Longitudinal MRI-based fusion novel model predicts pathological complete response in breast cancer treated with neoadjuvant chemotherapy: a multicenter, retrospective study
Open accessAbstract
Background: Accurate identification of pCR to neoadjuvant chemotherapy (NAC) is essential for determining appropriate surgery strategy and guiding resection extent in breast cancer. However, a non-invasive tool to predict pCR accurately is lacking. Our study aims to develop ensemble learning models using longitudinal multiparametric MRI to predict pCR in breast cancer. Methods: From July 2015 to December 2021, we collected pre-NAC and post-NAC multiparametric MRI sequences per patient. We then extracted 14,676 radiomics and 4096 deep learning features and calculated additional delta-value features. In the primary cohort (n = 409), the inter-class correlation coefficient test, U-test, Boruta and the least absolute shrinkage and selection operator regression were used to select the most significant features for each subtype of breast cancer. Five machine learning classifiers were then developed to predict pCR accurately for each subtype. The ensemble learning strategy was used to integrate the single-modality models. The diagnostic performances of models were evaluated in the three external cohorts (n = 343, 170 and 340, respectively). Findings: A total of 1262 patients with breast cancer from four centers were enrolled in this study, and pCR rates were 10.6% (52/491), 54.3% (323/595) and 37.5% (66/176) in HR+/HER2-, HER2+ and TNBC subtype, respectively. Finally, 20, 15 and 13 features were selected to construct the machine learning models in HR+/HER2-, HER2+ and TNBC subtypes, respectively. The multi-Layer Perception (MLP) yields the best diagnostic performances in all subtypes. For the three subtypes, the stacking model integrating pre-, post- and delta-models yielded the highest AUCs of 0.959, 0.974 and 0.958 in the primary cohort, and AUCs of 0.882-0.908, 0.896-0.929 and 0.837-0.901 in the external validation cohorts, respectively. The stacking model had accuracies of 85.0%-88.9%, sensitivities of 80.0%-86.3%, and specificities of 87.4%-91.5% in the external validation cohorts. Interpretation: Our study established a novel tool to predict the responses of breast cancer to NAC and achieve excellent performance. The models could help to determine post-NAC surgery strategy for breast cancer. Funding: This study is supported by grants from the National Natural Science Foundation of China (82171898, 82103093), the Deng Feng project of high-level hospital construction (DFJHBF202109), the Guangdong Basic and Applied Basic Research Foundation (grant number, 2020A1515010346, 2022A1515012277), the Science and Technology Planning Project of Guangzhou City (202002030236), the Beijing Medical Award Foundation (YXJL-2020-0941-0758), and the Beijing Science and Technology Innovation Medical Development Foundation (KC2022-ZZ-0091-5). Funding sources were not involved in the study design, data collection, analysis and interpretation, writing of the report, or decision to submit the article for publication.
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Predicting NAC response in patients with locally advanced breast cancer based on a deep learning algorithm is feasible.
“Researchers found that predicting NAC response in patients with locally advanced breast cancer based on a deep learning algorithm is feasible (13).”
From A multimodal and fully automated system for prediction of pathological complete response to neoadjuvant chemotherapy in breast cancer (2025) · cites this paper as [13]
The Methods (Deep learning analysis) describe a deep-learning model, and the Discussion reports that MRI-based models predicted pathological complete response to NAC in validation cohorts. However, the Study participants section specifies invasive breast cancer, not a locally advanced cohort; the best-performing model also combined radiomics and deep-learning features rather than relying on deep learning alone. (LLM, conf=0.86)
Experimental — accuracy not yet measuredDeep learning can improve the prediction ability of NAC response prediction in breast cancer.
“Many researchers found that deep learning can improve the prediction ability of NAC response prediction in breast cancer (13, 22).”
From A multimodal and fully automated system for prediction of pathological complete response to neoadjuvant chemotherapy in breast cancer (2025) · cites this paper as [13]
The model was developed based on single-center data.
“the model was developed based on single-center data.”
From A multimodal and fully automated system for prediction of pathological complete response to neoadjuvant chemotherapy in breast cancer (2025) · cites this paper as [13]
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- Authors
- Huang, Y., Zhu, T., Zhang, X., Li, W., Zheng, X., Cheng, M., Ji, F., Zhang, L., Yang, C., Wu, Z., Ye, G., Lin, Y., & Wang, K.
- Affiliations
- Guangdong Academy of Medical Sciences (CN)
- Sun Yat-sen University (CN)
- First People's Hospital of Foshan (CN)
- Corresponding author
- Ye, GuoLin
- Lin, Ying
- Wang, Kun
- Venue
- eClinicalMedicine
- Publisher
- Elsevier BV
- Published
- 2023-04
- Volume
- 58
- Pages
- 101899
- ISSN
- 2589-5370 (ISSN-L)
- PMC
- PMC10050775
- OpenAlex
- W4360796946
- Cited by
- 175
- References
- 55
- Citations by year
- 2026: 49 · 2025: 67 · 2024: 46 · 2023: 13
- FWCI
- 28.98
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- EClinicalMedicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- High-level Hospital Construction Project of Guangdong Provincial People's Hospital (DFJHBF202109)
- Basic and Applied Basic Research Foundation of Guangdong Province (2020A1515010346, 2021A1515011570, 2022A1515012277)
- Scientific and Technological Planning Project of Guangzhou City
- National Natural Science Foundation of China (82103093)
- Guangzhou Municipal Science and Technology Project (202002030236, 202102021055)
- Foundation for Innovative Research Groups of the National Natural Science Foundation of China (82171898)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiomics and Machine Learning in Medical Imaging
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › MRI in cancer diagnosis
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Keywords
- breast cancer, pathological complete response, neoadjuvant chemotherapy, multiparametric MRI, longitudinal MRI, radiomics, deep features, ensemble learning, stacking ensemble, breast cancer subtypes, triple-negative breast cancer, HER2-positive breast cancer, hormone receptor-positive HER2-negative breast cancer, treatment response prediction, feature selection, external validation, multilayer perceptron
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