title: Support vector machine learning model for the prediction of sentinel node status in patients with cutaneous melanoma.
abstract: BACKGROUND
  Currently, approximately 80% of melanoma patients undergoing sentinel node biopsy (SNB) have negative sentinel lymph nodes (SLNs), and no prediction system is reliable enough to be implemented in the clinical setting to reduce the number of SNB procedures. In this study, the predictive power of support vector machine (SVM)-based statistical analysis was tested.
  
  
  METHODS
  The clinical records of 246 patients who underwent SNB at our institution were used for this analysis. The following clinicopathologic variables were considered: the patient's age and sex and the tumor's histological subtype, Breslow thickness, Clark level, ulceration, mitotic index, lymphocyte infiltration, regression, angiolymphatic invasion, microsatellitosis, and growth phase. The results of SVM-based prediction of SLN status were compared with those achieved with logistic regression.
  
  
  RESULTS
  The SLN positivity rate was 22% (52 of 234). When the accuracy was > or = 80%, the negative predictive value, positive predictive value, specificity, and sensitivity were 98%, 54%, 94%, and 77% and 82%, 41%, 69%, and 93% by using SVM and logistic regression, respectively. Moreover, SVM and logistic regression were associated with a diagnostic error and an SNB percentage reduction of (1) 1% and 60% and (2) 15% and 73%, respectively.
  
  
  CONCLUSIONS
  The results from this pilot study suggest that SVM-based prediction of SLN status might be evaluated as a prognostic method to avoid the SNB procedure in 60% of patients currently eligible, with a very low error rate. If validated in larger series, this strategy would lead to obvious advantages in terms of both patient quality of life and costs for the health care system.
authors.affiliation: Clinica Chirurgica 2, Dipartimento di Scienze Oncologiche e Chirurgiche, Università di Padova, Via Giustiniani, 2, 35128 Padova, Italy. mocellins@hotmail.com
authors.forename: Simone
authors.initials: S
authors.lastname: Mocellin
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ambrosi
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Montesco
authors.forename: Mirto
authors.initials: M
authors.lastname: Foletto
authors.forename: Giorgio
authors.initials: G
authors.lastname: Zavagno
authors.forename: Donato
authors.initials: D
authors.lastname: Nitti
authors.forename: Mario
authors.initials: M
authors.lastname: Lise
authors.forename: Carlo Riccardo
authors.initials: CR
authors.lastname: Rossi
mesh_terms: D001185:Artificial Intelligence; D005260:Female; D006801:Humans; D016247:Information Storage and Retrieval / Q000379:methods; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000556:secondary*; D011237:Predictive Value of Tests; D012372:ROC Curve; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*