ArticleBreast cancer research : BCR2026
Enhancing lymph node metastases assessment in breast cancer post-neoadjuvant therapy using artificial intelligence-driven diagnostics.
Article in Breast cancer research : BCR, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNeoadjuvant therapy (NAT) is crucial for locally advanced breast cancer, but post-NAT lymph node assessment is challenging due to histological changes. Current methods like immunohistochemistry (IHC) are labor-intensive and imprecise in distinguishing isolated tumor cells (ITCs), micro-metastases (Micro), and macro-metastases (Macro). We aimed to develop and validate an AI-driven model for precise classification of lymph node metastasis status (negative, ITC, Micro, Macro) in breast cancer patients post-NAT.
methodsWe used a weakly supervised Clustering-constrained Attention Multiple Instance Learning (CLAM) framework to analyze 7764 lymph node samples from 7 cohorts. The CLAM model identifies high-diagnostic-value subregions within whole-slide images (WSIs) and generates high-resolution interpretability heatmaps. Performance was evaluated using binary and multi-class metrics, with external validation on diverse datasets. A human-AI comparative analysis was conducted on 24 patient-derived lymph node sections.
resultsThe AI model achieved an AUROC of 0.97 (95% CI: 0.962-0.977) in binary classification and an overall accuracy of 0.8436 (95% CI: 0.8282-0.8562) for multi-class differentiation. In the human-AI comparison, the model outperformed junior pathologists, reducing diagnostic discrepancies by 83%.
conclusionThis study establishes a robust AI model that significantly improves the accuracy and efficiency of post-NAT lymph node metastasis assessment in breast cancer, automating classification and reducing pathologist workload.
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