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Review
. 2023 Dec;23(8):800-812.
doi: 10.1016/j.clbc.2023.06.004. Epub 2023 Jun 21.

A Review of AI-Based Radiomics and Computational Pathology Approaches in Triple-Negative Breast Cancer: Current Applications and Perspectives

Affiliations
Review

A Review of AI-Based Radiomics and Computational Pathology Approaches in Triple-Negative Breast Cancer: Current Applications and Perspectives

Germán Corredor et al. Clin Breast Cancer. 2023 Dec.

Abstract

Breast cancer is one of the most common and deadly cancers worldwide. Approximately, 20% of all breast cancers are characterized as triple negative (TNBC). TNBC typically is associated with a poorer prognosis relative to other breast cancer subtypes. Due to its aggressiveness and lack of response to hormonal therapy, conventional cytotoxic chemotherapy is the usual treatment; however, this treatment is not always effective, and an important percentage of patients develop recurrence. More recently, immunotherapy has started to be used on some populations with TNBC showing promising results. Unfortunately, immunotherapy is only applicable to a minority of patients and responses in metastatic TNBC have overall been modest in comparison to other cancer types. This situation evidences the need for developing effective biomarkers that help to stratify and personalize patient management. Thanks to recent advances in artificial intelligence (AI), there has been an increasing interest in its use for medical applications aiming at supporting clinical decision making. Several works have used AI in combination with diagnostic medical imaging, more specifically radiology and digitized histopathological tissue samples, aiming to extract disease-specific information that is difficult to quantify by the human eye. These works have demonstrated that analysis of such images in the context of TNBC has great potential for (1) risk-stratifying patients to identify those patients who are more likely to experience disease recurrence or die from the disease and (2) predicting pathologic complete response. In this manuscript, we present an overview on AI and its integration with radiology and histopathological images for developing prognostic and predictive approaches for TNBC. We present state of the art approaches in the literature and discuss the opportunities and challenges with developing AI algorithms regarding further development and clinical deployment, including identifying those patients who may benefit from certain treatments (e.g., adjuvant chemotherapy) from those who may not and thereby should be directed toward other therapies, discovering potential differences between populations, and identifying disease subtypes.

Keywords: Computational pathology and Radiomics; Deep learning; Machine learning; Predictive biomarkers; Prognostic biomarkers.

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Conflict of interest statement

Disclosures

Dr Madabhushi is an equity holder in Elucid Bioimaging and in Inspirata Inc. In addition, he has served as a scientific advisory board member for Inspirata Inc, AstraZeneca, Bristol Myers Squibb and Merck. Currently, he serves on the advisory board of Aiforia Inc. He also has sponsored research agreements with Philips, AstraZeneca, Boehringer-Ingelheim, and Bristol Myers Squibb. His technology has been licensed to Elucid Bioimaging. He is also involved in a NIH U24 grant with PathCore Inc, and 3 different R01 grants with Inspirata Inc. No potential conflicts of interest were disclosed by the other authors.

Figures

Figure 1.
Figure 1.
General pipeline for TNBC and opportunity areas for AI-based imaging biomarkers. Radiological scans and histopathological tissue samples are usually employed for diagnostic purposes and for guiding the treatment. The integration with AI has the potential to provide complementary information for a more tailored treatment by predicting pathologic complete response (pCR), risk-stratifying patients, and predicting early recurrence.
Figure 2.
Figure 2.
Examples of radiomic and computational pathology approaches using imaging-based predictive and prognostic biomarkers; (a) Tumor segmentation and 3D volumetric reconstruction of whole tumor and peritumoral ring (68) (b) Depiction of mammographic radiomic features and the level of TILs with mass density color overlay showing uneven, smooth mass (top pane in b) and uniform, unsmooth mass (bottom pane in b) (73) ; (c) Breast CE-MRI scans with prognostic radiomic feature Peri_V_DN (71) ; (d) Invasive ductal carcinoma with epithelium (red), stroma (green) and fat (white) cells (54); (e) Intratumor heterogeneity of cancer cell and lymphocyte distributions where the height of the hills represents the density of cells (45); (f) H&E, IF image (shown with higher magnification), and heat map based on density of CD3+ lymphocytes (38).

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