Deep Learning Signature Based On Staging CT For Preoperative Prediction Of Sentinel Lymph Node Metastasis In Breast Cancer

Background and Objectives:The sentinel lymph node(SLN)status provides a valuable prognostic factor for guiding treatment decision in patients with breast cancer.To evaluate the noninvasive predictive performance of deep learning features based on staging CT for SLN metastasis of breast cancerMaterials and Methods:A total of 348 breast cancer patients were enrolled in this study,with their SLN metastases pathologically con-firmed.All patients received contrast-enhanced CT preoperative examinations and CT images were segmented and analyzed to extract deep features.After the feature selection,deep learning signature was built using the multivariable logistic regression with the selected key deep features.The performance of the deep learning signatures was assessed with respect to discrimination,calibration,and clinical usefulness in the primary cohort(184 patients from January 2016 to March 2017)and then validated in the independent validation cohort(164 patients from April 2017 to December 2018)Results:Ten deep learning features were automatically selected in the primary cohort to establish the deep learning signature of SLN metastasis.The deep learning signature shows favorable discriminative ability with an area under curve(AUC)of 0.801(95%confidence interval[CI]:0.736-0.867)in primary cohort and 0.817(95%CI:0.751-0.884)in validation cohort.To further distinguish the number of metastatic SLNs(1-2 or more than two metastatic SLN),another deep learning signature was constructed and also showed moderate performance,with an AUC of 0.777(95%CI:0.660-0.895)in the primary cohort and 0.770(95%CI:0.611-0.929)in the validation cohortConclusion:We developed the deep learning signatures for preoperative prediction of SLN metastasis status and numbers(1-2 or more than two metastatic SLN)in patients with breast cancer.The deep learning signature may potentially provide a noninvasive approach to assist clinicians in predicting SLN metastasis in patients with breast cancer.