{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T04:00:51Z","timestamp":1779163251840,"version":"3.51.4"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Although preoperative prediction of axillary lymph nodes status has been achieved using radiomics and combined models, there is a dearth of research on internal mammary lymph node (IMN) metastasis status prediction. We developed a predictive model by combining clinicopathological factors with preoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) radiomics to accurately predict IMN metastasis in breast cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients who had no evidence of IMN metastasis on preoperative images but underwent internal mammary sentinel lymph node biopsy (IM-SLNB) were included in this study. Preoperative DCE-MRI and clinicopathological data of 124 patients with breast cancer were obtained, to developed Clinical, radiomics, and clinical\u2013radiomics models, separately. Decision curve analysis (DCA) was employed to assess the models\u2019 clinical applicability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The resulting area under the curves (AUCs) were 0.913, 0.831, 0.964 for the clinical model, the radiomics model, and the clinical\u2013radiomics model, respectively. The Delong test revealed significant differences in the receiver operating characteristic (ROC) curves only between the clinical and clinical\u2013radiomics models (all P&amp;lt;0.05). DCA substantiated the clinical\u2013radiomics model\u2019s optimal predictive efficiency, enhanced discriminatory ability, and maximum benefit. The AUC (95% confidence interval: 0.935-0.993) of the clinical\u2013radiomics model is 0.964. Repeated k-fold cross validation showed that average accuracy and Standard deviation of clinical\u2013radiomics model are 90.23% and 8.45%, respectively. And the calibration slope of clinical\u2013radiomics model is 1.08(p=0.071).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although the clinical model was effective in predicting IMN status, the addition of DCE<jats:bold>-<\/jats:bold>MRI radiomics significantly improved the predictive value of the clinical\u2013radiomics model, which showed excellent discrimination, calibration, and stability. This suggests that the clinic-radiomics model has potential for preoperative assessment of IMN metastasis risk in breast cancer patients, but external validation is needed to confirm its clinical utility. IMN irradiation is recommended for early patients with high IMN metastasis risk, and overtreatment should be avoided for patients with low metastasis risk.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2025.1477866","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T04:10:36Z","timestamp":1743653436000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical\u2013radiomics model for predicting internal mammary lymph node metastasis in operable breast cancer patients"],"prefix":"10.3389","volume":"15","author":[{"given":"Wei","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenyu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ting","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"QingWei","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ChengLin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianbin","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,3]]},"reference":[{"key":"B1","article-title":"Surveillance, epidemiology, and end results","volume-title":"SEER stat fact sheets: female breast cancer","year":"2016"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2008.06.003","article-title":"Internal mammary sentinel node biopsy for breast cancer","volume":"196","author":"Avisar","year":"2008","journal-title":"Am J Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/s12957-019-1683-8","article-title":"Should internal mammary lymph node sentinel biopsy be performed in breast cancer: a systematic review and meta-analysis","volume":"17","author":"Gong","year":"2019","journal-title":"World J Surg Oncol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1111\/ans.17982","article-title":"Internal mammary node involvement in patients with axilla-negative early breast cancer: a narrative review","volume":"93","author":"Braue","year":"2023","journal-title":"ANZ J Surg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.2217\/fon-2020-0225","article-title":"The hypothesis of internal mammary lymph node drainage chain in breast cancer","volume":"16","author":"Bi","year":"2020","journal-title":"Future Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-1744503","article-title":"Internal mammary lymph node biopsy during microsurgical breast reconstruction: a prospective study","volume":"38","author":"Schultz","year":"2022","journal-title":"J Reconstr Microsurg."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-019-07705-0","article-title":"Internal Mammary sentinel lymph node biopsy in clinically axillary lymph node-positive breast cancer: diagnosis and implications for patient management","volume":"27","author":"Qiu","year":"2020","journal-title":"Ann Surg Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00561-6","article-title":"Internal mammary node irradiation and breast cancer survival","volume":"17","author":"Venkatesan","year":"2016","journal-title":"Lancet Oncol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.63.6456","article-title":"DBCG-IMN: a population-based cohort study on the effect of internal mammary node irradiation in early node-positive breast cancer","volume":"34","author":"Thorsen","year":"2016","journal-title":"J Clin Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-198512000-00007","article-title":"Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes","volume":"202","author":"Veronesi","year":"1985","journal-title":"Ann Surg"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/BF02303699","article-title":"Internal mammary node status: a major prognosticator in axillary node-negative breast cancer","volume":"2","author":"Cody","year":"1995","journal-title":"Ann Surg Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-017-4422-2","article-title":"Impact of pathologic diagnosis of internal mammary lymph node metastasis in clinical N2b and N3b breast cancer patients","volume":"166","author":"Joo","year":"2017","journal-title":"Breast Cancer Res Treat"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/s0959-8049(99)00133-1","article-title":"The dissection of internal mammary nodes does not improve the survival of breast cancer patients. 