Artificial intelligence and triple negative breast cancer: can pathomics help oncologists?

Triple-negative breast cancer (TNBC) is an aggressive and heterogeneous subtype of breast cancer with limited targeted therapies and poor prognosis. Recent advances in digital pathology and artificial intelligence (AI) are transforming traditional, qualitative histopathology into quantitative, data-driven analysis. Within computational pathology, pathomics (the extraction of handcrafted, high-dimensional features from digitized histological images) and deep learning (DL)-based whole-slide image analysis have been investigated for the prediction of molecular subtypes, biomarker expression, tumor-infiltrating lymphocytes, and treatment response in TNBC. AI models, including DL and multimodal systems integrating histopathology, omics, and clinical data, are being explored for patient stratification, risk assessment, and therapy personalization, encompassing chemotherapy, immunotherapy, PARP inhibitors, and antibody-drug conjugates. By linking spatial tissue architecture with molecular profiles, these approaches may provide new insights into tumor biology and the tumor microenvironment. Most TNBC-specific studies are retrospective, small or single-center, few have been externally validated and, to our knowledge, none has yet demonstrated clinical utility in prospective trials; prediction of biomarkers such as PD-L1 or homologous recombination deficiency from hematoxylin and eosin slides remains investigational and cannot replace validated testing. Despite these challenges, AI-assisted computational pathology is a promising decision-support tool, which complements and does not replace pathologists and oncologists, for enhancing diagnosis, prognosis, and therapeutic decision-making in TNBC.