Axillary lymph node (ALN) status is an important prognostic factor for overall breast cancer survival. The number of axillary lymph node metastases is closely related to the risk of distant metastasis1. Accurate identiﬁcation of axillary lymph node involvement in patients with breast cancer is crucial for prognosis and treatment strategy decisions. Axillary lymph node dissection (ALND) is currently the standard procedure for determining ALN status. Sentinel lymph node biopsy was used to determine whether axillary lymph node dissection was needed, which is invasive2. Image based non-invasive predictors of axillary lymph nodes are highly desirable, and currently face challenges. The aim of this study was to develop and validate a radiomics nomogram that incorporates both the radiomics signature and clinicopathologic risk factors for individual preoperative prediction of axillary lymph node metastasis in patients with breast cancer.