30-year results of a randomized trial","volume":"35","author":"Veronesi","year":"1999","journal-title":"Eur J Cancer."},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2010.10.005","article-title":"Stage migration and therapy modification after thoracoscopic internal mammary lymph node dissection in breast cancer patients","volume":"20","author":"Long","year":"2011","journal-title":"Breast."},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s00432-021-03606-6","article-title":"Radiomics MRI for lymph node status prediction in breast cancer patients: the state of art","volume":"147","author":"Calabrese","year":"2021","journal-title":"J Cancer Res Clin Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-016-4022-6","article-title":"Internal mammary node adenopathy on breast MRI and PET\/CT for initial staging in patients with operable breast cancer: prevalence and associated factors","volume":"160","author":"Cheon","year":"2016","journal-title":"Breast Cancer Res Treat"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2017.06.011","article-title":"Development of postoperative radiotherapy for breast cancer: UK consensus statements \u2013 a model of patient, clinical and commissioner engagement","volume":"29","author":"Bloomfield","year":"2017","journal-title":"Clin Oncol (R Coll Radiol)."},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2019.01193","article-title":"Nomogram to predict internal mammary lymph nodes metastasis in patients with breast cancer","volume":"9","author":"Xie","year":"2019","journal-title":"Front Oncol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2023.107040","article-title":"Development and validation of a nomogram for predicting internal mammary sentinel node metastasis in breast cancer patients","volume":"49","author":"Qiu","year":"2023","journal-title":"Eur J Surg Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-013-3263-4","article-title":"Accurate staging with internal mammary chain sentinel node biopsy for breast cancer","volume":"21","author":"Gnerlich","year":"2014","journal-title":"Ann Surg Oncol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1111\/tbj.14105","article-title":"Evaluation of internal mammary lymph node biopsy during microsurgical breast reconstruction: an analysis of 230 consecutive patients","volume":"27","author":"Karanetz","year":"2021","journal-title":"Breast J"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000011296","article-title":"Predictors of internal mammary lymph nodes (IMLN) metastasis and disease-free survival comparison between IMLN-positive and IMLN-negative breast cancer patients: Results From Western China Clinical Cooperation Group (WCCCG) database (CONSORT)","volume":"97","author":"Wang","year":"2018","journal-title":"Med (Baltim)."},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.semcancer.2020.04.002","article-title":"Radiomics in breast cancer classification and prediction","volume":"72","author":"Conti","year":"2021","journal-title":"Semin Cancer Biol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"3","DOI":"10.2174\/1573405617666210303102526","article-title":"Radiomics \u2013 Quantitative biomarker analysis for breast cancer diagnosis and prediction: a review","volume":"18","author":"Moyya","year":"2022","journal-title":"Curr Med Imaging."},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.28086","article-title":"Development and validation of a preoperative magnetic resonance imaging radiomics-based signature to predict axillary lymph node metastasis and disease-free survival in patients with early-stage breast cancer","volume":"3","author":"Yu","year":"2020","journal-title":"JAMA Netw Open"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-017-5005-7","article-title":"Preoperative prediction of sentinel lymph node metastasis in breast cancer based on radiomics of T2-weighted fat-suppression and diffusion-weighted MRI","volume":"28","author":"Dong","year":"2018","journal-title":"Eur Radiol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-018-5981-2","article-title":"Radiomic nomogram for prediction of axillary lymph node metastasis in breast cancer","volume":"29","author":"Han","year":"2019","journal-title":"Eur Radiol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"4429","DOI":"10.1038\/s41598-019-40831-z","article-title":"Preoperative prediction of axillary lymph node metastasis in breast cancer using mammography-based radiomics method","volume":"9","author":"Yang","year":"2019","journal-title":"Sci Rep"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.26224","article-title":"Preoperative prediction of sentinel lymph node metastasis in breast cancer by radiomic signatures from dynamic contrast-enhanced MRI","volume":"49","author":"Liu","year":"2019","journal-title":"J Magn Reson Imaging."},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.26701","article-title":"Differentiating Axillary lymph node metastasis in Invasive Breast Cancer Patients: A Comparison of Radiomic Signatures from multiparametric Breast MR Sequences","volume":"50","author":"Chai","year":"2019","journal-title":"J Magn Reson Imaging."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(14)71116-7","article-title":"Nomograms in oncology: more than meets the eye","volume":"16","author":"Balachandran","year":"2015","journal-title":"Lancet Oncol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.754843","article-title":"Development and internal validation of a preoperative prediction model for sentinel lymph node status in breast cancer: combining radiomics signature and clinical factors","volume":"11","author":"Wang","year":"2021","journal-title":"Front Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1477866\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T04:10:40Z","timestamp":1743653440000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1477866\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,3]]},"references-count":32,"alternative-id":["10.3389\/fonc.2025.1477866"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1477866","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,3]]},"article-number":"1477866"}}