Artificial neural network models to predict nodal status in clinically node-negative breast cancer
(2019) In BMC Cancer 19(1).- Abstract
Background: Sentinel lymph node biopsy (SLNB) is standard staging procedure for nodal status in breast cancer, but lacks therapeutic benefit for patients with benign sentinel nodes. For patients with positive sentinel nodes, individualized surgical strategies are applied depending on the extent of nodal involvement. Preoperative prediction of nodal status is thus important for individualizing axillary surgery avoiding unnecessary surgery. We aimed to predict nodal status in clinically node-negative breast cancer and identify candidates for SLNB omission by including patient-related and pathological characteristics into artificial neural network (ANN) models. Methods: Patients with primary breast cancer were consecutively included... (More)
Background: Sentinel lymph node biopsy (SLNB) is standard staging procedure for nodal status in breast cancer, but lacks therapeutic benefit for patients with benign sentinel nodes. For patients with positive sentinel nodes, individualized surgical strategies are applied depending on the extent of nodal involvement. Preoperative prediction of nodal status is thus important for individualizing axillary surgery avoiding unnecessary surgery. We aimed to predict nodal status in clinically node-negative breast cancer and identify candidates for SLNB omission by including patient-related and pathological characteristics into artificial neural network (ANN) models. Methods: Patients with primary breast cancer were consecutively included between January 1, 2009 and December 31, 2012 in a prospectively maintained pathology database. Clinical- and radiological data were extracted from patient's files and only clinically node-negative patients constituted the final study cohort. ANN-based models for nodal prediction were constructed including 15 risk variables for nodal status. Area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow goodness-of-fit test (HL) were used to assess performance and calibration of three predictive ANN-based models for no lymph node metastasis (N0), metastases in 1-3 lymph nodes (N1) and metastases in ≥ 4 lymph nodes (N2). Linear regression models for nodal prediction were calculated for comparison. Results: Eight hundred patients (N0, n = 514; N1, n = 232; N2, n = 54) were included. Internally validated AUCs for N0 versus N+ was 0.740 (95% CI = 0.723-0.758); median HL was 9.869 (P = 0.274), for N1 versus N0, 0.705 (95% CI = 0.686-0.724; median HL: 7.421; P = 0.492) and for N2 versus N0 and N1, 0.747 (95% CI = 0.728-0.765; median HL: 9.220; P = 0.324). Tumor size and vascular invasion were top-ranked predictors of all three end-points, followed by estrogen receptor status and lobular cancer for prediction of N2. For each end-point, ANN models showed better discriminatory performance than multivariable logistic regression models. Accepting a false negative rate (FNR) of 10% for predicting N0 by the ANN model, SLNB could have been abstained in 27.25% of patients with clinically node-negative axilla. Conclusions: In this retrospective study, ANN showed promising result as decision-supporting tools for estimating nodal disease. If prospectively validated, patients least likely to have nodal metastasis could be spared SLNB using predictive models. Trial registration: Registered in the ISRCTN registry with study ID ISRCTN14341750. Date of registration 23/11/2018. Retrospectively registered.
(Less)
- author
- Dihge, Looket LU ; Ohlsson, Mattias LU ; Edén, Patrik LU ; Bendahl, Pär Ola LU and Rydén, Lisa LU
- organization
-
- Breast Cancer Surgery (research group)
- BioCARE: Biomarkers in Cancer Medicine improving Health Care, Education and Innovation
- eSSENCE: The e-Science Collaboration
- Artificial Intelligence in CardioThoracic Sciences (AICTS) (research group)
- Computational Biology and Biological Physics - Has been reorganised
- The Liquid Biopsy and Tumor Progression in Breast Cancer (research group)
- publishing date
- 2019-06-21
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Artificial neural networks, Breast cancer, Nodal status, Prediction models, Sentinel lymph node biopsy
- in
- BMC Cancer
- volume
- 19
- issue
- 1
- article number
- 610
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:31226956
- scopus:85068524021
- ISSN
- 1471-2407
- DOI
- 10.1186/s12885-019-5827-6
- language
- English
- LU publication?
- yes
- id
- 4b3622ff-e993-4913-9c58-9f7d0952028f
- date added to LUP
- 2019-07-17 08:55:45
- date last changed
- 2024-08-08 03:10:58
@article{4b3622ff-e993-4913-9c58-9f7d0952028f, abstract = {{<p>Background: Sentinel lymph node biopsy (SLNB) is standard staging procedure for nodal status in breast cancer, but lacks therapeutic benefit for patients with benign sentinel nodes. For patients with positive sentinel nodes, individualized surgical strategies are applied depending on the extent of nodal involvement. Preoperative prediction of nodal status is thus important for individualizing axillary surgery avoiding unnecessary surgery. We aimed to predict nodal status in clinically node-negative breast cancer and identify candidates for SLNB omission by including patient-related and pathological characteristics into artificial neural network (ANN) models. Methods: Patients with primary breast cancer were consecutively included between January 1, 2009 and December 31, 2012 in a prospectively maintained pathology database. Clinical- and radiological data were extracted from patient's files and only clinically node-negative patients constituted the final study cohort. ANN-based models for nodal prediction were constructed including 15 risk variables for nodal status. Area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow goodness-of-fit test (HL) were used to assess performance and calibration of three predictive ANN-based models for no lymph node metastasis (N0), metastases in 1-3 lymph nodes (N1) and metastases in ≥ 4 lymph nodes (N2). Linear regression models for nodal prediction were calculated for comparison. Results: Eight hundred patients (N0, n = 514; N1, n = 232; N2, n = 54) were included. Internally validated AUCs for N0 versus N+ was 0.740 (95% CI = 0.723-0.758); median HL was 9.869 (P = 0.274), for N1 versus N0, 0.705 (95% CI = 0.686-0.724; median HL: 7.421; P = 0.492) and for N2 versus N0 and N1, 0.747 (95% CI = 0.728-0.765; median HL: 9.220; P = 0.324). Tumor size and vascular invasion were top-ranked predictors of all three end-points, followed by estrogen receptor status and lobular cancer for prediction of N2. For each end-point, ANN models showed better discriminatory performance than multivariable logistic regression models. Accepting a false negative rate (FNR) of 10% for predicting N0 by the ANN model, SLNB could have been abstained in 27.25% of patients with clinically node-negative axilla. Conclusions: In this retrospective study, ANN showed promising result as decision-supporting tools for estimating nodal disease. If prospectively validated, patients least likely to have nodal metastasis could be spared SLNB using predictive models. Trial registration: Registered in the ISRCTN registry with study ID ISRCTN14341750. Date of registration 23/11/2018. Retrospectively registered.</p>}}, author = {{Dihge, Looket and Ohlsson, Mattias and Edén, Patrik and Bendahl, Pär Ola and Rydén, Lisa}}, issn = {{1471-2407}}, keywords = {{Artificial neural networks; Breast cancer; Nodal status; Prediction models; Sentinel lymph node biopsy}}, language = {{eng}}, month = {{06}}, number = {{1}}, publisher = {{BioMed Central (BMC)}}, series = {{BMC Cancer}}, title = {{Artificial neural network models to predict nodal status in clinically node-negative breast cancer}}, url = {{http://dx.doi.org/10.1186/s12885-019-5827-6}}, doi = {{10.1186/s12885-019-5827-6}}, volume = {{19}}, year = {{2019}}, }