血清AREG联合多模态超声预测cN0期浸润性乳腺癌SLN转移的临床价值OA

Objective To explore the predictive value of multimodal ultrasound combined with serum Amphiregulin(AREG)for sentinel lymph node(SLN)metastasis in patients with clinically negative axillary lymph node(cN0)invasive breast cancer(IBC).Methods A total of 218 IBC patients admitted to Xuzhou Central Hospital from July 2023 to January 2025 with preoperative clinical assessment of cNO were randomly divided into a training set(153 cases)and validation set(65 cases)in a 7∶3 ratio.Based on postoperative pathology,patients were classified into SLN-positive and SLN-negative groups.Multimodal ultrasound features and serum AREG levels were compared between the two groups.The predictive value of multimodal ultrasound alone and combined with serum AREG for SLN metastasis was analyzed and validated.Results Age,menstrual status,tumor size,differentiation degree,molecular subtype,Ki-67 index,TNM stage and family history of breast cancer were comparable between the training set and the validation set(P＞0.05).There were statistically significant differences in lymph hilum echogenicity,penetrating vessels,maximum elastic modulus(Emax),mean elastic modulus(Esd),peak intensity and peak time between the SLN positive group and the SLN negative group in the training set and validation set(P＜0.05).Serum AREG levels were significantly higher in the SLN-positive group compared to the SLN-negative group in both datasets(P＜0.05).Multivariate Logistic regression analysis showed that lymphatic echo(abnormal vs normal:OR=3.758,95％CI:1.523～9.277),perforator vessels(with vs without:OR=3.019,95％CI:1.323～6.891),Emax(every 1 kPa increase:OR=1.046,95％CI:1.024～1.069),peak intensity(every 1 dB increase:OR=1.037,95％CI:1.011～1.063),serum AREG(every 1 ng/mL increase:OR=1.005,95％CI:1.001～1.009)were independent influencing factors of SLN metastasis in IBC patients(P＜0.05).The Logit(P)predictive model based on multivariate logistic regression achieved areas under the curve(AUC)of 0.890(95％CI:0.848～0.954)in the training set and 0.879(95％CI:0.816～0.926)in the validation set.Calibration analysis demonstrated good model fit with no significant difference between predicted and observed probabilities.Decision curve analysis showed positive net clinical benefit within the threshold probability range of 10％～80％in both datasets.Conclusion Multimodal ultrasound combined with serum AREG has high predictive value for SLN metastasis in cN0-stage IBC patients,enabling more accurate preoperative prediction of SLN metastasis status and providing evidence to guide surgical decision-making.