Deep-Learning Solution Providing Molecular Marker Subtyping of Breast Cancer Whole Slide Images: Protocol for a UK Clinical Service Evaluation Study.

Abstract

BACKGROUND: As the histopathology workforce continues to struggle and service demand continues to increase, it has become prudent to consider viable avenues to try to alleviate diagnostic workload burden. One such avenue is computer-based technologies (CBTs). Breast cancer (BC) is the most common malignant neoplasm in the United Kingdom and requires additional testing for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) status at the time of histological diagnosis. This makes BC diagnostics a promising candidate for the application of an efficient CBT. However, for clinical acceptance, these technologies must prove that they work within a real-life diagnostic environment.

OBJECTIVE: We present a study protocol for a prospective clinical service evaluation aimed to validate a UK Conformity Assessed-marked CBT's ability to provide ER, PR, and HER2 results for invasive BCs from scanned hematoxylin and eosin-stained whole slide images.

METHODS: This protocol has been designed to use and mimic a preexisting digital pathology workflow within a National Health Service tertiary referral cancer center without disrupting normal patient care. Eligible cases are identified prospectively through the laboratory information management system, and their whole slide images are extracted from the clinical digital workflow. After verification of national data opt-out status and the exclusion of appropriate cases (N=400 analyzable cases), these cases are analyzed on a dedicated computer in parallel to the existing clinical workflow by a UK Conformity Assessed-marked deep learning-based CBT in a separate environment, providing results for ER, PR, and HER2 status. These results are compared to the ER, PR, and HER2 status reported on the corresponding pathology report. To evaluate the CBT's performance, a range of accepted concordance measures will be applied, including specificity, sensitivity, false-positive rate, false-negative rate, positive predictive value, and negative predictive value. Moreover, time stamps representing the duration of image analysis will also be collected.

RESULTS: This study started in April 2025. There are no results to present, as this paper focuses on study design, and results have yet to be generated. As of March 2026, overall, 366 potentially analyzable cases have been collected. The anticipated end date of the study is May 2026 (400-case target). Results will be presented in a separate publication.

CONCLUSIONS: This design assesses a CBT within a clinical environment while effectively eliminating any unwanted effects on patient care. This type of service evaluation provides a useful step to establish confidence in a CBT before trialing its effect on patient care. It also offers the opportunity to support interventional randomized controlled trials, health economic evaluations, and usability studies. This protocol will hopefully prove useful to others who wish to conduct a similar service evaluation at their own institution.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/76785.