Evidence mapPaperPMID 40440915Full record

ArticleEBioMedicine2025

Deep learning for predicting invasive recurrence of ductal carcinoma in situ: leveraging histopathology images and clinical features.

Shannon Doyle, Esther H Lips, Eric Marcus, Lennart Mulder, Yat-Hee Liu, Francesco Dal Canton, Timo Kootstra, Maartje M van Seijen, Ihssane Bouybayoune, Elinor J Sawyer and 6 more

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Article in EBioMedicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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2citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Shannon DoyleDivision of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Informatics Institute, University of Amsterdam, Amsterdam, the Netherlands.
Esther H LipsDivision of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
Eric MarcusDivision of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Informatics Institute, University of Amsterdam, Amsterdam, the Netherlands.
Lennart MulderDivision of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
Yat-Hee LiuDivision of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
Francesco Dal CantonDepartment of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
Timo KootstraDepartment of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
Maartje M van SeijenDepartment of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
Ihssane BouybayouneSchool of Cancer & Pharmaceutical Sciences, King's College London, UK.
Elinor J SawyerSchool of Cancer & Pharmaceutical Sciences, King's College London, UK.
Alastair M ThompsonDepartment of Surgery, Baylor College of Medicine, Houston, TX, USA.
Sarah E PinderSchool of Cancer & Pharmaceutical Sciences, King's College London, UK.
Clara I SánchezInformatics Institute, University of Amsterdam, Amsterdam, the Netherlands.
Jonas TeuwenDivision of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Medical Imaging, Radboud University Nijmegen, Nijmegen, the Netherlands.
Jelle WesselingDivision of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: j.wesseling@nki.nl.
Grand Challenge PRECISION ConsortiumDivision of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDuctal Carcinoma In Situ (DCIS) can progress to ipsilateral invasive breast cancer (IBC) but over 75% of DCIS lesions do not progress if untreated. Currently, DCIS that might progress to IBC cannot reliably be identified. Therefore, most patients with DCIS undergo treatment resembling IBC. To facilitate identification of low-risk DCIS, we developed deep learning models using histology whole-slide images (WSIs) and clinico-pathological data.

methodsWe predicted invasive recurrence in patients with primary, pure DCIS treated with breast-conserving surgery using clinical Cox proportional hazards models and deep learning. Deep learning models were trained end-to-end with only WSIs or in combination with clinical data (integrative). We employed nested k-fold cross-validation (k = 5) on a Dutch multicentre dataset (n = 558). Models were also tested on the UK-based Sloane dataset (n = 94).

findingsEvaluated over 20 years on the Dutch dataset, deep learning models using only WSIs effectively stratified patients into low-risk (no recurrence) and high-risk (invasive recurrence) groups (negative predictive value (NPV) = 0.79 (95% CI: 0.74-0.83); hazard ratio (HR) = 4.48 (95% CI: 3.41-5.88, p < 0.0001); area under the receiver operating characteristic curve (AUC) = 0.75 (95% CI: 0.70-0.79)). Integrative models achieved similar results with slightly enhanced hazard ratios compared to the image-only models (NPV = 0.77 (95% CI 0.73-0.82); HR = 4.85 (95% CI 3.65-6.45, p < 0.0001); AUC = 0.75 (95% CI 0.7-0.79)). In contrast, clinical models were borderline significant (NPV = 0.64 (95% CI 0.59-0.69); HR = 1.37 (95% CI 1.03-1.81, p = 0.041); AUC = 0.57 (95% CI 0.52-0.62)). Furthermore, external validation of the models was unsuccessful, limited by the small size and low number of cases (22/94) in our external dataset, WSI quality, as well as the lack of well-annotated datasets that allow robust validation.

interpretationDeep learning models using routinely processed WSIs hold promise for DCIS risk stratification, while the benefits of integrating clinical data merit further investigation. Obtaining a larger, high-quality external multicentre dataset would be highly valuable, as successful generalisation of these models could demonstrate their potential to reduce overtreatment in DCIS by enabling active surveillance for women at low risk.

fundingCancer Research UK, the Dutch Cancer Society (KWF), and the Dutch Ministry of Health, Welfare and Sport.

Indexed as

Breast NeoplasmsCarcinoma, Intraductal, NoninfiltratingDeep LearningNeoplasm Recurrence, LocalAdultAgedFemaleHumansMiddle AgedPrognosisProportional Hazards ModelsROC CurveDeep learningDuctal carcinoma in situMultiomic integrationRisk prediction

Identifiers

PMID40440915
PMCPMC12162051

What Socratic holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.