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However, the imaging features that are clinically crucial for lymph node metastasis have not been fully elucidated. Hence, we developed a bimodal model to predict ALN metastasis in patients with early breast cancer by integrating CEUS images with the annotated imaging features. The model adopted a light-gradient boosting machine to produce feature importance, enabling the extraction of clinically crucial imaging features. In this retrospective study, the diagnostic performance of the model was investigated using 788 CEUS images of ALNs obtained from 788 patients who underwent breast surgery between 2013 and 2021, with the ground truth defined by the pathological diagnosis. The results indicated that the test cohort had an area under the receiver operating characteristic curve (AUC) value of 0.93 (95% confidence interval: 0.88, 0.98). The model had an accuracy of 0.93, which was higher than the radiologist\u2019s diagnosis (accuracy of 0.85). The most important imaging features were heterogeneous enhancement, diffuse cortical thickening, and eccentric cortical thickening. Our model has an excellent diagnostic performance, and the extracted imaging features could be crucial for confirming ALN metastasis in clinical settings.<\/jats:p>","DOI":"10.1038\/s41598-025-90099-9","type":"journal-article","created":{"date-parts":[[2025,2,15]],"date-time":"2025-02-15T14:02:12Z","timestamp":1739628132000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Artificial intelligence can extract important features for diagnosing axillary lymph node metastasis in early breast cancer using contrast-enhanced ultrasonography"],"prefix":"10.1038","volume":"15","author":[{"given":"Tomohiro","family":"Oshino","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Enda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirokazu","family":"Shimizu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megumi","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mutsumi","family":"Nishida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumi","family":"Kato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshitaka","family":"Oda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuchika","family":"Hosoda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohsuke","family":"Kudo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norimasa","family":"Iwasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6641-9598","authenticated-orcid":false,"given":"Masato","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,15]]},"reference":[{"key":"90099_CR1","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3322\/caac.21820","volume":"74","author":"RL Siegel","year":"2024","unstructured":"Siegel, R. 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