Artificial Intelligence Assistance Significantly Improves Gleason Grading of Prostate Biopsies by Pathologists
Radboud University Medical Center（拉德堡德大学医学中心）；Radboud Institute for Health Sciences（拉德堡德健康科学研究所）；University of Yaounde 1（雅温得第一大学）；Salomão Zoppi Diagnostics/DASA（萨洛芒·佐皮诊断中心/DASA）；Istanbul Medipol University（伊斯坦布尔 Medipol 大学）；Public Health Agency of Catalonia（加泰罗尼亚公共卫生署）；Centre de Pathologie（病理中心）；Hopital Diaconat Mulhouse（米卢斯迪亚科纳医院）；Aix en Provence Hospital（艾克斯-普罗旺斯医院）；Histo Patologia Cirúrgica e Citologia（组织外科病理与细胞学中心）；Tata Medical Center（塔塔医疗中心）；labor team w ag（W 实验室有限公司）；Instituto Mário Penna（马里奥·彭纳研究所）；Medics Pathologie（梅迪克病理中心）；Antoni van Leeuwenhoek Hospital（安东尼·范·列文虎克医院）；Netherlands Cancer Institute（荷兰癌症研究所）；Laboratory of Pathology East Netherlands（荷兰东部病理实验室）；Center for Medical Image Science and Visualization（医学影像科学与可视化中心）；Linköping University（林雪平大学）
While the Gleason score is the most important prognostic marker for prostate cancer patients, it suffers from significant observer variability. Artificial Intelligence (AI) systems, based on deep learning, have proven to achieve pathologist-level performance at Gleason grading. However, the performance of such systems can degrade in the presence of artifacts, foreign tissue, or other anomalies. Pathologists integrating their expertise with feedback from an AI system could result in a synergy that outperforms both the individual pathologist and the system. Despite the hype around AI assistance, existing literature on this topic within the pathology domain is limited. We investigated the value of AI assistance for grading prostate biopsies. A panel of fourteen observers graded 160 biopsies with and without AI assistance. Using AI, the agreement of the panel with an expert reference standard significantly increased (quadratically weighted Cohen's kappa, 0.799 vs 0.872; p=0.018). Our results show the added value of AI systems for Gleason grading, but more importantly, show the benefits of pathologist-AI synergy.
Radboud University Medical Center（拉德堡德大学医学中心）；Radboud Institute for Health Sciences（拉德堡德健康科学研究所）；The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital (NKI-AVL)（荷兰癌症研究所-安东尼·范·列文虎克医院（NKI-AVL））；Laboratory of Pathology East Netherlands (LabPON)（荷兰东部病理实验室（LabPON））
The Gleason score is the most important prognostic marker for prostate cancer patients but suffers from significant inter-observer variability. We developed a fully automated deep learning system to grade prostate biopsies. The system was developed using 5834 biopsies from 1243 patients. A semi-automatic labeling technique was used to circumvent the need for full manual annotation by pathologists. The developed system achieved a high agreement with the reference standard. In a separate observer experiment, the deep learning system outperformed 10 out of 15 pathologists. The system has the pote…
Breast cancer is one of the most common cancer in women around the world. For diagnosis, pathologists evaluate biomarkers such as HER2 protein using immunohistochemistry over tissue extracted by a biopsy. Through microscopic inspection, this assessment estimates the intensity and integrity of the membrane cells' staining and scores the sample as 0, 1+, 2+, or 3+: a subjective decision that depends on the interpretation of the pathologist. This paper presents the preliminary data analysis of the annotations of three pathologists over the same set of samples obtained using 20x magnification and …
Poisson Ordinal Network for Gleason Group Estimation Using Bi-Parametric MRI
Centre for Medical Image Computing, University College London（伦敦大学学院医学影像计算中心）；School of Artificial Intelligence, Beijing University of Posts and Telecommunications（北京邮电大学人工智能学院）；Centre for Medical Imaging, University College London（伦敦大学学院医学影像中心）；National Institute of Health Data Science, Peking University（北京大学健康数据科学国家研究院）
