TopoTxR: A topology-guided deep convolutional network for breast parenchyma learning on DCE-MRIs.

Characterization of breast parenchyma in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a challenging task owing to the complexity of underlying tissue structures. Existing quantitative approaches, like radiomics and deep learning models, lack explicit quantification of intricate and subtle parenchymal structures, including fibroglandular tissue. To address this, we propose a novel topological approach that explicitly extracts multi-scale topological structures to better approximate breast parenchymal structures, and then incorporates these structures into a deep-learning-based prediction model via an attention mechanism. Our topology-informed deep learning model, TopoTxR, leverages topology to provide enhanced insights into tissues critical for disease pathophysiology and treatment response. We empirically validate TopoTxR using the VICTRE phantom breast dataset, showing that the topological structures extracted by our model effectively approximate the breast parenchymal structures. We further demonstrate TopoTxR's efficacy in predicting response to neoadjuvant chemotherapy. Our qualitative and quantitative analyses suggest differential topological behavior of breast tissue in treatment-naïve imaging, in patients who respond favorably to therapy as achieving pathological complete response (pCR) versus those who do not. In a comparative analysis with several baselines on the publicly available I-SPY 1 dataset (N = 161, including 47 patients with pCR and 114 without) and the Rutgers proprietary dataset (N = 120, with 69 patients achieving pCR and 51 not), TopoTxR demonstrates a notable improvement, achieving a 2.6% increase in accuracy and a 4.6% enhancement in AUC compared to the state-of-the-art method.