.4%);the P value was 0.019 <0.05,which was statistically significant.The relationship between pathological types of TNBC and metastasis of axillary lymph nodes Non-special type of invasive breast cancer: 53 patients with TNBC,the primary pathological type was 43 cases(81.2%)of non-special type of invasive breast cancer,including 30 cases with axillary lymph node metastasis(69.8%)and 13 cases without metastasis(30.2%);infiltration Lobular carcinoma in 4 cases(7.5%),including 2 cases with axillary lymph node metastasis(50.0%)and 2 cases without metastasis(50.0%);4 cases(7.5%)with medullary features cancer,including 3 cases with axillary lymph node metastasis(75.0%)and 1 case without metastasis(25.0%);There were 2 cases(3.8%)of neoplastic carcinoma,1 case with axillary lymph node metastasis(50.0%),and 1 case without metastasis(50.0%);the P value of the four was 0.732> 0.05,which was not statistically significant.The relationship between histological grades of TNBC and metastasis of axillary lymph nodes Of the 53 patients with TNBC,the histological grade of primary lesions was grade I in 8 cases(15.1%),including 6 cases with axillary lymph node metastasis(75.0%)and 2 cases without metastasis(25.0%);grade ? in 24 cases(45.3%)including axillary lymph node There were 15 cases with metastasis(62.5%),9 cases without metastasis(37.5%);21 cases(39.6%)of grade ?,including 15 cases with axillary lymph node metastasis(71.4%)and 6 cases without metastasis(28.6%);the comparison of the three values was 0.791> 0.05,which was not statistically significant.Risk factors affecting axillary lymph node metastasis After logistic regression analysis,the Quadrant,size,shape,Adler blood flow grade P value and OR value of TNBC were calculated: 0.013 &0.210;0.047 & 4.175;0.010 & 0.119;0.022 & 0.240 The risk factors for axillary lymph node metastasis include the location,size,shape and Adler blood flow grade of the primary lesion.Conclusion Ultrasound features of TNBC have a certain relationship with axillary lymph node metastasis,including quadrant,size,shape,Adler blood flow.Whether breast cancer patients with axillary lymph node metastasis provides a certain imaging basis.Although TNBC often shows ultrasound features of benign lesions,the benign lymph node metastasis rate is higher than the malignant sign axillary lymph node metastasis rate,indicating that triple-negative breast cancer may have axillary lymph node metastasis in the early stage,which is a clinical predict whether TNBC is associated with axillary lymph node metastasis provides a certain imaging basis,reduce unnecessary axillary lymph node dissection,and improve the quality of life of patients after surgery. |
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