Karolinska Institutet（卡罗林斯卡医学院）；Tampere University（坦佩雷大学）；Uppsala University（乌普萨拉大学）；University of Otago（奥塔哥大学）；Queen Mary University of London（伦敦玛丽女王大学）；Bostwick Laboratories（博斯特威克实验室）；University Health Network（大学健康网络）；Indiana University School of Medicine（印第安纳大学医学院）；Yale University School of Medicine（耶鲁大学医学院）；Medical College of Wisconsin（威斯康星医学院）；Royal Prince Alfred Hospital（阿尔弗雷德王子医院）；University of Sydney（悉尼大学）；University Hospital Bonn（波恩大学医院）；University of São Paulo Medical School（圣保罗大学医学院）；Cleveland Clinic（克利夫兰医学中心）；Southmead Hospital（索斯米德医院）；Taipei Veterans General Hospital（台北荣民总医院）；Aquesta Uropathology（Aquesta泌尿病理中心）；University of Queensland（昆士兰大学）；University of Toronto（多伦多大学）；Jikei University School of Medicine（慈惠会医科大学）；Aichi Medical University（爱知医科大学）；University Hospital of Wales（威尔士大学医院）；UT Southwestern Medical Center（德克萨斯大学西南医学中心）；SciLifeLab（生命科学实验室）；S:t Göran Hospital（圣约兰医院）
Background: An increasing volume of prostate biopsies and a world-wide shortage of uro-pathologists puts a strain on pathology departments. Additionally, the high intra- and inter-observer variability in grading can result in over- and undertreatment of prostate cancer. Artificial intelligence (AI) methods may alleviate these problems by assisting pathologists to reduce workload and harmonize grading. Methods: We digitized 6,682 needle biopsies from 976 participants in the population based STHLM3 diagnostic study to train deep neural networks for assessing prostate biopsies. The networks were …
East China Normal University（华东师范大学）；School of Computer Science, East China Normal University（华东师范大学计算机科学学院）
Prostate cancer (PCa) is one of the most common cancers in men around the world. The most accurate method to evaluate lesion levels of PCa is microscopic inspection of stained biopsy tissue and estimate the Gleason score of tissue microarray (TMA) image by expert pathologists. However, it is time-consuming for pathologists to identify the cellular and glandular patterns for Gleason grading in large TMA images. We used Gleason2019 Challenge dataset to build a convolutional neural network (CNN) model to segment TMA images to regions of different Gleason grades and predict the Gleason score accor…
Prostate cancer is one of the main diseases affecting men worldwide. The Gleason scoring system is the primary diagnostic tool for prostate cancer. This is obtained via the visual analysis of cancerous patterns in prostate biopsies performed by expert pathologists, and the aggregation of the main Gleason grades in a combined score. Computer-aided diagnosis systems allow to reduce the workload of pathologists and increase the objectivity. Recently, efforts have been made in the literature to develop algorithms aiming the direct estimation of the global Gleason score at biopsy/core level with gl…
Pathologist-like explainable AI for interpretable Gleason grading in prostate cancer
German Cancer Research Center (DKFZ)（德国癌症研究中心）；University Heidelberg（海德堡大学）；RWTH Aachen University（亚琛工业大学）；University of Ulm（乌尔姆大学）；University of Saarland（萨尔大学）；University Hospital Düsseldorf（杜塞尔多夫大学医院）；Medical University of Vienna（维也纳医科大学）；University Hospital Schleswig-Holstein（石勒苏益格-荷尔斯泰因大学医院）；Martin Luther University Halle-Wittenberg（马丁路德·哈勒维腾贝格大学）；University Hospital Zurich（苏黎世大学医院）；Städtisches Klinikum Karlsruhe（卡尔斯鲁厄市立医院）；University of Leipzig（莱比锡大学）；University Medical Center Freiburg（弗莱堡大学医学中心）
Universitat Politècnica de València（瓦伦西亚理工大学）；ETS Montreal（蒙特利尔高等技术学院）
Prostate cancer is one of the main diseases affecting men worldwide. The gold standard for diagnosis and prognosis is the Gleason grading system. In this process, pathologists manually analyze prostate histology slides under microscope, in a high time-consuming and subjective task. In the last years, computer-aided-diagnosis (CAD) systems have emerged as a promising tool that could support pathologists in the daily clinical practice. Nevertheless, these systems are usually trained using tedious and prone-to-error pixel-level annotations of Gleason grades in the tissue. To alleviate the need of…
Universitat Politècnica de València（瓦伦西亚理工大学）；University Clinical Hospital of Valencia（瓦伦西亚大学临床医院）；University of Granada（格拉纳达大学）
