Prediction of pathological complete response to neoadjuvant chemotherapy in breast cancer using a deep learning (DL) method

Abstract Background The aim of the study was to develop a deep learning (DL) algorithm to evaluate the pathological complete response (pCR) to neoadjuvant chemotherapy in breast cancer. Methods A total of 302 breast cancer patients in this retrospective study were randomly divided into a training set ( n = 244) and a validation set ( n = 58). Tumor regions were manually delineated on each slice by two expert radiologists on enhanced T1‐weighted images. Pathological results were used as ground truth. Deep learning network contained five repetitions of convolution and max‐pooling layers and ended with three dense layers. The pre‐NAC model and post‐NAC model inputted six phases of pre‐NAC and post‐NAC images, respectively. The combined model used 12 channels from six phases of pre‐NAC and six phases of post‐NAC images. All models above included three indexes of molecular type as one additional input channel. Results The training set contained 137 non‐pCR and 107 pCR participants. The validation set contained 33 non‐pCR and 25 pCR participants. The area under the receiver operating characteristic (ROC) curve (AUC) of three models was 0.553 for pre‐NAC, 0.968 for post‐NAC and 0.970 for the combined data, respectively. A significant difference was found in AUC between using pre‐NAC data alone and combined data ( P < 0.001). The positive predictive value of the combined model was greater than that of the post‐NAC model (100% vs. 82.8%, P = 0.033). Conclusion This study established a deep learning model to predict PCR status after neoadjuvant therapy by combining pre‐NAC and post‐NAC MRI data. The model performed better than using pre‐NAC data only, and also performed better than using post‐NAC data only. Key points Significant findings of the study. It achieved an AUC of 0.968 for pCR prediction. It showed a significantly greater AUC than using pre‐NAC data only. What this study adds This study established a deep learning model to predict PCR status after neoadjuvant therapy by combining pre‐NAC and post‐NAC MRI data.