MRI-based artificial intelligence models for post-neoadjuvant surgery personalization in breast cancer: a narrative review of evidence from Western Pacific

Abstract

Breast magnetic resonance imaging (MRI) is the most sensitive imaging method for diagnosing breast cancer and assessing treatment response. Artificial intelligence (AI) and radiomics offer new opportunities to identify patterns in imaging data, supporting personalized post-neoadjuvant surgical decisions. This paper reviewed breast MRI-based AI models for predicting outcomes after neoadjuvant therapy, with a focus on evidence from the Western Pacific region, to evaluate the quality of existing models, discuss their inherent limitations, and outline potential future directions. A literature search in MEDLINE, EMBASE, and Web of Science identified 51 relevant studies in the region, with the majority conducted in China, followed by South Korea and Japan. Most studies focused on predicting pathologic complete response (pCR), with a median sample size of 152 and largely retrospective single-center designs. Model performance was commonly assessed using validation sets, with pooled sensitivity and specificity for pCR prediction showing promising results. Models incorporating multitemporal MRI features were associated with improved accuracy. While MRI-based AI models show potential for guiding surgical planning, improved methodological quality and algorithmic explainability are needed to facilitate clinical translation.