Z0011 和 AMAROS 试验发现，对于具有一两个转移性腋窝淋巴结 (mALN) 的早期乳腺癌患者，不再强制进行腋窝淋巴结清扫术 (ALND)。我们研究的目的是建立一个列线图，可用于定量预测高负荷 mALN (≥3 mALN) 的个体可能性。我们回顾性分析了 564 名早期乳腺癌女性，她们均接受了超声 (US) 和磁力检查磁共振成像 (MRI) 用于在根治性手术前检查腋窝淋巴结。所有患者均按照计算机生成的随机数分为训练组 (n = 452) 和验证组 (n = 112)。通过逻辑回归分析评估其临床病理特征和与高负荷 mALN 相关的术前影像学，以开发列线图来预测高负荷 mALN 的概率。多变量分析显示，高负荷 mALN 与置换肺门和最短直径 >10mm 显着相关MRI 上显示，US 上皮层厚度 >3mm（每个 p < 0.05）。这些成像标准加上乳腺肿瘤的更高级别（II 级和 III 级）和象限用于开发列线图，计算高负荷 mALN 的概率。训练集列线图的 AUC 为 0.853 (95% CI: 0.790-0.908)，验证集为 0.783 (95% CI: 0.638-0.929)。内部和外部验证均评估列线图的准确性良好。开发了一种具有良好区分性的列线图来预测早期乳腺患者的高负荷 mALN，这可以帮助乳腺外科医生选择合适的手术方法。© 2023作者。中国肺肿瘤学组与John Wiley联合出版《胸癌》

The Z0011 and AMAROS trials found that axillary lymph node dissection (ALND) was no longer mandatory for early-stage breast cancer patients who had one or two metastatic axillary lymph nodes (mALNs). The aim of our study was to establish a nomogram which could be used to quantitatively predict the individual likelihood of high burden mALN (≥3 mALN).We retrospectively analyzed 564 women with early breast cancer who had all undergone both ultrasound (US) and magnetic resonance imaging (MRI) to examine axillary lymph nodes before radical surgery. All the patients were divided into training (n = 452) and validation (n = 112) cohorts by computer-generated random numbers. Their clinicopathological features and preoperative imaging associated with high burden mALNs were evaluated by logistic regression analysis to develop a nomogram for predicting the probability of high burden mALNs.Multivariate analysis showed that high burden mALNs were significantly associated with replaced hilum and the shortest diameter >10 mm on MRI, with cortex thickness >3 mm on US (p < 0.05 each). These imaging criteria plus higher grade (grades II and III) and quadrant of breast tumor were used to develop a nomogram calculating the probability of high burden mALNs. The AUC of the nomogram was 0.853 (95% CI: 0.790-0.908) for the training set and 0.783 (95% CI: 0.638-0.929) for the validation set. Both internal and external validation evaluated the accuracy of nomogram to be good.A well-discriminated nomogram was developed to predict the high burden mALN in early-stage breast patients, which may assist the breast surgeon in choosing the appropriate surgical approach.© 2023 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.