ARTIFICIAL INTELLIGENCE IN BREAST CANCER IMMUNE INFILTRATION PATHOLOGY IMAGING

Authors

  • Jumaniyazova Shakhnoza Iskanderovna Tashkent State Medical University, Physiology and Pathological Anatomy Department

DOI:

https://doi.org/10.55640/

Keywords:

Breast cancer, tumor-infiltrating lymphocytes (TILs), artificial intelligence, deep learning, computational pathology, whole slide imaging, stromal TILs, foundation models, U-Net, StarDist, QuPath, spatial analysis, digital pathology, neoadjuvant chemotherapy, immunotherapy biomarkers, tumor microenvironment.

Abstract

Breast cancer prognosis and treatment response depend on tumor-infiltrating lymphocytes (TILs) within the tumor microenvironment, but manual assessment of H&E-stained slides suffers from inter-observer variability and labor intensity. This review paper synthesizes current evidence on artificial intelligence (AI), particularly deep learning, for automated TIL quantification in whole slide images (WSIs) of breast cancer pathology. The review examines convolutional neural networks (e.g., U-Net, StarDist) for cell detection and segmentation, foundation models (e.g., ECTIL) for label-efficient learning, open-source pipelines (e.g., QuPath), and multimodal approaches integrating spatial TIL patterns, tertiary lymphoid structures, and multiomics data. AI methods show strong concordance with expert pathologist assessments across multi-center cohorts, provide independent prognostic value for patient survival, and offer improved prediction of neoadjuvant chemotherapy response over manual scoring. Label-efficient foundation models reduce annotation demands while preserving clinical utility, and spatial analyses of TIL distribution and cellular interactions yield additional biological insights. Challenges encompass staining variability, generalization across breast cancer subtypes and populations, and clinical workflow integration. Future directions include standardization efforts, regulatory approval pathways, real-time decision support for pathologists, and broader application to multiplexed immune profiling for immunotherapy guidance. This review highlights AI's potential to standardize TIL assessment and advance precision breast cancer pathology.

Downloads

Download data is not yet available.

References

[1] Y. Schirris et al., "ECTIL: Label-efficient Computational Tumour Infiltrating Lymphocyte (TIL) assessment in breast cancer: Multicentre validation in 2,340 patients with breast cancer," arXiv, 2025. doi: 10.48550/arxiv.2501.14379

[2] M. González-Farré et al., "Automated quantification of stromal tumour infiltrating lymphocytes is associated with prognosis in breast cancer," Virchows Archiv, 2023. doi: 10.1007/s00428-023-03608-4

[3] M. Rasic et al., "AI assessment of tumor-infiltrating lymphocytes on routine H&E-slides as a predictor of response to neoadjuvant therapy in breast cancer—a real-world study," Virchows Archiv, 2025. doi: 10.1007/s00428-025-04283-3

[4] Y. Xi et al., "Prognostic value of tumor-infiltrating lymphocytes (TILs) in Luminal breast cancer: A novel computational method for assessing TILs abundance and spatial distribution patterns," The Breast, 2025. doi: 10.1016/j.breast.2025.104634

[5] S. Makhlouf et al., "Evaluation of tumour infiltrating lymphocytes in luminal breast cancer using artificial intelligence," Cell Biology and Immunology of Leukocyte Function, 2023. doi: 10.1038/s41416-023-02451-3

[6] K. Kobayashi et al., "AI-based quantification of TILs using hematoxylin and eosin and immunohistochemistry-stained slides in triple-negative breast cancer," Journal of Clinical Oncology, vol. 42, no. 16_suppl, p. e13608, 2024. doi: 10.1200/jco.2024.42.16_suppl.e13608

[7] C. Lu et al., "Deep-learning–based characterization of tumor-infiltrating lymphocytes in breast cancers from histopathology images and multiomics data," JCO Clinical Cancer Informatics, 2020. doi: 10.1200/CCI.19.00126

[8] J. Lee et al., "Artificial intelligence (AI)–powered spatial analysis of tumor-infiltrating lymphocytes (TIL) for prediction of response to neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC)," Journal of Clinical Oncology, vol. 40, no. 16_suppl, p. 595, 2022. doi: 10.1200/jco.2022.40.16_suppl.595

[9] A. Shephard et al., "An Automated Pipeline for Tumour-Infiltrating Lymphocyte Scoring in Breast Cancer," in Proc. IEEE ISBI, 2024. doi: 10.1109/isbi56570.2024.10635302

[10] F. Albalawi et al., "Artificial intelligence based quantification of T lymphocyte infiltrate predicts prognosis in high grade breast cancer using deep learning and statistical validation."

[11] D. Fassler, "Digital Pathology-Based Approaches for Assessing the Tumor Microenvironment: Surveys of the Immune Landscape and Patient Prognosis."

