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Predicting of Sentinel Lymph Node Status in Breast Cancer Patients with Clinically Negative Nodes: A Validation Study

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Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
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Oncologia Medica Sperimentale, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
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Dipartimento di Matematica, Università degli Studi di Bari, 70121 Bari, Italy
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Struttura Semplice Dipartimentale di Chirurgia, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
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Unità Operativa Complessa di Oncologia Medica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
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Struttura Semplice Dipartimentale di Radiologia Senologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
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Unità Operativa Complessa di Anatomia Patologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Cancers 2021, 13(2), 352; https://doi.org/10.3390/cancers13020352
Received: 20 December 2020 / Revised: 14 January 2021 / Accepted: 15 January 2021 / Published: 19 January 2021
(This article belongs to the Section Cancer Causes, Screening and Diagnosis)
Sentinel lymph node biopsy procedure is time consuming and expensive, but it is still the intra-operative exam capable of the best performance. However, sometimes, surgery is achieved without a clear diagnosis, so clinical decision support systems developed with artificial intelligence techniques are essential to assist current diagnostic procedures. In this work, we evaluated the usefulness of a CancerMath tool in the sentinel lymph nodes positivity prediction for clinically negative patients. We tested it on 993 patients referred to our institute characterized by sentinel lymph node status, tumor size, age, histologic type, grading, expression of estrogen receptor, progesterone receptor, HER2, and Ki-67. By training the CancerMath (CM) model on our dataset, we reached a sensitivity value of 72%, whereas the online one was 46%, despite a specificity reduction. It was found the addiction of the prognostic factors Her2 and Ki67 could help improve performances on the classification of particular types of patients.
In the absence of lymph node abnormalities detectable on clinical examination or imaging, the guidelines provide for the dissection of the first axillary draining lymph nodes during surgery. It is not always possible to arrive at surgery without diagnostic doubts, and machine learning algorithms can support clinical decisions. The web calculator CancerMath (CM) allows you to estimate the probability of having positive lymph nodes valued on the basis of tumor size, age, histologic type, grading, expression of estrogen receptor, and progesterone receptor. We collected 993 patients referred to our institute with clinically negative results characterized by sentinel lymph node status, prognostic factors defined by CM, and also human epidermal growth factor receptor 2 (HER2) and Ki-67. Area Under the Curve (AUC) values obtained by the online CM application were comparable with those obtained after training its algorithm on our database. Nevertheless, by training the CM model on our dataset and using the same feature, we reached a sensitivity median value of 72%, whereas the online one was equal to 46%, despite a specificity reduction. We found that the addition of the prognostic factors Her2 and Ki67 could help improve performances on the classification of particular types of patients with the aim of reducing as much as possible the false positives that lead to axillary dissection. As showed by our experimental results, it is not particularly suitable for use as a support instrument for the prediction of metastatic lymph nodes on clinically negative patients. View Full-Text
Keywords: sentinel lymph node; early breast cancer; decision support system; OSNA; clinically negative lymph node; CancerMath sentinel lymph node; early breast cancer; decision support system; OSNA; clinically negative lymph node; CancerMath
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MDPI and ACS Style

Fanizzi, A.; Pomarico, D.; Paradiso, A.; Bove, S.; Diotaiuti, S.; Didonna, V.; Giotta, F.; La Forgia, D.; Latorre, A.; Pastena, M.I.; Tamborra, P.; Zito, A.; Lorusso, V.; Massafra, R. Predicting of Sentinel Lymph Node Status in Breast Cancer Patients with Clinically Negative Nodes: A Validation Study. Cancers 2021, 13, 352. https://doi.org/10.3390/cancers13020352

AMA Style

Fanizzi A, Pomarico D, Paradiso A, Bove S, Diotaiuti S, Didonna V, Giotta F, La Forgia D, Latorre A, Pastena MI, Tamborra P, Zito A, Lorusso V, Massafra R. Predicting of Sentinel Lymph Node Status in Breast Cancer Patients with Clinically Negative Nodes: A Validation Study. Cancers. 2021; 13(2):352. https://doi.org/10.3390/cancers13020352

Chicago/Turabian Style

Fanizzi, Annarita, Domenico Pomarico, Angelo Paradiso, Samantha Bove, Sergio Diotaiuti, Vittorio Didonna, Francesco Giotta, Daniele La Forgia, Agnese Latorre, Maria I. Pastena, Pasquale Tamborra, Alfredo Zito, Vito Lorusso, and Raffaella Massafra. 2021. "Predicting of Sentinel Lymph Node Status in Breast Cancer Patients with Clinically Negative Nodes: A Validation Study" Cancers 13, no. 2: 352. https://doi.org/10.3390/cancers13020352

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