Comprehensive Summary
This study by Xu et al. developed a predictive fusion model combining multi sequence MRI radiomics, deep learning features, and habitat imaging, to predict pathological complete response (pCR) in breast cancer patients that were undergoing neoadjuvant therapy (NAT). A retrospective analysis of 203 patients (training = 162, test = 41) used T2 weighted imaging, diffusion weighted imaging, and dynamic contrast enhanced MRI to extract intra tumoral and peri tumoral radiomics features. Habitat imaging segmented tumors into biologically distinct subregions to capture heterogeneity. Deep learning features were also used to enrich tumor representation. The fusion model outperformed both single sequence and single region models, achieving an AUC of 0.913 on the test set, with an improved precision recall balance and a higher clinical benefit based off a decision curve analysis. SHAP identified DCE_LLL_DependenceUniformity as the strongest predictor of pCR, while PC72 indicated non pCR outcomes, and LIME provided patient specific interpretability. Overall, the authors concluded that combining radiomics, habitat imaging, and deep learning in this fusion model creates a comprehensive and non-invasive framework for improving pCR prediction.
Outcomes and Implications
This research shows an approach to personalizing breast cancer treatment by predicting patient responses to neoadjuvant therapy before surgery. The ability to identify likely responders allows clinicians to consider less invasive surgical strategies, while early recognition of non responders allows for quicker adjustments to alternative therapies. Because the model relies entirely on widely available MRI sequences, it offers strong clinical feasibility without requiring additional procedures or specialized imaging. The integration of SHAP and LIME into the model enhances model transparency, making its predictions more understandable and trustworthy for physicians. While the results are promising, the authors noted that multicenter studies and workflow integration are necessary before clinical use. If validated, this model could have an important role in advancing precision oncology and improving treatment outcomes for breast cancer patients.