Multimodal Prediction of Breast Cancer Relapse Prior to Neoadjuvant Chemotherapy Treatment

Abstract

Neoadjuvant chemotherapy (NAC) is one of the treatment options for women diagnosed with breast cancer, in which chemotherapy is administered prior to surgery. In current clinical practice, it is not possible to predict whether the patient is likely to encounter a relapse after treatment and have the breast cancer reoccur in the same place. If this outcome could be predicted prior to the start of NAC, it could inform therapeutic options. We explore the use of multimodal imaging and clinical features to predict the risk of relapse following NAC treatment. We performed a retrospective study on a cohort of 1738 patients who were administered with NAC. Of these patients, 567 patients also had magnetic resonance imaging (MRI) taken before the treatment started. We analyzed the data using deep learning and traditional machine learning algorithms to increase the set of discriminating features and create effective models. Our results demonstrate the ability to predict relapse prior to NAC treatment initiation, using each modality alone. We then show the possible improvement achieved by combining MRI and clinical data, as measured by the AUC, sensitivity, and specificity. When evaluated on holdout data, the overall combined model achieved 0.735 AUC and 0.438 specificity at a sensitivity operation point of 0.95. This means that almost every patient encountering relapse will also be correctly classified by our model, enabling the reassessment of this treatment prior to its start. Additionally, the same model was able to correctly predict in advance 44% of the patients that would not encounter relapse.