Dual-attention ResNet outperforms transformers in HER2 prediction on DCE-MRI

Abstract: Breast cancer is the most diagnosed cancer in women, with HER2 status critically guiding treatment decisions. Noninvasive prediction of HER2 status from dynamic contrast-enhanced MRI (DCE-MRI) could streamline diagnostics and reduce reliance on biopsy. However, preprocessing high-dynamic-range DCE-MRI into standardized 8-bit RGB format for pretrained neural networks is nontrivial, and normalization strategy significantly affects model performance. We benchmarked intensity normalization strategies using a Triple-Head Dual-Attention ResNet that processes RGB-fused temporal sequences from three DCE phases. Trained on a multicenter cohort (n=1,149) from the I-SPY trials and externally validated on BreastDCEDL_AMBL (n=43 lesions), our model outperformed transformer-based architectures, achieving 0.75 accuracy and 0.74 AUC on I-SPY test data. N4 bias field correction slightly degraded performance. Without fine-tuning, external validation yielded 0.66 AUC, demonstrating cross-institutional generalizability. These findings highlight the effectiveness of dual-attention mechanisms in capturing transferable spatiotemporal features for HER2 stratification, advancing reproducible deep learning biomarkers in breast cancer imaging.