Abstract PO4-07-10: Validation of An Ultrasound-Based Scoring System of Axillary Metastasis in Breast Cancer
Authors: Van Decar Spencer , Carpenter Elizabeth , Adams Alexandra , Shore Jason , Dragusin Iulian , Davis Erika , Tork Craig , Krell Robert , Graybeal Troy , Clifton Katherine , Buckley Arianna , Clifton Guy 
Published: May 2024

Abstract
Introduction:
Ultrasound is the imaging modality of choice in the evaluation of axillary involvement in breast cancer. Our group previously created a scoring method to predict axillary lymph node metastasis (ALNM) based on ultrasound characteristics. In this study we validated the model and tested it among different Memorial Sloan Kettering Breast Cancer Sentinel Lymph Node Metastasis Nomogram1 (MSK) subgroups.
Methods:
The ultrasound score (table 1) was previously developed using data collected at a single institution from 2019 – 2021 by allocating points based on the regression coefficients of variables found to significantly predict ALNM. Subsequent evaluation of the discrimination of this model found it was robust to different patient demographic and tumor characteristics based on receiver operating characteristic curve analysis2. In this study, we validated the test statistics of our score at an outside institution. We also pooled patients from both institutions and evaluated the score performance in different MSK subgroups by the likelihood for sentinel node metastasis based off of clinical and pathologic data without accounting for imaging findings.
Results:
Between 2019-2021, 140 patients with breast cancer were analyzed for validation of the axillary ultrasound scoring system and when combined with the dataset of patients from the index institution, 358 pooled patients were stratified by predicted ALNM positivity according to MSK. In the validation cohort, the NPV for low risk (0-1) scores was 87%, while the PPV for high-risk (5+) scores was 71%. Overall in the combined cohort, 241 (67%) patients had low risk (0-1) axillary ultrasound scores and 33 (9%) had high risk (5+) scores. In this combined cohort, NPV was 84% (203/241 low-risk score patients were node negative), while PPV for high-risk scores was 85% (28/33 high risk score patients were node positive). When analyzed according to level of MSK predicted ALNM rates, for patients with &lt; 50% predicted ALNM positivity, the NPV of low-risk scores was 87-89% and the PPV for high-risk axillary scores was 100%. For patients with &gt;50% predicted ALNM positivity, the NPV of low-risk scores was 66% and the PPV of high-risk scores was 82%.
Conclusions:
A scoring system to predict ALNM among biopsy proven breast cancer patients undergoing upfront surgery was successfully developed from a multivariate model based on axillary ultrasound characteristics. This model was validated at a separate institution. The scoring system shows advantageous negative and positive predictive values for axillary node metastasis, especially among patients with &lt; 50% predicted nodal involvement based on the MSK nomogram. This data may help foster better communication about ALNM risk between radiologists and treating clinicians to inform treatment decisions.
Table. Scoring System for Likelihood of ALNM based on Ultrasound Characteristics
Citation Format: Spencer Van Decar, Elizabeth Carpenter, Alexandra Adams, Jason Shore, Iulian Dragusin, Erika Davis, Craig Tork, Robert Krell, Troy Graybeal, Katherine Clifton, Arianna Buckley, Guy Clifton. Validation of An Ultrasound-Based Scoring System of Axillary Metastasis in Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-07-10.