ArticleInternational journal of surgery (London, England)2026
Noninvasive stratification of HER2 status in breast cancer using multiparametric DECT: a prospective cohort study.
Article in International journal of surgery (London, England), 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
Background: HER2 heterogeneity in breast cancer requires precise stratification for treatment guidance. Differences in dual-energy computed tomography (DECT)-derived parameters among HER2-zero, HER2-low, and HER2-positive breast cancers remain unknown. We aimed to evaluate the performance of DECT-based quantitative parameters to distinguish HER2-zero, HER2-low, and HER2-positive expression status in breast cancer, and to compare the efficacy between DECT-predicted HER2 status and pathological HER2 status in predicting pathologic complete response (pCR). Methods: A total of 469 breast cancer patients who underwent chest DECT for staging (November 2020-May 2023) were prospectively recruited. DECT quantitative parameters, such as the normalized iodine concentration (NIC), the normalized effective atomic number (nZeff), the slope of the spectral Hounsfield unit curve (λHu), and polyenergetic images (PEI), were obtained from reconstructed images. Decision tree models were constructed to classify the HER2-zero, HER2-low, and HER2-positive status based on six DECT parameters. These models were tested for performance using the area under the receiver operating characteristic curve (AUC) in training ( Results: Statistical analysis revealed significant differences in arterial and venous phase NIC, ΔNIC, venous phase λHu, ΔλHu, and venous phase PEI (HU) among HER2 subtypes (all Conclusions: DECT-based quantitative parameters enable noninvasive stratification of HER2-zero, HER2-low, and HER2-positive breast cancers. Additionally, HER2 predicted by DECT outperformed conventional pathological HER2 status in predicting pCR in patients undergoing neoadjuvant chemotherapy.
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