Jatoi I, Hilsenbeck SG, Clark GM, Osborne CK. Significance of axillary lymph node metastasis in primary breast cancer. J Clin Oncol. 1999;17:2334–2334. https://doi.org/10.1200/JCO.1999.17.8.2334.

Article  CAS  PubMed  Google Scholar 

Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349:546–53. https://doi.org/10.1056/NEJMoa012782.

Article  PubMed  Google Scholar 

Park KU, Somerfield MR, Anne N, et al. Sentinel lymph node biopsy in early-stage breast cancer: ASCO guideline update. J Clin Oncol. 2025;43:1720–41. https://doi.org/10.1200/JCO-25-00099.

Article  CAS  PubMed  Google Scholar 

Gentilini OD, Botteri E, Sangalli C, et al. Sentinel lymph node biopsy vs no axillary surgery in patients with small breast cancer and negative results on ultrasonography of axillary lymph nodes: the SOUND randomized clinical trial. JAMA Oncol. 2023;9:1557–64. https://doi.org/10.1001/jamaoncol.2023.3759.

Article  PubMed  PubMed Central  Google Scholar 

Reimer T, Stachs A, Veselinovic K, et al. Axillary surgery in breast cancer: primary results of the INSEMA trial. N Engl J Med. 2025;392:1051–64. https://doi.org/10.1056/NEJMoa2412063.

Article  PubMed  Google Scholar 

Balachandran VP, Gonen M, Smith JJ, DeMatteo RP. Nomograms in oncology: more than meets the eye. Lancet Oncol. 2015;16:e173–80. https://doi.org/10.1016/S1470-2045(14)71116-7.

Article  PubMed  PubMed Central  Google Scholar 

Breast Cancer Nomogram to Predict Positive Sentinel Lymph Nodes, Without Neoadjuvant Chemotherapy. MD Anderson Cancer Center. https://www3.mdanderson.org/app/medcalc/bc_nomogram3/index.cfm?pagename=sln. Accessed 30 July 2025.

Breast Cancer Nomogram: Sentinel Lymph Node Metastasis/Memorial Sloan Kettering Cancer Center. https://nomograms.mskcc.org/Breast/BreastSLNodeMetastasisPage.aspx. Accessed 30 July 2025.

Bevilacqua JLB, Kattan MW, Fey JV, Cody HS, Borgen PI, Van Zee KJ. Doctor, what are my chances of having a positive sentinel node? A validated nomogram for risk estimation. J Clin Oncol Off J Am Soc Clin Oncol. 2007;25:3670–9. https://doi.org/10.1200/JCO.2006.08.8013.

Article  Google Scholar 

Green TA, Whitt S, Belden JL, Erdelez S, Shyu CR. Medical calculators: prevalence, and barriers to use. Comput Methods Programs Biomed. 2019;179:105002. https://doi.org/10.1016/j.cmpb.2019.105002.

Article  PubMed  Google Scholar 

Aakre C, Dziadzko M, Keegan MT, Herasevich V. Automating clinical score calculation within the electronic health record. Appl Clin Inform. 2017;8:369–80. https://doi.org/10.4338/ACI-2016-09-RA-0149.

Article  PubMed  PubMed Central  Google Scholar 

Bednarczyk L, Reichenpfader D, Gaudet-Blavignac C, et al. Scientific evidence for clinical text summarization using large language models: scoping review. J Med Internet Res. 2025;27:e68998. https://doi.org/10.2196/68998.

Article  PubMed  PubMed Central  Google Scholar 

Van Veen D, Van Uden C, Blankemeier L, et al. Adapted large language models can outperform medical experts in clinical text summarization. Nat Med. 2024;30:1134–42. https://doi.org/10.1038/s41591-024-02855-5.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Chung P, Fong CT, Walters AM, Aghaeepour N, Yetisgen M, O’Reilly-Shah VN. Large language model capabilities in perioperative risk prediction and prognostication. JAMA Surg. 2024;159:928–37. https://doi.org/10.1001/jamasurg.2024.1621.

