New research confirms the role of Tumour Infiltrating Lymphocytes (TILs), measured using an Artificial Intelligence (AI) based tool (CPath TILs), in predicting long-term outcomes for Ductal Carcinoma in Situ (DCIS), a pre-invasive stage of breast cancer.
Using randomised data from the UK/ANZ DCIS trial in the first, largest and most robust investigation of automated estimation of TILs, researchers address the problem of overdiagnosis for patients with DCIS. Previous studies of the role of TILs in DCIS encountered problems with bias and confounding, and relied on variable and tedious manual counting of TILs.
The study shows that a high density of TILs is associated with a 3-fold higher risk of progression to invasive breast cancer, an outcome patients and clinicians are most interested in preventing through use of adjuvant treatments. Results also show that tumours with a high density of these tumour infiltrating immune cells derive greater benefit from adjuvant radiotherapy, and therefore that using this AI-based biomarker will help in personalised treatment selection.
This work provides a new way to help distinguish and identify those women with DCIS who would benefit from radiation therapy over and above surgery, from women who could be spared overtreatment in the form of radiation therapy.
Researchers say that, because the assay is non-tissue destructive, it could be provided at lower cost to women with DCIS all over the world, to help in more informed treatment decision making.
Senior co-author Mangesh Thorat said: We have done two key things here. Firstly, using the material from a randomised trial, we employed a very robust study design. This allowed us to eliminate limitations of previous studies and evaluate the biomarker in the best possible manner. Secondly, we harnessed the potential of AI to measure biomarker in a very precise quantitative manner, something humans cannot easily do. The result is that we have a robust biomarker that not only predicts which patients are at a substantially higher risk of progressing to invasive breast cancer but also tells us which subgroup of patients can avoid radiotherapy and thus help us prevent overtreatment.
This study was conducted by WIPH researchers with colleagues from Emory University, Atlanta, Georgia. The work was funded by Cancer Research UK, the US National Cancer Institute and the Breast Cancer Research Foundation, New York (NY, USA).
Haojia Li, Arpit Aggarwal, Paula Toro, Pingfu Fu, Sunil S Badve, Jack Cuzick, Anant Madabhushi, Mangesh Thorat. A Prognostic and Predictive Computational Pathology Immune Signature for ductal carcinoma in situ: Results from a cohort within the UK/ANZ DCIS randomized trial. Lancet Digital Health https://doi.org/10.1016/ S2589-7500(24)00116-X