Decoding the molecular subtypes of breast cancer seen on multimodal ultrasound images using an assembled convolutional neural network model: A prospective and multicentre study
Bo-Yang Zhou,
Li-Fan Wang,
Hao-Hao Yin,
Ting-Fan Wu,
Tian-Tian Ren,
Chuan Peng,
De-Xuan Li,
Hui Shi,
Li-Ping Sun,
Chong-Ke Zhao,
Hui-Xiong Xu
Affiliations
Bo-Yang Zhou
Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
Li-Fan Wang
Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
Hao-Hao Yin
Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
Ting-Fan Wu
Translational Medicine Team, GE Healthcare, Shanghai, China
Tian-Tian Ren
Department of Medical Ultrasound, Ma'anshan People's Hospital, Ma'anshan, China
Chuan Peng
Department of Medical Ultrasound, Sun Yat-Sen University Cancer Center, Guangzhou, China
De-Xuan Li
Beijing XiaoBaiShiJi Network Technical Co., Ltd, Beijing, China
Hui Shi
Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
Li-Ping Sun
Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
Chong-Ke Zhao
Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China; Corresponding authors at: Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
Hui-Xiong Xu
Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China; Corresponding authors at: Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
Background: Preoperative determination of breast cancer molecular subtypes facilitates individualized treatment plan-making and improves patient prognosis. We aimed to develop an assembled convolutional neural network (ACNN) model for the preoperative prediction of molecular subtypes using multimodal ultrasound (US) images. Methods: This multicentre study prospectively evaluated a dataset of greyscale US, colour Doppler flow imaging (CDFI), and shear-wave elastography (SWE) images in 807 patients with 818 breast cancers from November 2016 to February 2021. The St. Gallen molecular subtypes of breast cancer were confirmed by postoperative immunohistochemical examination. The monomodal ACNN model based on greyscale US images, the dual-modal ACNN model based on greyscale US and CDFI images, and the multimodal ACNN model based on greyscale US and CDFI as well as SWE images were constructed in the training cohort. The performances of three ACNN models in predicting four- and five-classification molecular subtypes and identifying triple negative from non-triple negative subtypes were assessed and compared. The performance of the multimodal ACNN was also compared with preoperative core needle biopsy (CNB). Finding: The performance of the multimodal ACNN model (macroaverage area under the curve [AUC]: 0.89–0.96) was superior to that of the dual-modal ACNN model (macroaverage AUC: 0.81–0.84) and the monomodal ACNN model (macroaverage AUC: 0.73–0.75) in predicting four-classification breast cancer molecular subtypes, which was also better than that of preoperative CNB (AUC: 0.89–0.99 vs. 0.67–0.82, p < 0.05). In addition, the multimodal ACNN model outperformed the other two ACNN models in predicting five-classification molecular subtypes (AUC: 0.87–0.94 vs. 0.78-0.81 vs. 0.71–0.78) and identifying triple negative from non-triple negative breast cancers (AUC: 0.934–0.970 vs. 0.688–0.830 vs. 0.536–0.650, p < 0.05). Moreover, the multimodal ACNN model obtained satisfactory prediction performance for both T1 and non-T1 lesions (AUC: 0.957–0.958 and 0.932–0.985). Interpretation: The multimodal US-based ACNN model is a potential noninvasive decision-making method for the management of patients with breast cancer in clinical practice. Funding: This work was supported in part by the National Natural Science Foundation of China (Grants 81725008 and 81927801), Shanghai Municipal Health Commission (Grants 2019LJ21 and SHSLCZDZK03502), and the Science and Technology Commission of Shanghai Municipality (Grants 19441903200, 19DZ2251100, and 21Y11910800).
