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Based on this evidence, we developed and externally validated a nomogram to predict ypN0 in patients with clinically node-positive (cN+) breast cancer treated with NAC. This retrospective, multicenter study included 609 patients with cN\u2009+\u2009breast cancer who underwent NAC followed by surgery. A nomogram was developed using a training cohort (n\u2009=\u2009330) and validated in an independent cohort (n\u2009=\u2009279). Diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, decision curve analysis (DCA), and positive predictive value (PPV). The nomogram incorporated five predictors: ypT stage, cN stage, hormone receptor status, HER2 status, and post-NAC cN stage. It showed strong discriminative ability, with bias-corrected AUCs of 0.858 in the training cohort and 0.855 in the validation cohort. Calibration and DCA confirmed good model performance. PPV exceeded 0.90 when the nomogram-predicted probability was \u2265\u20090.7 in both cohorts. This nomogram demonstrated high diagnostic accuracy for predicting ypN0 and may support the selection of candidates for axillary surgery de-escalation based on post-NAC biopsy findings. Prospective validation using biopsy-confirmed pCR is warranted.<\/jats:p>","DOI":"10.1038\/s41598-025-32167-8","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T20:04:58Z","timestamp":1765397098000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Development and validation of a nomogram incorporating YpT stage for predicting ypN0 using multicenter data in clinically node-positive breast cancer"],"prefix":"10.1038","volume":"16","author":[{"given":"Hideo","family":"Shigematsu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinsuke","family":"Sasada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junji","family":"Hashizume","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsunari","family":"Sasada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinji","family":"Ozaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Midori","family":"Noma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyuki","family":"Yoshiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Goda","family":"Noriko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayumi","family":"Kawamata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiko","family":"Emi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Kaneko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiko","family":"Kajitani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Itagaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morihito","family":"Okada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"32167_CR1","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1002\/bjs.5894","volume":"94","author":"JS Mieog","year":"2007","unstructured":"Mieog, J. 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Central ethical review by Hiroshima University Hospital covers Higashihiroshima Medical Center and Asa Citizens Hospital, while Hiroshima Prefectural Hospital, JA Hiroshima General Hospital, and JA Onomichi General Hospital maintain independent institutional review board approvals. Because of the retrospective nature of the study, the requirement for written informed consent was waived by the Institutional Review Board of Hiroshima University Hospital (approval number: E2014-1157). Study details were publicly disclosed, and an opt-out option was provided to patients.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"2344"}}