Characteristics of regional lymph node metastasis in breast cancer and construction of a nomogram model based on ultrasonographic Analysis: A Retrospective Study

Abstract

Objective: The ultrasonographic characteristics of lymph node metastasis in breast cancer patients were retrospectively analyzed and a predicted nomogram model was conducted, aiming to provide an imaging basis for better clinical evaluation of lymph node metastasis in breast cancer patients. Methods:B-mode ultrasound was used to retrospectively analyze the imaging characteristics of regional lymph nodes and tumor. Pathological examination of lymph node metastasis was confirmed in breast cancer patients. Univariable and multivariable logistic regression analyses were performed to analyze the risk factors of lymph node metastasis. LASSO regression analysis was further carried out to screen non-invasive indicators and a nomogram prediction model was conducted for breast cancer patients with lymph node metastasis. Results: A total of 187 breast cancer patients were included in this study. Of them, 74 patients with lymph node metastasis were assigned to the Positive group, and 113 non-metastases were assigned to the Negative group. Multivariate analysis indicated that pathological type (OR=4.58, 95%CI: 1.44-14.6, p=0.01), tumor diameter (OR=1.37, 95%CI: 1.07-1.74, p=0.012), spiculated margins (OR=7.92, 95%CI:3.03-20.67, p<0.001), mixture echo of the breast tumor (OR=37.09, 95%CI:3.49-394.1, p=0.003) and unclear lymphatic hilum structure (OR=16.07, 95%CI:2.41-107.02, p=0.004) were independent risk factors for lymph node metastasis. A nomogram model was constructed for predicting breast cancer with lymph node metastasis, incorporating three significantly correlated indicators identified through LASSO regression analysis: tumor spiculated margins, cortical thickness of lymph nodes, and unclear lymphatic hilum structure. The receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) for the training set was 0.717 (95% CI, 0.614-0.820) and the validation set was 0.817 (95% CI, 0.738-0.890). The Hosmer Lemeshow test for the training-set and the validation- set was p=0.9148 and p=0.1648, separately. The predicted nomogram has a good diagnostic performance. Conclusions:B-mode ultrasound is helpful in preoperative assessment of breast cancer with lymph node metastasis. Our predicted nomogram model based on logistic regression and LASSO regression analysisis clinical predictive safe, reliable, and highly practical.