Prediction of intraductal cancer microinfiltration based on the hierarchical fusion of peri-tumor imaging histology and dual view deep learning.

objectiveThe aim of this study was to develop a multimodal fusion model for accurate risk prediction and clinical decision support for ductal carcinoma in-situ (DCIS).

methodBy integrating deep learning (DL), radiomics and clinical features, this study constructed the combined model and validated its performance in a multicenter cohort containing 232 patients (103 in the training set, 43 in the validation set and 86 in the external test set).

resultsUnimodal DL models showed significant overfitting in external tests (e.g., DenseNet201 training set AUC = 0.85 vs. test set 1 AUC = 0.47), whereas the multimodal fusion model achieved optimal predictive performance across cohorts through heterogeneous data synergy (training set AUC = 0.925, test set 2 AUC = 0.801) with the DeLong test confirmed that it significantly outperformed the unimodal model (P < 0.05). Grad-CAM visualization showed that the model focus region was highly consistent with the radiologist annotation (81% overlap, Cohen's κ = 0.68). Calibration curves (Hosmer-Leeshawn test P > 0.05) and decision curve analysis (DCA) validated the model prediction reliability (error < 5%) with a net clinical benefit advantage (net benefit difference of 7% to 28% at thresholds of 5% to 80%).

conclusionThe multimodal fusion strategy could potentially mitigate the limitations of unimodal models, presenting a potential solution with promising high accuracy and interpretability for individualized diagnosis and treatment of DCIS.