Computer-aided prediction model for axillary lymph node metastasis in breast cancer using tumor morphological and textural features on ultrasound

Abstract

Background and objectives: Axillary lymph node (ALN) status is a key indicator in assessing and determining the treatment strategy for patients with newly diagnosed breast cancer. Previous studies suggest that sonographic features of a primary tumor have the potential to predict ALN status in the preoperative staging of breast cancer. In this study, a computer-aided prediction (CAP) model as well as the tumor features for ALN metastasis in breast cancers were developed using breast ultrasound (US) images.

Methods: A total of 249 malignant tumors were acquired from 247 female patients (ages 20-84 years; mean 55 ± 11 years) to test the differences between the non-metastatic (130) and metastatic (119) groups based on various features. After applying semi-automatic tumor segmentation, 69 quantitative features were extracted. The features included morphology and texture of tumors inside a ROI of breast US image. By the backward feature selection and linear logistic regression, the prediction model was constructed and established to estimate the likelihood of ALN metastasis for each sample collected.

Results: In the experiments, the texture features showed higher performance for predicting ALN metastasis compared to morphology (Az, 0.730 vs 0.667). The difference, however, was not statistically significant (p-values > 0.05). Combining the textural and morphological features, the accuracy, sensitivity, specificity, and Az value achieved 75.1% (187/249), 79.0% (94/119), 71.5% (93/130), and 0.757, respectively.

Conclusions: The proposed CAP model, which combines textural and morphological features of primary tumor, may be a useful method to determine the ALN status in patients with breast cancer.

Keywords: Axillary lymph node; Breast cancer; Computer-aided prediction; Lymph node metastasis; Ultrasound.