Prediction of Regional Lymph Node Metastasis from the Clinicopathological Features of Breast Carcinoma: Application of Deep Learning
Abstract
Objective: Breast cancer is the leading cause of cancer-related mortality in women globally, with invasive ductal carcinoma (IDC) as the predominant subtype. Regional lymph node (LN) metastasis significantly impacts prognosis, staging, and treatment strategies. However, the role of deep learning in predicting LN metastasis is underexplored. To develop and evaluate a deep learning model leveraging clinicopathological features for predicting LN metastasis in IDC patients, with an aim to enhance diagnostic accuracy and reduce reliance on invasive methods.
Material and Methods: A cross-sectional study was conducted on 351 IDC cases from a tertiary-care hospital. Input variables included clinicopathological features: age, tumor size, modified Bloom-Richardson grade, ER, PR, HER2 receptor status, Ki-67 index, and microvessel density (MVD). LN status was dichotomized using a cut-off ratio of 0.3. A neural network model with an input layer of 8 neurons, 3 hidden layers (50 neurons each), and ReLU activation was developed. Data were split into training (70%) and test (30%) sets. Predictive accuracy was evaluated using standard performance metrics.
Results: The mean age was 46.4±11.29 years and tumor volume averaged 44.9 cm³. Low ER (35.6%) and PR (26.8%) positivity rates were observed, with HER2 positivity at 21.7%. The model achieved 78.3% accuracy in predicting LN metastasis. The F1 score of the model was 0.83.
Conclusion: The study demonstrates the utility of deep learning models in predicting LN metastasis using clinicopathological data. With 78.3% accuracy, the model highlights AI’s potential in oncology diagnostics, supporting personalized treatment approaches. Further integration of imaging and molecular data could enhance model performance and clinical applicability.
Keywords
Full Text:
PDFReferences
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021;71:209-49. doi: 10.3322/caac.21660.
Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin 2023;73:17-48. doi: 10.3322/caac.21763
Harbeck N, Penault-Llorca F, Cortes J, Gnant M, Houssami N, Poortmans P, et al. Breast cancer. Nat Rev Dis Primers 2019;5:66. doi: 10.1038/s41572-019-0111-2.
Perou CM, Sørlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees CA, et al. Molecular portraits of human breast tumours. Nature 2000;406:747-52. doi: 10.1038/35021093.
Natale G, Stouthandel MEJ, Van Hoof T, Bocci G. The lymphatic system in breast cancer: anatomical and molecular approaches. Medicina (Kaunas) 2021;57:1272. doi: 10.3390/medicina57111272.
Liu J, Li Y, Zhang W, Yang C, Yang C, Chen L, et al. The prognostic role of lymph node ratio in breast cancer patients received neoadjuvant chemotherapy: a dose-response meta-analysis. Front Surg 26;9:971030. doi: 10.3389/fsurg.2022.971030.
Kim JY, Ryu MR, Choi BO, Park WC, Oh SJ, Won JM, et al. The prognostic significance of the lymph node ratio in axillary lymph node positive breast cancer. J Breast Cancer 2011;14:204-12. doi: 10.4048/jbc.2011.14.3.204.
Ozmen V, Cabioglu N. Sentinel lymph node biopsy for breast cancer: current controversies. Breast J 2006;12(Suppl 2):S134-42. doi: 10.1111/j.1075-122X.2006.00327.x.
LeCun Y, Bengio Y, Hinton G. Deep learning. Nature 2015;521:436-44. doi: 10.1038/nature14539.
Ahn JS, Shin S, Yang SA, Park EK, Kim KH, Cho SI, et al. Artificial intelligence in breast cancer diagnosis and personalized medicine. J Breast Cancer 2023;26:405-35. doi: 10.4048/jbc.2023.26.e45.
Shahriarirad R, Meshkati Yazd SM, Fathian R, Fallahi M, Ghadiani Z, Nafissi N. Prediction of sentinel lymph node metastasis in breast cancer patients based on preoperative features: a deep machine learning approach. Sci Rep 2024;14:1351. doi: 10.1038/s41598-024-51244-y.
