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PET/MRI Machine Learning Model Eliminates Sentinel Lymph Node Biopsy in Most Breast Cancer Patients

By MedImaging International staff writers
Posted on 21 Nov 2022

Image: Graphical abstract (Photo courtesy of University Hospital Düsseldorf)

The presence of lymph node metastases in breast cancer patients plays a crucial role in treatment planning, especially regarding the extent of surgery and radiation. Therefore, it is of high clinical relevance to distinguish patients with lymph node metastases from patients without lymph node metastases. Now, nearly 70% of breast cancer patients could find out if their cancer has spread to their lymph nodes without having to undergo an invasive sentinel node biopsy. New research shows that with the help of machine learning (a type of artificial intelligence), axillary lymph node metastasis can be reliably ruled out based on imaging with PET/MRI.

In the study, researchers at the Institute for Diagnostic and Interventional Radiology at the University Hospital Düsseldorf (Düsseldorf, Germany) sought to determine whether machine learning prediction models could determine lymph node status in PET/MRI examinations as accurately as an experienced radiologist could. A total of 303 primary breast cancer patients from three medical centers were recruited for the study and were divided into a training group sample and a testing group sample.

All patients underwent MRI and dedicated whole-body 18F-FDG PET/MRI. The imaging datasets were evaluated for axillary lymph node metastases based on structural and functional features. Machine learning models were developed based on the MRI and PET/MRI training group sample and were then applied to the testing group sample. The diagnostic accuracy of MRI was 87.5% for both radiologists and the machine learning algorithm. For PET/MRI, the accuracy was 89.3% for radiologists and 91.2% for machine learning. After adjusting the machine learning model for PET/MRI, a sensitivity of 96.2% and a specificity of 68.2% was achieved.

“Sixty percent of patients do not have lymph node metastases at initial diagnosis of breast cancer,” said study author Janna Morawitz, MD, radiology resident at the Institute for Diagnostic and Interventional Radiology at the University Hospital Düsseldorf. “As such, it would be desirable to be able to prove negative lymph node status by imaging with a high degree of certainty to spare these patients the invasive procedure of biopsy or surgery.”

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70 (370.97930908203): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294795404 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (299.93057250977): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294795404 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (82.969665527344): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (43.869018554688): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294795404 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.994415283203): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294795404 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (34.809112548828): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (57.93571472168): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (48.87580871582): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

105 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

106 (55.074691772461): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294795404 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (66.041946411133): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294795404 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

109 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

110 (69.141387939453): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294795404 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (581.02607727051): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294795404 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (600.09956359863): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (380.03921508789): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

115 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

116 (123.97766113281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

117 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

118 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

119 (37.908554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

120 (282.04917907715): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 22747.993469238): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

123 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

124 (404.11949157715): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294795404 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294795404 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 440651.89361572): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (99.897384643555): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (56.982040405273): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (37.908554077148): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (61.03515625): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (41.961669921875): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (41.007995605469): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (36.954879760742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (638.96179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (542.87910461426): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (298.02322387695): SELECT name FROM jos_deeppockets WHERE id=212

136 (38.862228393555): SELECT name FROM jos_deeppockets WHERE id=212

137 (530.95817565918): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (563.14468383789): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

140 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

141 (!!!!! 11296.033859253): TRUNCATE TABLE jos_trademed_module

142 (130.89179992676): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294795404 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (72.002410888672): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294795404 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (!!!!! 1032.1140289307): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

147 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

148 (!!!!! 1624.1073608398): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

150 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

151 (65.088272094727): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294795404 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294795404 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (48.87580871582): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

153 (43.153762817383): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

154 (53.882598876953): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

156 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795404 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795404 AND published='1' LIMIT 1

157 (47.922134399414): select jos_twitters.link from jos_twitters where cat=10

158 (36.001205444336): select jos_facebook.link from jos_facebook where cat=10

159 (38.14697265625): select jos_google_plus.link from jos_google_plus where cat=10

160 (36.001205444336): select jos_linkedin.link from jos_linkedin where cat=10

161 (338.07754516602): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1596.9276428223): insert into jos_banners_delta values (14615,'2025-04-30 14:46:03','18.221.176.186','view'),(14202,'2025-04-30 14:46:03','18.221.176.186','view'),(14203,'2025-04-30 14:46:03','18.221.176.186','view')

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