An unsupervised clustering analysis of breast cancer data derived from electronic health records enhanced through UMAP dimensionality reduction

While UMAP is widely used for exploring high-dimensional data, typical workflows focus on its lower-dimensional embedding, largely overlooking the rich k-nearest-neighbor (kNN) graph that UMAP constructs internally. This graph encodes the data manifold in its original high-dimensional space, before the distortion that UMAP's 2D projection introduces. We demonstrate the untapped potential of this internal representation, showing how standard graph algorithms applied to this graph enhance data sensemaking: (1) PageRank identifies representative data points, (2) k-core decomposition reveals dense core regions versus sparse periphery, and (3) clustering coefficient detects tight-knit neighborhoods with highly-similar data points. Through quantitative and qualitative evaluation on MNIST and Fashion MNIST, we show that these graph-based analyses are not only practical but also competitive with or complementary to purpose-built methods (e.g., k-medoids for exemplar selection, HDBSCAN for density-based clustering).

Despite being ubiquitous in science, clustering lacks a unified framework for quantitatively evaluating the replicability of its results. We present evaluating replicability via iterative clustering assignments (ERICA), a method for determining whether clusters can be identified reproducibly in a dataset. The pipeline computes a statistic that determines whether reproducible cluster structure is present in a dataset. Quantitative visualization methods are also introduced to characterize similarities between clusters and identify observations that may represent outliers or unstable assignments. Experiments on synthetic datasets demonstrate that ERICA successfully identifies reproducible cluster structure. In contrast, application of ERICA to three breast cancer gene-expression datasets reveals instances in which clustering solutions are not reproducible. The study underscores the importance of rigorously evaluating clustering solutions and provides a practical framework for doing so.

Breast cancer is a leading cause of cancer-related mortality worldwide, and timely accurate diagnosis is critical to improving survival outcomes. While convolutional neural networks (CNNs) have demonstrated strong performance on histopathology image classification, and machine learning models on structured electronic health records (EHR) have shown utility for clinical risk stratification, most existing work treats these modalities in isolation. This paper presents a systematic multimodal framework that integrates patch-level histopathology features from the BreCaHAD dataset with structured clinical data from MIMIC-IV. We train and evaluate unimodal image models (a simple CNN baseline and ResNet-18 with transfer learning), unimodal tabular models (XGBoost and a multilayer perceptron), and an intermediate-fusion model that concatenates latent representations from both modalities. ResNet-18 achieves near-perfect accuracy (1.000) and AUC (1.000) on three-class patch-level classification, while XGBoost achieves 98% accuracy on the EHR prediction task. The intermediate fusion model yields a macro-average AUC of 0.997, outperforming all unimodal baselines and delivering the largest improvements on the diagnostically critical but class-imbalanced mitosis category (AUC 0.994). Grad-CAM and SHAP interpretability analyses validate that model decisions align with established pathological and clinical criteria. Our results demonstrate that multimodal integration delivers meaningful improvements in both predictive performance and clinical transparency.