ORIGINAL RESEARCH article
Front. Oncol.
Sec. Breast Cancer
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1536984
A preoperative prediction model for ipsilateral axillary lymph nodes metastasis of breast cancer based on clinicopathological and ultrasonography features: a prospective cohort study
Provisionally accepted
- West China Hospital, Sichuan University, Chengdu, China
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Background: For breast cancer, developing non-invasive methods to accurately predict axillary lymph nodes (ALN) status before surgery has become a general trend. This study aimed to develop and evaluate a nomogram to predict the probability of ALN metastasis (ALNM) preoperatively, based on clinicopathological and ultrasonography (US) features. Methods: Patients firstly diagnosed with breast cancer by preoperative histopathologic biopsy in West China Hospital from 1 August 2022 to 31 January 2024 and undergoing surgical treatment with preoperative US in West China Hospital were prospectively included. Preoperative clinicopathological and US features, along with postoperative pathological ALN status were collected. Patients included were randomly divided into a training set and a test set (7:3). In training cohort, independent predictors of ALNM were obtained by univariate and multivariate binary logistic regression analysis, and were used to develop a binary logistic regression model presented as a nomogram. Model performance was evaluated by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Results: 610 patients were included for analysis, 427 in training set and 183 in test set. Molecular subtypes, tumor infiltration of subcutaneous layer, tumor infiltration of retromammary space, lymph nodes (LN) short axis, LN long/short (L/S) axis ratio, LN corticomedullary demarcation, and LN cortical thickness evenness were independent predictors of ALNM. The nomogram showed good discrimination with an area under the ROC curve (AUC) of 0.854 for training set and 0.822 for test set, and presented well agreements between predicted and observed probability, as well as acquired net benefit across a wide threshold range. Conclusions: The nomogram demonstrated strong discrimination, calibration, and clinical net benefit to assist clinical decisions.
Keywords: breast cancer, axillary lymph nodes (ALN), ultrasonography (US), nomogram, Preoperative
Received: 29 Nov 2024; Accepted: 29 May 2025.
Copyright: © 2025 Guo, Ling, Peng, Tan, Xie, Zhao and Lv. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
HaiNa Zhao, West China Hospital, Sichuan University, Chengdu, China
Qing Lv, West China Hospital, Sichuan University, Chengdu, China
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