Fig 1.
Immunohistochemical test images (×200).
A: ER+; B:ER-; C: PR+; D:PR-; E: HER2+; F: HER2-; G: Ki67 high; H: Ki67 low; I: AR+; J: AR-; K: P53+; L: P53-.
Fig 2.
Histopathologic analysis for tumor-infiltrating lymphocyte (TIL) density was performed on a single full-face hematoxylin and eosin-stained tumor section.
A: Tumor-infiltrating lymphocyte density is less than 10% (TILs < 10%) (Tumour percentage is 85%, and the TILs score is 1%) (H&E × 200). B: Tumor-infiltrating lymphocyte density is greater than or equal to 10% and less than 50% (10% ≤ TILs < 50%) (Tumour percentage is 60%, and TILs score is 30%) (H&E × 200). C: Tumor-infiltrating lymphocyte density is greater than or equal to 50% (TILs ≥ 50%) (Tumour percentage is 35%, and TILs score is 70%) (H&E × 200).
Table 1.
Patients’ baseline characteristics.
Table 2.
The relationship between sentinel lymph node metastasis and clinical pathological features in patients.
Table 3.
Patients’ TILs and the relationship with clinical and pathological features.
Fig 3.
Dividing the density of Tumor-Infiltrating Lymphocytes (TILs) at a threshold of 50% to categorize into lymphocyte predominant breast cancer (LPBC) and non-lymphocyte predominant breast cancer (nLPBC), patients with Triple-Negative Breast Cancer (TNBC) have a higher proportion of LPBC, followed by those with HER2-enriched breast cancer.
Patients with Luminal A (LA) and Luminal B (LB) breast cancer have the smallest proportion of LPBC (P < 0.001) (A). When dividing the density of Tumor-Infiltrating Lymphocytes (TILs) with a cutoff of 10% into high TILs and low TILs, there is no significant difference in TILs among Luminal A (LA), Luminal B (LB), HER2-overexpressing, and Triple-Negative (TN) breast cancer types (P = 0.902) (B).
Table 4.
Univariate and multivariate analysis of sentinel lymph node metastasis in early breast cancer patients.
Table 5.
Univariate and multivariate analysis of sentinel lymph node metastasis in early triple-negative, Luminal A, and Luminal B breast cancer patients.
Fig 4.
Based on the multivariate analysis, a forest plot was constructed, showing that clinical T stage (P = 0.002, OR = 0.464) and the level of Tumor-Infiltrating Lymphocytes (TILs) (P < 0.001, OR = 4.549) are independent predictive factors for Sentinel Lymph Node Metastasis (SLNM).
Fig 5.
Using t-tests and box plots to analyze the correlation between TILs (Tumor-Infiltrating Lymphocytes) density and SLNM (Sentinel Lymph Node Metastasis), it was found that in all patients, those with SLNM had a significantly lower TILs density than those without SLN metastasis (P = 0.001).
(A). When analyzing each subtype, only Luminal B (LB) breast cancer (P = 0.014) and Triple-Negative Breast Cancer (TNBC) (P < 0.001) showed statistical differences (C, E), while other subtypes did not exhibit significant differences (B, D).
Fig 6.
Using the ROC (Receiver Operating Characteristic) curve to evaluate the value of TILs (Tumor-Infiltrating Lymphocytes) density in predicting Sentinel Lymph Node Metastasis (SLNM) in early-stage (cT1-2N0) breast cancer, the AUC (Area Under the Curve) was 0.624 (CI: 0.559-0.689), with a sensitivity of 0.440 and a specificity of 0.783.
The optimal cutoff value was 17.5%, indicating good predictive performance.
Fig 7.
Based on the results of multivariate regression analysis, a nomogram model for Sentinel Lymph Node Metastasis (SLNM) was constructed using the R programming language.