Deep Learning-Based Recurrence Prediction in HER2-Low Breast Cancer: Comparison of MRI-Alone, Clinicopathologic-Alone, and Combined Models.

To develop a DL-based model predicting recurrence risk in HER2-low breast cancer patients and to compare performance of the MRI-alone, clinicopathologic-alone, and combined models. We analyzed 453 patients with HER2-low breast cancer who underwent surgery and preoperative breast MRI between May 2018 and April 2022. Patients were randomly assigned to either a training cohort ( = 331) or a test cohort ( = 122). Imaging features were extracted from DCE-MRI and ADC maps, with regions of interest manually annotated by radiologists. Clinicopathological features included tumor size, nodal status, histological grade, and hormone receptor status. Three DL prediction models were developed: a CNN-based MRI-alone model, a clinicopathologic-alone model based on a multi-layer perceptron (MLP) and a combined model integrating CNN-extracted MRI features with clinicopathological data via MLP. Model performance was evaluated using AUC, sensitivity, specificity, and F1-score. The MRI-alone model achieved an AUC of 0.69 (95% CI, 0.68-0.69), with a sensitivity of 37.6% (95% CI, 35.7-39.4), specificity of 87.5% (95% CI, 86.9-88.2), and F1-score of 0.34 (95% CI, 0.33-0.35). The clinicopathologic-alone model yielded the highest AUC of 0.92 (95% CI, 0.92-0.92) and sensitivity of 93.6% (95% CI, 93.4-93.8), but showed the lowest specificity (72.3%, 95% CI, 71.8-72.8) and F1-score of 0.50 (95% CI, 0.49-0.50). The combined model demonstrated the most balanced performance, achieving an AUC of 0.90 (95% CI, 0.89-0.91), sensitivity of 80.0% (95% CI, 78.7-81.3), specificity of 83.2% (95% CI: 82.7-83.6), and the highest F1-score of 0.55 (95% CI, 0.54-0.57). The DL-based model combining MRI and clinicopathological features showed superior performance in predicting recurrence in HER2-low breast cancer. This multimodal approach offers a framework for individualized risk assessment and may aid in refining follow-up strategies.