{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:47:51Z","timestamp":1786121271772,"version":"build-2736575974"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically evaluate the utility of multiparametric MRI (mpMRI) combined with radiomics and artificial intelligence (AI) for non-invasive assessment of human epidermal growth factor receptor 2 (HER2) status in breast cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following the PRISMA 2020 guidelines, we searched PubMed, Web of Science, and Embase for studies published between January 2015 and December 2025 (last search: 27 June 2026). After duplicate removal using Zotero, two reviewers independently screened the records. Thirty-four studies were included and assessed using PROBAST, with the 16 radiomics studies additionally evaluated using the RQS. We qualitatively synthesized evidence on conventional MRI, diffusion imaging (DWI\/ADC, IVIM, DKI, and DSI), DCE-MRI, metabolic MRI, and radiomics\/AI approaches without performing a meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>mpMRI sequences provide complementary insights into HER2 status. Advanced diffusion techniques (DKI: *p*\u202f=\u202f0.003; DSI: AUC range, 0.700\u20130.721) and DCE-MRI radiomics provide predictive value by capturing microstructural and dynamic tumor characteristics. Multiparametric radiomics incorporating peritumoral features achieved AUCs of 0.84\u20130.923 for three-level HER2 classification, while radiomics and deep learning distinguished HER2-low from HER2-zero tumors with AUCs up to 0.892. Machine learning and deep learning models demonstrated moderate cross-center generalizability (external AUC, 0.66\u20130.84). However, variability in reference standards, retrospective study designs, and limited external validation remain major limitations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>mpMRI combined with radiomics and AI demonstrates promising value for HER2 assessment, with internal testing often AUCs exceeding 0.90 but less consistent on external validation. It complements rather than replaces biopsy by capturing intratumoral heterogeneity and supporting treatment decisions. Future priorities include prospective multicenter validation, methodological standardization, and radiopathogenomic integration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1893638","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T04:22:18Z","timestamp":1786076538000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Multiparametric MRI and artificial intelligence for non-invasive HER2 assessment in breast cancer: a comprehensive review"],"prefix":"10.3389","volume":"13","author":[{"given":"Yao","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Yangtze University","place":["Jingzhou, Hubei Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiyi","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Yangtze University","place":["Jingzhou, Hubei Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, School of Medicine, Yangtze University","place":["Jingzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"He","sequence":"additional","affiliation":[{"name":"Department of Anatomy, School of Medicine, Yangtze University","place":["Jingzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiulan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Yangtze University","place":["Jingzhou, Hubei Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanghai","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Yangtze University","place":["Jingzhou, Hubei Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2020","journal-title":"CA Cancer J Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1056\/NEJMoa2203690","article-title":"Trastuzumab deruxtecan in previously treated HER2-low advanced breast cancer","volume":"387","author":"Modi","year":"2022","journal-title":"N Engl J Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1038\/modpathol.2012.36","article-title":"Intratumoral heterogeneity of HER2 gene amplification in breast cancer: its clinicopathological significance","volume":"25","author":"Seol","year":"2012","journal-title":"Modern Pathol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"3867","DOI":"10.1200\/jco.22.02864","article-title":"Human epidermal growth factor receptor 2 testing in breast cancer: ASCO-college of American pathologists guideline update","volume":"41","author":"Wolff","year":"2023","journal-title":"J Clin Oncol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1887","DOI":"10.1200\/JCO.19.02318","article-title":"Antitumor activity and safety of trastuzumab deruxtecan in patients with HER2-low-expressing advanced breast Cancer: results from a phase Ib study","volume":"38","author":"Modi","year":"2020","journal-title":"J Clin Oncol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s10549-011-1632-x","article-title":"HER2 discordance between primary breast cancer and its paired metastasis: tumor biology or test artefact? 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