Enhancing Specificity in Predicting Axillary Lymph Node Metastasis in Breast Cancer through an Interpretable Machine Learning Model with CEM and Ultrasound Integration.

Journal: Technology in cancer research & treatment
PMID: 40241520

Abstract

IntroductionThe study aims to evaluate the performance of an interpretable machine learning model in predicting preoperative axillary lymph node metastasis using primary breast cancer and lymph node features derived from contrast-enhanced mammography (CEM) and ultrasound (US) breast imaging reporting and data systems (BI-RADS).MethodsThis retrospective study included patients diagnosed with primary breast cancer. Two experienced radiologists extracted the BI-RADS features from the largest cross-section of the lesions and axillary lymph nodes based on CEM and US images, creating three datasets. Each dataset will train six base models to predict axillary lymph nodes, with pathological results serving as the gold standard. The top three models were used to train the five ensemble models. Additionally, SHapley Additive exPlanations (SHAP) was used to interpret the optimal model. The receiver-operating characteristic curve (ROC) and AUC were used to evaluate model performance.ResultsThis study involved 292 female patients, of whom 99 had axillary lymph node metastasis and 193 did not. The combination of CEM and ultrasound BI-RADS demonstrated the best performance in predicting axillary lymph node metastasis. Among these, the LightGBM achieved the highest AUC (0.762) and specificity (86.67%, while the ensemble model using RF as the meta-model had an AUC (0.754) and specificity (83.33%. The most important variables identified by SHAP were the long diameters of the lymph nodes in the CEM recombined image, along with their complete morphology in the low-energy image.ConclusionThe machine learning model using CEM and US BI-RADS features accurately predicted axillary lymph node metastasis before surgery, thereby serving as a valuable tool for clinical decision-making in patients with breast cancer.

Authors

  • Weimin Xu
    Institute of Agricultural Products Processing, Jiangsu Academy of Agricultural Sciences, Nanjing, 210014, PR China.
  • Bowen Zheng
    Department of Mechanical Engineering, University of California, Berkeley, CA, 94720, USA.
  • Chanjuan Wen
    Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
  • Hui Zeng
    Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China.
  • Sina Wang
    Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
  • Zilong He
    Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
  • Xin Liao
    Department of Medical Imaging, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.
  • Weiguo Chen
    Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. Electronic address: chenweiguo1964@21cn.com.
  • Yingjia Li
    Department of Ultrasound, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Baiyun District, Guangzhou, Guangdong Province, P. R. China. lyjia@smu.edu.cn.
  • Genggeng Qin
    Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.

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