Objective:

To explore the association between preoperative serum total cholesterol (TC) and high axillary lymph node (ALN) burden in breast cancer and to develop a preliminary risk estimation model.

Approach:

• Study Design: Retrospective study including 100 patients with primary breast cancer who underwent modified radical mastectomy.
• Data Analysis: Logistic regression analysis was used to assess the association between TC and nodal burden, adjusting for tumor size.
• Model Evaluation: Model performance was evaluated using receiver operating characteristic analysis and bootstrap internal validation.

Key Findings:

• High ALN burden occurred in 25% of patients.
• Higher TC levels were associated with increased odds of high nodal burden (OR = 1.56 per 1 mmol/L increase; 95% CI: 1.07–2.38; P = 0.026).
• No significant association was observed in univariate analysis.
• The optimism-corrected C-index was 0.61, indicating limited discriminative performance.

Interpretation:

Preoperative total cholesterol was associated with axillary nodal burden in breast cancer; however, findings are exploratory due to limited sample size, low event rate, and poor model performance.

Limitations:

• Limited sample size and low event rate.
• Absence of key confounders.
• Poor model performance and limited discriminative ability.

Conclusion:

The proposed model is not suitable for clinical application and requires further validation in larger studies.