Contrast-Enhanced Ultrasound-Based Radiomics for the Prediction of Axillary Lymph Nodes Status in Breast Cancer

Background: Breast cancer is the leading cause of cancer-related deaths in the female population. Axillary lymph nodes (ALN) are a group of the most common metastatic sites of breast cancer. Timely assessment of ALN status is of paramount clinical importance for medical decision making. Aims: To utilize contrast-enhanced ultrasound (CEUS)-based radiomics models for noninvasive pretreatment prediction of ALN status. Methods and Results: Clinical data and pretreatment CEUS images of primary breast tumors were retrospectively studied to build radiomics signatures for pretreatment prediction of nodal status between May 2015 and July 2021. The cases were divided into the training cohorts and test cohorts in a 9:1 ratio. The mRMR approach and stepwise forward logistic regression technique were used for feature selection, followed by the multivariate logistic regression technique for building radiomics signatures in the training cohort. The confusion matrix and receiver operating characteristic (ROC) analysis were used for accessing the prediction efficacy of the radiomics models. The radiomics models, which consist of six features, achieved predictive accuracy with the area under the ROC curve (AUC) of 0.713 in the test set for predicting lymph node metastasis. Conclusion: The CEUS-based radiomics is promising to be developed as a reliable noninvasive tool for predicting ALN status.