Deep learning-based radiomics does not improve residual cancer burden prediction post-chemotherapy in LIMA breast MRI trial.

Objectives: This study aimed to evaluate the potential additional value of deep radiomics for assessing residual cancer burden (RCB) in locally advanced breast cancer, after neoadjuvant chemotherapy (NAC) but before surgery, compared to standard predictors: tumor volume and subtype.

Materials And Methods: This retrospective study used a 105-patient single-institution training set and a 41-patient external test set from three institutions in the LIMA trial. DCE-MRI was performed before and after NAC, and RCB was determined post-surgery. Three networks (nnU-Net, Attention U-net and vector-quantized encoder-decoder) were trained for tumor segmentation. For each network, deep features were extracted from the bottleneck layer and used to train random forest regression models to predict RCB score. Models were compared to (1) a model trained on tumor volume and (2) a model combining tumor volume and subtype. The potential complementary performance of combining deep radiomics with a clinical-radiological model was assessed. From the predicted RCB score, three metrics were calculated: area under the curve (AUC) for categories RCB-0/RCB-I versus RCB-II/III, pathological complete response (pCR) versus non-pCR, and Spearman's correlation.

Results: Deep radiomics models had an AUC between 0.68-0.74 for pCR and 0.68-0.79 for RCB, while the volume-only model had an AUC of 0.74 and 0.70 for pCR and RCB, respectively. Spearman's correlation varied from 0.45-0.51 (deep radiomics) to 0.53 (combined model). No statistical difference between models was observed.

Conclusions: Segmentation network-derived deep radiomics contain similar information to tumor volume and subtype for inferring pCR and RCB after NAC, but do not complement standard clinical predictors in the LIMA trial.

Key Points: Question It is unknown if and which deep radiomics approach is most suitable to extract relevant features to assess neoadjuvant chemotherapy response on breast MRI. Findings Radiomic features extracted from deep-learning networks yield similar results in predicting neoadjuvant chemotherapy response as tumor volume and subtype in the LIMA study. However, they do not provide complementary information. Clinical relevance For predicting response to neoadjuvant chemotherapy in breast cancer patients, tumor volume on MRI and subtype remain important predictors of treatment outcome; deep radiomics might be an alternative when determining tumor volume and/or subtype is not feasible.