SUMMARY

DETERMINING BREAST
CANCER BIOMARKER
STATUS AND ASSOCIATED
MORPHOLOGICAL
FEATURES USING DEEP
LEARNING
Breast cancer diagnosis and characterization requires evaluation of biomarkers that
are within or on the surface of tumor cells.

These include estrogen receptor, progesterone receptor and human epidermal growth
factor receptor 2 or HER2.

The levels of these markers determine how the person with breast cancer is treated
in the clinical setting.

The study explores the ability of artificial intelligence to determine the status of these
markers in digitized images without the need for immunohistochemical staining.

The study demonstrates that artificial intelligence can predict the status of all 3
biomarkers in pathology images and additional testing identifies specific imaging
features that enable these predictions.

This type of study and approach can reduce costs and time needed to improve the
quality of biomarker detection.

METHODS

Three deep learning systems or DLS were developed to predict

the status of estrogen receptor, progesterone receptor and
HER2 proteins. Both for images of focal tissue regions (patches)
and for slides with H&E, which were used as input (both).

All 3 DLS models were trained and evaluated using pathologist

annotated slides.

ROC curves were calculated for both patch and slide testing:
>135 million patches, 181 slides. 3274 slides, 1249 cases, 37
sites

Interpretability analysis was performed with a TCAV (Concept

activation vectors) test, saliency analysis and a pathologist
review of the pooled patches.
SUMMARY

RESULTS

The ROC curves for the patch level are: 0.9339 (65%
confidence interval 0.936 - 0.941), 0.938 (0.936-0.940) and
0.808 (0.802-0.813) for estrogen receptor, progesterone
receptor and HER2 respectively.

The ROC curves for slide level are: 0.86 (95% confidence
interval 0.84-0.87), 0.75 (0.73-0.77) and 0.6 (0.56-0.64) for
estrogen receptor, progesterone receptor and HER2
respectively.

Interpretability analyses show known associations between

biomarkers with histology/histomorphology among which low
grade and lobular histology associations with estrogen receptor
and progesterone receptor positivity. also an inflammatory
infiltrate with triple negative staining.

(GAMBLE ET AL., 2021)

CONCLUSIONS

This research presents a rapid estimation of biomarkers

important in the diagnosis, prognosis and treatment of breast
cancer from slides routinely stained with hematoxylin eosin. It
further adds to previous advances made in prioritizing the
interpretability of features learned by artificial intelligence in the
context of background pathological knowledge
SUMMARY

REFERENCES

Gamble, P., Jaroensri, R., Wang, H., Tan, F., Moran, M., Brown,
T., Flament-auvigne, I., Rakha, E. A., Toss, M., Dabbs, D. J.,
Regitnig, P., Olson, N., Wren, J. H., Robinson, C., Corrado, G.
S., Peng, L. H., Liu, Y., Mermel, C. H., Steiner, D. F., & Chen, P.
C. (2021). learning. 1–12.

AUTHOR: JUAN FELIPE DUARTE

ZAMBRANO