Article  PubMed  PubMed Central  Google Scholar 

Liévin V, Hother CE, Motzfeldt AG, Winther O. Can large language models reason about medical questions? Patterns. 2024;5:100943. https://doi.org/10.1016/j.patter.2024.100943.

Article  PubMed  PubMed Central  Google Scholar 

Gallifant J, Afshar M, Ameen S, et al. The TRIPOD-LLM reporting guideline for studies using large language models. Nat Med. 2025;31:60–9. https://doi.org/10.1038/s41591-024-03425-5.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Liu C, Zhao Z, Gu X, et al. Establishment and verification of a bagged-trees-based model for prediction of sentinel lymph node metastasis for early breast cancer patients. Front Oncol. 2019;9:282. https://doi.org/10.3389/fonc.2019.00282.

Article  PubMed  PubMed Central  Google Scholar 

Chen M, Kong C, Lin G, et al. Development and validation of convolutional neural network-based model to predict the risk of sentinel or non-sentinel lymph node metastasis in patients with breast cancer: a machine-learning study. EClinicalMedicine. 2023;63:102176. https://doi.org/10.1016/j.eclinm.2023.102176.

Article  PubMed  PubMed Central  Google Scholar 

Ding Y, Yang F, Han M, et al. Multi-center study on predicting breast cancer lymph node status from core needle biopsy specimens using multi-modal and multi-instance deep learning. Npj Breast Cancer. 2023;9:58. https://doi.org/10.1038/s41523-023-00562-x.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Leeds IL, Rosenblum AJ, Wise PE, et al. Eye of the beholder: risk calculators and barriers to adoption in surgical trainees. Surgery. 2018;164:1117–23. https://doi.org/10.1016/j.surg.2018.07.002.

Article  PubMed  PubMed Central  Google Scholar 

Goodell AJ, Chu SN, Rouholiman D, Chu LF. Large language model agents can use tools to perform clinical calculations. Npj Digit Med. 2025;8:163. https://doi.org/10.1038/s41746-025-01475-8.

Article  PubMed  PubMed Central  Google Scholar 

Wan N, Jin Q, Chan J, et al. Humans and large language models in clinical decision support: a study with medical calculators. arXiv. Published online 21 March 2025. Available from: arXiv:2411.05897v2.

Khandekar N, Jin Q, Xiong G, et al. MedCalc-Bench: evaluating large language models for medical calculations. arXiv. Preprint posted online 30 June 2024. Available from: https://doi.org/10.48550/arXiv.2406.12036.

Savage T, Nayak A, Gallo R, Rangan E, Chen JH. Diagnostic reasoning prompts reveal the potential for large language model interpretability in medicine. Npj Digit Med. 2024;7:20. https://doi.org/10.1038/s41746-024-01010-1.

Article  PubMed  PubMed Central  Google Scholar 

Levin C, Orkaby B, Kerner E, Saban M. Can large language models assist with pediatric dosing accuracy? Pediatr Res Published online. 2025;8:1–6. https://doi.org/10.1038/s41390-025-03980-8.

Article  Google Scholar 

Jia Z, Chen J, Xu X, et al. The importance of resource awareness in artificial intelligence for healthcare. Nat Mach Intell. 2023;5:687–98. https://doi.org/10.1038/s42256-023-00670-0.

Article  Google Scholar 

You J. How much energy does ChatGPT use? Epoch AI. https://epoch.ai/gradient-updates/how-much-energy-does-chatgpt-use. (2025). Accessed 2 August 2025.

Meskó B, Topol EJ. The imperative for regulatory oversight of large language models (or generative AI) in healthcare. Npj Digit Med. 2023;6:120. https://doi.org/10.1038/s41746-023-00873-0.

Article  PubMed  PubMed Central  Google Scholar