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Background: To develop and validate a radiomics model based on 18F-FDG PET/CT images to preoperatively predict occult axillary lymph node (ALN) metastases in patients with invasive ductal breast cancer (IDC) with clinically node-negative (cN0); Methods: A total of 180 patients (mean age, 55 years; range, 31–82 years) with pathologically proven IDC and a preoperative 18F-FDG PET/CT scan from January 2013 to January 2021 were included in this retrospective study. According to the intraoperative pathological results of ALN, we divided patients into the true-negative group and ALN occult metastasis group. Radiomics features were extracted from PET/CT images using Pyradiomics implemented in Python, t-tests, and LASSO were used to screen the feature, and the random forest (RF), support vector machine (SVM), stochastic gradient descent (SGD), and k-nearest neighbor (KNN) were used to build the prediction models. The best-performing model was further tested by the permutation test; Results: Among the four models, RF had the best prediction results, the AUC range of RF was 0.661–0.929 (mean AUC, 0.817), and the accuracy range was 65.3–93.9% (mean accuracy, 81.2%). The p-values of the permutation tests for the RF model with maximum and minimum accuracy were less than 0.01; Conclusions: The developed RF model was able to predict occult ALN metastases in IDC patients based on preoperative 18F-FDG PET/CT radiomic features.

Predictive Value of 18F-FDG PET/CT-Based Radiomics Model for Occult Axillary Lymph Node Metastasis in Clinically Node-Negative Breast Cancer