浙江医学2025，Vol.47Issue(20)：2135-2141,7.DOI:10.12056/j.issn.1006-2785.2025.47.20.2025-625
基于临床与超声特征的列线图模型在乳腺导管原位癌伴微浸润预测中的应用
The application of a nomogram model based on clinical and ultrasound features in predicting ductal carcinoma in situ with micro-invasion of the breast
摘要
Abstract
Objective To analyze the ultrasound features of ductal carcinoma in situ(DCIS)and DCIS with microinvasion(DCIS-Mi),and to evaluate the clinical value of a nomogram model based on clinical and ultrasound characteristics in the preoperative differentiation between DCIS and DCIS-Mi.Methods A retrospective analysis was conducted on data of 203 patients with DCIS and 113 patients with DCIS-Mi who were treated with at Zhejiang Cancer Hospital between July 2019 and March 2023 and at Quzhou People's Hospital between February 2022 and December 2024.Patients were randomly divided into a training set(n=221)and a validation set(n=95)in a 7∶3 ratio.Independent predictors of DCIS-Mi were identified using univariate and multivariate logistic regression,and a clinical prediction model was constructed with a nomogram.The model's diagnostic performance and clinical utility were evaluated using ROC curves,calibration curves,and decision curve analysis(DCA).Results Multivariate logistic regression analysis revealed that intermediate nuclear grade(OR=4.78,P=0.043),high nuclear grade(OR=6.51,OR=0.011),indistinct margins(OR=5.43,P=0.027),angular/spiculated margins(OR=6.00,P=0.012),presence of color doppler flow signals(OR=2.54,P=0.011),and peripheral echo enhancement(OR=4.53,P=0.043)were independent predictors of DCIS-Mi.The nomogram constructed based on the above features demonstrated an AUC,accuracy,sensitivity,and specificity of 0.82,0.75,0.74,and 0.77 in the training set,and 0.77,0.73,0.78,and 0.61 in the validation set,respectively.Calibration curves indicated good agreement between predicted and observed probabilities(all P＞0.05).DCA confirmed clinical net benefits across a wide threshold probability range(training set:0.05-0.83,validation set:0.10-0.82).Conclusion Intermediate/high nuclear grade,indistinct or angular/spiculated margins,color doppler flow signals,and peripheral echo enhancement can effectively differentiate between DCIS and DCIS-Mi.The nomogram-based model can provide reliable imaging evidence for preoperative assessment and help optimize clinical decision-making.关键词
乳腺/导管原位癌/微浸润/超声检查/列线图Key words
Breast/Ductal carcinoma in situ/Microinvasion/Ultrasonography/Nomogram引用本文复制引用
刘丹,欧笛,周金红,周玲燕,闫玉琪,徐栋..基于临床与超声特征的列线图模型在乳腺导管原位癌伴微浸润预测中的应用[J].浙江医学,2025,47(20):2135-2141,7.基金项目
浙江省科学技术厅"尖兵""领雁"研发攻关计划项目(2023C04039) （2023C04039）
