Abstract
Purpose: Lymph node metastasis is a multifactorial event. Several scholars have developed nomograph models to predict the sentinel lymph nodes (SLN) metastasis before operation. According to the clinical and pathological characteristics of breast cancer patients, we use the new method to establish a more comprehensive model and add some new factors which have never been analyzed in the world and explored the prospect of its clinical application.Materials and methods: The clinicopathological data of 633 patients with breast cancer who underwent SLN examination from January 2011 to December 2014 were retrospectively analyzed. Because of the imbalance in data, we used smote algorithm to oversample the data to increase the balanced amount of data. Our study for the first time included the shape of the tumor and breast gland content. The location of the tumor was analyzed by the vector combining quadrant method, at the same time we use the method of simply using quadrant or vector for comparing. We also compared the predictive ability of building models through logistic regression and Bagged-Tree algorithm. The Bagged-Tree algorithm was used to categorize samples. The SMOTE-Bagged Tree algorithm and 5-fold cross-validation was used to established the prediction model. The clinical application value of the model in early breast cancer patients was evaluated by confusion matrix and the area under receiver operating characteristic (ROC) curve (AUC).Results: Our predictive model included 12 variables as follows: age, body mass index (BMI), quadrant, clock direction, the distance of tumor from the nipple, morphology of tumor molybdenum target, glandular content, tumor size, ER, PR, HER2, and Ki-67.Finally, our model obtained the AUC value of 0.801 and the accuracy of 70.3%.We used logistic regression to established the model, in the modeling and validation groups, the area under the curve (AUC) were 0.660 and 0.580.We used the vector combining quadrant method to analyze the original location of the tumor, which is more precise than simply using vector or quadrant (AUC 0.801 vs. 0.791 vs. 0.701, Accuracy 70.3 vs. 70.3 vs. 63.6%).Conclusions: Our model is more reliable and stable to assist doctors predict the SLN metastasis in breast cancer patients before operation.
Highlights
The incidence of breast cancer is the first in female malignant tumors, in which the highest incidence of breast cancer has been reported in Europe and the United States, in recent years, the incidence of breast cancer in China has annually increased [1, 2]
The patients with early-stage breast cancer who met the following criteria were selected for treatment with sentinel lymph node biopsy (SLNB): [1] diagnosis of breast cancer; [2] without receiving neoadjuvant chemotherapy; [3] the result for preoperative axillary lymph node to be negative, according to clinical and imaging examinations; [4] Primary diameter of tumor ranges at 0–5 cm; [5] Complete clinicopathological information; and [6] without pregnancy
633 cases of raw data were sampled by Synthetic minority oversampling (SMOTE), in which 169 new data were generated according to the characteristics of the original data
Summary
The incidence of breast cancer is the first in female malignant tumors, in which the highest incidence of breast cancer has been reported in Europe and the United States, in recent years, the incidence of breast cancer in China has annually increased [1, 2]. Based on surgery as an important step in the treatment of breast cancer, in recent years, different individuals have never stopped exploration of a novel and optimum approach. NSABP-04, ASCOG-Z0011, and other tests have shown that for breast cancer patients with T1-T2 stage and clinical negative lymph node (cN0) during breast preservation surgery and total breast radiotherapy, axillary lymph node dissection (ALND) does not contain great benefits to the long-term survival of patients. Sentinel lymph node biopsy (SLNB) has been gradually replaced with conventional ALND as a routine surgical method for early breast cancer patients [3,4,5,6,7]. SLNB has a high degree of professional requirement for physicians, and the richness of physician’s experience directly affects the evaluation of the pathological status of sentinel lymph nodes (SLN)
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