Radiomics nomogram based on ultrafast DCE-MRI and DWI: preoperative evaluation of axillary lymph node status in invasive breast cancer

Motivation: Accurately evaluating the ALN status is pivotal for both prognosis and treatment planning, especially in the context of decreasing axillary surgery. Goal(s): This retrospective study aimed to develop a radiomics nomogram for preoperative prediction of ALN status in clinical T1-2 stage invasive breast cancer patients. Approach: Radiomics features were extracted from ultrafast DCE-MRI and DWI, and clinical characteristics were incorporated to construct a radiomics nomogram. Results: A radiomics signature achieved AUCs of 0.831 and 0.821 in training and validation cohorts, respectively. The radiomics nomogram, incorporating this signature, multifocality, and MRI-reported ALN status, showed superior performance with AUCs of 0.890 and 0.905. Impact: The proposed nomogram could be valuable for noninvasively assessing ALN status, aiding prognosis and treatment planning while reducing the need for axillary surgery in breast cancer patients.