HER2 Expression Prediction with Flexible Multi-Modal Inputs via Dynamic Bidirectional Reconstruction

Abstract: Current HER2 assessment models for breast cancer predominantly analyze H&E or IHC images in isolation,despite clinical reliance on their synergistic interpretation. However, concurrent acquisition of both modalities is often hindered by workflow complexity and cost constraints. We propose an adaptive bimodal framework enabling flexible single-/dual-modality HER2 prediction through three innovations: 1) A dynamic branch selector that activates either single-modality reconstruction or dual-modality joint inference based on input completeness; 2) A bidirectional cross-modal GAN performing context-aware feature-space reconstruction of missing modalities; 3) A hybrid training protocol integrating adversarial learning and multi-task optimization. This architecture elevates single-modality H&E prediction accuracy from 71.44% to 94.25% while achieving 95.09% dual-modality accuracy, maintaining 90.28% reliability with sole IHC inputs. The framework's "dual-preferred, single-compatible" design delivers near-bimodal performance without requiring synchronized acquisition, particularly benefiting resource-limited settings through IHC infrastructure cost reduction. Experimental validation confirms 22.81%/12.90% accuracy improvements over H&E/IHC baselines respectively, with cross-modal reconstruction enhancing F1-scores to 0.9609 (HE to IHC) and 0.9251 (IHC to HE). By dynamically routing inputs through reconstruction-enhanced or native fusion pathways, the system mitigates performance degradation from missing data while preserving computational efficiency (78.55% parameter reduction in lightweight variant). This elastic architecture demonstrates significant potential for democratizing precise HER2 assessment across diverse healthcare settings.