CT Radiomics for Predicting Pathological Complete Response of Axillary Lymph Nodes in Breast Cancer After Neoadjuvant Chemotherapy: A Prospective Study

Author(s): Yan-Ling Li1;Li-Ze Wang1;Qing-Lei Shi2;Ying-Jian He1;Jin-Feng Li1;Hai-Tao Zhu1;Tian-Feng Wang3;Xiao-Ting Li1;Zhao-Qing Fan3;Tao Ouyang3;Ying-Shi Sun1
Source: https://doi.org/10.1093/oncolo/oyad010
Maem Hussein MD

Dr. Maen Hussein's Thoughts

A way to avoid axillary dissection, with more neoadjuvant therapy treatments, this may help avoid unnecessary axillary dissection. Probably needs more validation with larger studies but is a good start. Also, the first related to radiological findings, so welcome input from our FCS Radiologists.


The diagnostic effectiveness of traditional imaging techniques is insufficient to assess the response of lymph nodes (LNs) to neoadjuvant chemotherapy (NAC), especially for pathological complete response (pCR). A radiomics model based on computed tomography (CT) could be helpful.


Prospective consecutive breast cancer patients with positive axillary LNs initially were enrolled, who received NAC prior to surgery. Chest contrast-enhanced thin-slice CT scan was performed both before and after the NAC (recorded as the first and the second CT respectively), and on both of them, the target metastatic axillary LN was identified and demarcated layer by layer. Using pyradiomics-based software that was independently created, radiomics features were retrieved. A pairwise machine learning workflow based on Sklearn (https://scikit-learn.org/) and FeAture Explorer was created to increase diagnostic effectiveness. An effective pairwise auto encoder model was developed by the improvement of data normalization, dimensionality reduction, and features screening scheme as well as the comparison of the prediction effectiveness of the various classifiers,


A total of 138 patients were enrolled, and 77 (58.7%) in the overall group achieved pCR of LN after NAC. Nine radiomics features were finally chosen for modeling. The AUCs of the training group, validation group, and test group were 0.944 (0.919-0.965), 0.962 (0.937-0.985), and 1.000 (1.000-1.000), respectively, and the corresponding accuracies were 0.891, 0.912, and 1.000.


The pCR of axillary LNs in breast cancer following NAC can be precisely predicted using thin-sliced enhanced chest CT-based radiomics.

Author Affiliations

1Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, People’s Republic of China2Chinese University of Hong Kong (Shenzhen) School of Medicine, Shenzhen Research Institute of Big Data, People’s Republic of China 3Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Breast Cancer Center, Peking University Cancer Hospital & Institute, People’s Republic of China

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