ArticleBreast cancer research : BCR2024
Image analysis-based identification of high risk ER-positive, HER2-negative breast cancers.
Article in Breast cancer research : BCR, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- A Landmark-Guided Dual-Stream Synergistic Framework for Automated Intracranial Aneurysm Detection in Magnetic Resonance Angiography.Journal of imaging informatics in medicine · 2026Article
- Towards interpretable prediction of recurrence risk in breast cancer using pathology foundation models.NPJ digital medicine · 2026Article
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8 authors.
Funding
Abstract
backgroundBreast cancer subtypes Luminal A and Luminal B are classified by the expression of PAM50 genes and may benefit from different treatment strategies. Machine learning models based on H&E images may contain features associated with subtype, allowing early identification of tumors with higher risk of recurrence.
methodsH&E images (n = 630 ER+/HER2-breast cancers) were pixel-level segmented into epithelium and stroma. Convolutional neural network and multiple instance learning were used to extract image features from original and segmented images. Patient-level classification models were trained to discriminate Luminal A versus B image features in tenfold cross-validation, with or without grade adjustment. The best-performing visual classifier was incorporated into envisioned diagnostic protocols as an alternative to genomic testing (PAM50). The protocols were then compared in time-to-recurrence models.
resultsAmong ER+/HER2-tumors, the image-based protocol differentiated recurrence times with a hazard ratio (HR) of 2.81 (95% CI: 1.73-4.56), which was similar to the HR for PAM50 (2.66, 95% CI: 1.65-4.28). Grade adjustment did not improve subtype prediction accuracy, but did help balance sensitivity and specificity. Among high grade participants, sensitivity and specificity (0.734 and 0.474, respectively) became more similar (0.732 and 0.624, respectively) in grade-adjusted models. The original and epithelium-specific images had similar performance and highest accuracy, followed by stroma or binarized images showing only the epithelial-stromal interface.
conclusionsGiven low rates of genomic testing uptake nationally, image-based methods may help identify ER+/HER2-patients who could benefit from testing.
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