Zhou LQ, Wu XL, Huang SY, Wu GG, Ye HR, Wei Q, et al. Lymph node metastasis prediction from primary breast cancer us images using deep learning. Radiology 2020;294:19-28. doi: 10.1148/radiol.2019190372.
Polat DS, Nguyen S, Karbasi P, Hulsey K, Cobanoglu MC, Wang L, et al. Machine learning prediction of lymph node metastasis in breast cancer: performance of a multi-institutional MRI-based 4D convolutional neural network. Radiol Imaging Cancer 2024;6:e230107. doi: 10.1148/rycan.230107.
Chen W, Wang C, Fu F, Yang B, Chen C, Sun Y. A model to predict the risk of lymph node metastasis in breast cancer based on clinicopathological characteristics. Cancer Manag Res 2020;12:10439-47. doi: 10.2147/CMAR.S272420.
Dihge L, Vallon-Christersson J, Hegardt C, Saal LH, Häkkinen J, Larsson C, et al. Prediction of lymph node metastasis in breast cancer by gene expression and clinicopathological models: development and validation within a population-based cohort. Clin Cancer Res 2019;25:6368-81. doi: 10.1158/1078-0432.16.
Shiner A, Kiss A, Saednia K, Jerzak KJ, Gandhi S, Lu FI, et al. Predicting patterns of distant metastasis in breast cancer patients following local regional therapy using machine learning. Genes (Basel) 2023;14:1768. doi: 10.3390/genes14091768.
Park TY, Kwon LM, Hyeon J, Cho BJ, Kim BJ. Deep learning prediction of axillary lymph node metastasis in breast cancer patients using clinical implication-applied preprocessed CT Images. Curr Oncol 2024;31:2278-88. doi: 10.3390/curroncol31040169.
Hu J, Lv H, Zhao S, Lin CJ, Su GH, Shao ZM. Prediction of clinicopathological features, multi-omics events and prognosis based on digital pathology and deep learning in HR+/HER2- breast cancer. J Thorac Dis 2023;15:2528-43. doi: 10.21037/jtd-23-445.
Xu F, Zhu C, Tang W, Wang Y, Zhang Y, Li J, et al. Predicting axillary lymph node metastasis in early breast cancer using deep learning on primary tumor biopsy slides. Front Oncol 2021 14;11:759007. doi: 10.3389/fonc.2021.759007.
Ding Y, Yang F, Han M, Li C, Wang Y, Xu X, et al. Multi-center study on predicting breast cancer lymph node status from core needle biopsy specimens using multi-modal and multi-instance deep learning. npj Breast Cancer 2023;9:58. doi: 10.1038/s41523-023-00562-x.
Shouket T, Mahmood S, Hassan MT, Iftikhar A. Overall and disease-free survival prediction of postoperative breast cancer patients using machine learning techniques. In: 2019 22nd International Multitopic Conference (INMIC). Islamabad: IEEE; 2019;p.1–6. doi: 10.1109/INMIC48123.2019.9022756.
Kalafi EY, Nor NAM, Taib NA, Ganggayah MD, Town C, Dhillon SK. Machine learning and deep learning approaches in breast cancer survival prediction using clinical data. Folia Biol (Praha) 2019;65:212-20.
Fu B, Liu P, Lin J, Deng L, Hu K, Zheng H. Predicting invasive disease-free survival for early-stage breast cancer patients using follow-up clinical data. IEEE Trans Biomed Eng 2018. doi: 10.1109/TBME.2018.2882867.
Sun D, Li A, Tang B, Wang M. Integrating genomic data and pathological images to effectively predict breast cancer clinical outcome. Comput Methods Programs Biomed. 2018;161:45-53. doi: 10.1016/j.cmpb.2018.04.008.
Refbacks
- There are currently no refbacks.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.