Identification of breast cancer patients with pathologic complete response in the breast after neoadjuvant systemic treatment by an intelligent vacuum-assisted biopsy

André Pfob, Chris Sidey-Gibbons, Han Byoel Lee, Marios Konstantinos Tasoulis, Vivian Koelbel, Michael Golatta, Gaiane M. Rauch, Benjamin D. Smith, Vicente Valero, Wonshik Han, Fiona MacNeill, Walter Paul Weber, Geraldine Rauch, Henry M. Kuerer, Joerg Heil

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Neoadjuvant systemic treatment elicits a pathologic complete response (pCR) in about 35% of women with breast cancer. In such cases, breast surgery may be considered overtreatment. We evaluated multivariate algorithms using patient, tumor, and vacuum-assisted biopsy (VAB) variables to identify patients with breast pCR. Methods: We developed and tested four multivariate algorithms: a logistic regression with elastic net penalty, an Extreme Gradient Boosting (XGBoost) tree, Support Vector Machines (SVM), and neural network. We used data from 457 women, randomly partitioned into training and test set (2:1), enrolled in three trials with stage 1–3 breast cancer, undergoing VAB before surgery. False-negative rate (FNR) and specificity were the main outcome measures. The best performing algorithm was validated in an independent fourth trial. Results: In the test set (n = 152), the logistic regression with elastic net penalty, XGboost tree, SVM, and neural network revealed an FNR of 1.2% (1 of 85 patients with missed residual cancer). Specificity of the logistic regression with elastic net penalty was 52.2% (35 of 67 women with surgically confirmed breast pCR identified), of the XGBoost tree 55.2% (37 of 67), of SVM 62.7% (42 of 67), and of the neural network 67.2% (45 of 67). External validation (n = 50) of the neural network showed an FNR of 0% (0 of 27) and a specificity of 65.2% (15 of 23). Area under the ROC curve for the neural network was 0.97 (95% CI, 0.94–1.00). Conclusion: A multivariate algorithm can accurately select breast cancer patients without residual cancer after neoadjuvant treatment.

Original languageEnglish (US)
Pages (from-to)134-146
Number of pages13
JournalEuropean Journal of Cancer
Volume143
DOIs
StatePublished - Jan 2021

Keywords

  • Artificial intelligence
  • Breast cancer
  • Individualized treatment
  • Machine learning
  • Neoadjuvant systemic treatment
  • Pathologic complete response
  • Surgical oncology
  • Vacuum-assisted biopsy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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