[12] M. Rijthoven et al., "Tumor-infiltrating lymphocytes in breast cancer through artificial intelligence: biomarker analysis from the results of the TIGER challenge," medRxiv, 2025. doi: 10.1101/2025.02.28.25323078

[13] Y. Bai et al., "An open-source, automated tumor-infiltrating lymphocyte algorithm for prognosis in triple-negative breast cancer."

[14] A. Shephard et al., "An Automated Pipeline for Tumour-Infiltrating Lymphocyte Scoring in Breast Cancer," arXiv.org, 2023. doi: 10.48550/arxiv.2311.06185

[15] "TIAger: Tumor-Infiltrating Lymphocyte Scoring in Breast Cancer for the TiGER Challenge 2022," arXiv, 2022. doi: 10.48550/arxiv.2206.11943

[16] Y. Xie et al., "Focal hotspot and diffuse immune subtypes of tumor-infiltrating lymphocytes: AI-powered spatial clustering classification and its clinical relevance to HER2 expression in triple-negative breast cancer," Journal of Translational Medicine, 2025. doi: 10.1186/s12967-025-07608-7

[17] M. Kushnarev et al., "Abstract P6-04-15: AI-based prediction of tertiary lymphoid structures and lymphocyte immune infiltration in breast carcinomas," Cancer Research, 2023. doi: 10.1158/1538-7445.sabcs22-p6-04-15

[18] M. Yosofvand et al., "Automated Detection and Scoring of Tumor-Infiltrating Lymphocytes in Breast Cancer Histopathology Slides," Cancers, vol. 15, no. 14, p. 3635, 2023. doi: 10.3390/cancers15143635

[19] I. Zerdes et al., "309P Machine learning-based characterization of tumor-immune microenvironment at a spatial and multiplexed resolution in early breast cancer: A sub-study of the EORTC 10994/BIG 1-00 randomized phase III trial with long-term follow-up," Annals of Oncology, 2023. doi: 10.1016/j.annonc.2023.09.505

[20] D. Krijgsman et al., "Quantitative whole slide assessment of tumor-infiltrating CD8-positive lymphocytes in ER-positive breast cancer in relation to clinical outcome," IEEE Journal of Biomedical and Health Informatics, 2021. doi: 10.1109/JBHI.2020.3003475

[21] C. Sun et al., "A computational tumor-infiltrating lymphocyte assessment method comparable with visual reporting guidelines for triple-negative breast cancer," EBioMedicine, 2021. doi: 10.1016/J.EBIOM.2021.103492

[22] S. Cho et al., "Abstract P4-05-07: Assistance with an artificial intelligence-powered tumor infiltrating lymphocytes (TIL) analyzer reduces interobserver variation in pathologic scoring of TIL in breast cancer," Cancer Research, 2022. doi: 10.1158/1538-7445.sabcs21-p4-05-07

[23] Y. Schirris et al., "1240P Multi-centric validation of an AI-based sTIL% scoring model for breast cancer H&E whole-slide images," Annals of Oncology, 2023. doi: 10.1016/j.annonc.2023.09.2329

[24] M. Tafavvoghi et al., "Automating tumor-infiltrating lymphocyte assessment in breast cancer histopathology images using QuPath: a transparent and accessible machine learning pipeline," arXiv, 2025. doi: 10.48550/arxiv.2504.16979

[25] A. Arab et al., "Assessment of machine learning algorithms for TILs scoring using whole slide images: comparison with pathologists," in Proc. SPIE, vol. 12933, 2024. doi: 10.1117/12.3008518

[26] H. Le et al., "Utilizing Automated Breast Cancer Detection to Identify Spatial Distributions of Tumor Infiltrating Lymphocytes in Invasive Breast Cancer," arXiv: Image and Video Processing, 2019.

[27] M. Amgad et al., "Joint Region and Nucleus Segmentation for Characterization of Tumor Infiltrating Lymphocytes in Breast Cancer," in Proc. SPIE, vol. 10956, 2019. doi: 10.1117/12.2512892

[28] I. Nederlof et al., "Spatial interplay of lymphocytes and fibroblasts in estrogen receptor-positive HER2-negative breast cancer," NPJ Breast Cancer, 2022. doi: 10.1038/s41523-022-00416-y

[29] K. Fanucci et al., "Image analysis-based tumor infiltrating lymphocytes measurement predicts breast cancer pathologic complete response in SWOG S0800 neoadjuvant chemotherapy trial," NPJ Breast Cancer, 2023. doi: 10.1038/s41523-023-00535-0

[30] Y. Chen et al., "Artificial Intelligence in digital pathology of breast cancer, new era of practice?" International Journal of Surgery, 2025. doi: 10.1097/js9.0000000000002953

Downloads

Published

2026-04-06

How to Cite

ARTIFICIAL INTELLIGENCE IN BREAST CANCER IMMUNE INFILTRATION PATHOLOGY IMAGING. (2026). Journal of Multidisciplinary Sciences and Innovations, 5(4), 299-308. https://doi.org/10.55640/

Similar Articles

1-10 of 1689

You may also start an advanced similarity search for this article.