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Abstract：
Objective This study aimed to examine the axillary pathological condition through the development of an assessment framework for hormone receptor-positive breast cancer subsequent to neoadjuvant chemotherapy (NAC). Furthermore, the primary objective of this study was to examine the association between axillary status and breast tumors that are positive for hormone receptors following neoadjuvant chemotherapy. Methodology The present retrospective investigation encompassed a cohort including 300 individuals who were administered neoadjuvant chemotherapy before receiving surgical intervention. The data collection period for this study was from September 2021 to December 2022. All patients received neoadjuvant chemotherapy, per the guidelines established by the National Comprehensive Cancer Network (NCCN). We divided patients into two distinct groups: a test set of 250 patients and a validity set of 50 patients. Patients with no evidence of lymphoid involvement underwent a biopsy of sentinel lymph nodes (SLNB) and would have undergone axillary dissection if the biopsy results had indicated positive findings. A logistic regression analysis was employed to investigate the variables linked to the presence of residual positive axillary lymph nodes in the test set. Subsequently, a multivariate analysis was conducted on the variables that exhibited a p-value below 0.2 in the univariate study. In addition, a value of 1 was assigned to all risk factors to construct a comprehensive correlation prediction model. Results The participants included in this study had a mean age and body mass index (BMI) of 46.24 ± 9.1 years and 25.8 ± 2.5 kg, respectively. The present investigation examined the presence of pathological axillary metastases in a cohort of 188 patients, which accounted for 62.55% of the total sample, by utilizing core-needle biopsy. Furthermore, the incidence rates of individuals presenting with clinical T1 were reported as 14.6%, while 55.2% cases of T2, 17.8% cases of T3, and 13% cases of T4 tumors were reported, respectively. Of the overall occurrences, the prevailing histological subtype was invasive ductal carcinoma, accounting for 91.4% (222 out of 243) of the cases. Multiple criteria were identified as independent predictors of the presence of residual positive axillary lymph nodes. The factors under consideration encompass lymphovascular invasion (odds ratio= 7.108; 95% breast cancer stage (odd ratio = 5.025; 95%, HER2 negativity (odd ratio= 2.997), low Ki-67 expression (odd ratio = 4.231), and suspected positive axillary lymph nodes before surgical intervention. Conclusion The present study presents a novel prediction model that integrates imaging and pathology data, aiming to assist patients and healthcare practitioners in evaluating the efficacy of NAC for hormone-receptor-positive breast tumors. The model holds particular significance for individuals who exhibit clinical positivity in their lymph nodes (LNs). Consequently, the model has the potential to provide guidance for the management of axillary lymph nodes and prevent unnecessary dissection.
摘要：
目的通过建立新辅助化疗（NAC）后激素受体阳性乳腺癌的评估框架，探讨腋窝病理状况。此外，本研究的主要目的是研究腋窝状态与新辅助化疗后激素受体阳性的乳腺肿瘤之间的关系.方法本回顾性调查包括一个队列，包括300名接受手术干预前接受新辅助化疗的个体。本研究的数据收集期为2021年9月至2022年12月。所有患者均接受新辅助化疗,根据国家综合癌症网络（NCCN）制定的指南。我们将患者分为两个不同的组：250名患者的测试集和50名患者的有效性集。没有淋巴受累证据的患者接受了前哨淋巴结（SLNB）活检，如果活检结果提示阳性，则将进行腋窝清扫。采用逻辑回归分析来研究与测试集中残留阳性腋窝淋巴结的存在相关的变量。随后，在单变量研究中,对p值低于0.2的变量进行多变量分析.此外,所有危险因素的值均为1,以构建综合相关预测模型.结果纳入研究的参与者的平均年龄和体重指数（BMI）为46.24±9.1岁和25.8±2.5kg，分别。本研究检查了188例患者中病理性腋窝转移的存在，占总样本的62.55%，利用芯针活检。此外，临床T1患者的发病率为14.6%，其中T2占55.2%,T3占17.8%,T4占13%,分别。在总体事件中，占优势的组织学亚型是浸润性导管癌,占91.4%(243例中的222例)。多个标准被确定为存在残留阳性腋窝淋巴结的独立预测因子。考虑的因素包括淋巴管浸润（比值比=7.108;95％乳腺癌分期（奇数比=5.025;95％，HER2阴性（奇数比=2.997），低Ki-67表达（奇数比=4.231），手术前怀疑腋窝淋巴结阳性。结论本研究提出了一种新颖的预测模型，该模型集成了影像学和病理学数据，旨在协助患者和保健医生评估NAC对激素受体阳性乳腺肿瘤的疗效。该模型对于在其淋巴结(LN)中表现出临床阳性的个体具有特别的意义。因此,该模型有可能为腋窝淋巴结的管理提供指导，并防止不必要的清扫。
