Rationale and Objectives
This study aimed to develop a model incorporating axillary tail position on mammography
(AT) for the prediction of non-sentinel Lymph Node (NSLN) metastasis in patients with
initial clinical node positivity (cN+).
Methods and Materials
The study reviewed a total of 257 patients with cN+ breast cancer who underwent both
sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) following
neoadjuvant chemotherapy (NAC). A logistic regression model was developed based on
these factors and the results of post-NAC AT and axillary ultrasound (AUS).
Results
Four clinical factors with p<0.1 in the univariate analysis, including ycT0(odds ratio
[OR]: 4.84, 95% confidence interval [CI]: 2.13-11.91, p<0.001), clinical stage before NAC (OR: 2.68, 95%CI: 1.15-6.58, p=0.025), estrogen receptor (ER) expression (OR: 3.29, 95%CI: 1.39-8.39, p=0.009), and HER2 status (OR: 0.21, 95%CI: 0.08-0.50, p=0.001), were independent predictors of NSLN metastases. The clinical model based
on the above four factors resulted in the area under the curve (AUC) of 0.82(95%CI:
0.76‐0.88) in the training set and 0.83(95% CI: 0.74‐0.92) in the validation set.
The results of post-NAC AUS and AT were added to the clinical model to construct a
clinical imaging model for the prediction of NSLN metastasis with AUC of 0.87(95%CI:
0.81‐0.93) in the training set and 0.89(95%CI: 0.82‐0.96) in the validation set.
Conclusions
The study incorporated the results of post-NAC AT and AUS with other clinal factors
to develop a model to predict NSLN metastasis in patients with initial cN+ before
surgery. This model performed excellently, allowing physicians to select patients
for whom unnecessary ALND could be avoided after NAC.
Key Word
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Article info
Publication history
Published online: April 30, 2022
Accepted:
March 12,
2022
Received in revised form:
March 1,
2022
Received:
December 23,
2021
Identification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
