ArticleScientific reports2025
Risk stratification system for sentinel lymph node metastasis in clinically node-negative early breast cancer with sonographically abnormal but cytologically negative axilla.
Article in Scientific reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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2 citing papers in PubMed.
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6 authors.
Funding
Abstract
For clinically node-negative (cN0) breast cancer patients with sonographically suspicious lymph nodes (iN+) but negative fine-needle aspiration cytology (N0(f)), sentinel lymph node biopsy (SLNB) remains the first-line approach for axillary staging. However, most of these patients ultimately demonstrate SLN-negative pathology, highlighting a critical need for a risk stratification to safely reduce unnecessary SLNB procedures. To address this unmet clinical challenge, we developed a preoperative risk stratification model integrating clinicopathological and ultrasonographic features. This prospective cohort study analyzed 369 consecutive iN+/N0(f) early breast cancer patients who underwent contrast-enhanced ultrasound (CEUS)-guided SLN fine-needle aspiration between September 2022 and December 2024. Multivariable logistic regression identified five independent predictors of SLN metastasis: cT2 staging, tumor grade III, conventional ultrasound type III, CEUS pattern III/IV, and abnormal sentinel lymphatic channel morphology. The resultant nomogram demonstrated good discrimination, with AUCs of 0.83 (95% CI: 0.77-0.89) and 0.82 (95% CI: 0.71-0.92) in training and temporal validation cohorts, respectively. The nomogram-based risk stratification system demonstrated good clinical utility: the very-low-risk subgroup exhibited only 2.6% SLN-positive incidence (2/76), achieving a negative predictive value of 97.4%, with no macrometastases observed in SLN-positive cases. This risk stratification system provides a clinically implementable method for personalized axillary management, improving preoperative identification of iN+/N0(f) patients likely to benefit from SLNB exemption.
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