The Gleason scoring system is the primary diagnostic and prognostic tool for prostate cancer. In recent years, with the development of digitisation devices, the use of computer vision techniques for the analysis of biopsies has increased. However, to the best of the authors' knowledge, the development of algorithms to automatically detect individual cribriform patterns belonging to Gleason grade 4 has not yet been studied in the literature. The objective of the work presented in this paper is to develop a deep-learning-based system able to support pathologists in the daily analysis of prostate…
Worldwide, prostate cancer is one of the main cancers affecting men. The final diagnosis of prostate cancer is based on the visual detection of Gleason patterns in prostate biopsy by pathologists. Computer-aided-diagnosis systems allow to delineate and classify the cancerous patterns in the tissue via computer-vision algorithms in order to support the physicians' task. The methodological core of this work is a U-Net convolutional neural network for image segmentation modified with residual blocks able to segment cancerous tissue according to the full Gleason system. This model outperforms othe…
Scientific Computing and Imaging Institute, University of Utah（犹他大学科学计算与成像研究所）；University of Utah（犹他大学）
Pathologists diagnose and grade prostate cancer by examining tissue from needle biopsies on glass slides. The cancer's severity and risk of metastasis are determined by the Gleason grade, a score based on the organization and morphology of prostate cancer glands. For diagnostic work-up, pathologists first locate glands in the whole biopsy core, and -- if they detect cancer -- they assign a Gleason grade. This time-consuming process is subject to errors and significant inter-observer variability, despite strict diagnostic criteria. This paper proposes an automated workflow that follows patholog…
Interpretable histopathology-based prediction of disease relevant features in Inflammatory Bowel Disease biopsies using weakly-supervised deep learning
Delft University of Technology（代尔夫特理工大学）；Erasmus University Medical Center（伊拉斯姆斯大学医学中心）；Academic Medical Center（学术医学中心）
Cribriform growth patterns in prostate carcinoma are associated with poor prognosis. We aimed to introduce a deep learning method to detect such patterns automatically. To do so, convolutional neural network was trained to detect cribriform growth patterns on 128 prostate needle biopsies. Ensemble learning taking into account other tumor growth patterns during training was used to cope with heterogeneous and limited tumor tissue occurrences. ROC and FROC analyses were applied to assess network performance regarding detection of biopsies harboring cribriform growth pattern. The ROC analysis yie…
Karolinska Institutet（卡罗林斯卡学院）；Tampere University（坦佩雷大学）；University of Turku（图尔库大学）；S:t Göran Hospital（圣戈兰医院）；Aquesta Uropathology（阿奎斯塔泌尿病理中心）；University of Queensland（昆士兰大学）；University of Otago（奥塔哥大学）；Wellington School of Medicine and Health Sciences（惠灵顿医学与健康科学学院）；Aichi Medical University（爱知医科大学）
Background: The detection of perineural invasion (PNI) by carcinoma in prostate biopsies has been shown to be associated with poor prognosis. The assessment and quantification of PNI is; however, labor intensive. In the study we aimed to develop an algorithm based on deep neural networks to aid pathologists in this task. Methods: We collected, digitized and pixel-wise annotated the PNI findings in each of the approximately 80,000 biopsy cores from the 7,406 men who underwent biopsy in the prospective and diagnostic STHLM3 trial between 2012 and 2014. In total, 485 biopsy cores showed PNI. We a…
University of Connecticut（康涅狄格大学）；University of Connecticut Health Center（康涅狄格大学健康中心）
Prostate cancer is the most common cancer in men worldwide and the second leading cause of cancer death in the United States. One of the prognostic features in prostate cancer is the Gleason grading of histopathology images. The Gleason grade is assigned based on tumor architecture on Hematoxylin and Eosin (H&E) stained whole slide images (WSI) by the pathologists. This process is time-consuming and has known interobserver variability. In the past few years, deep learning algorithms have been used to analyze histopathology images, delivering promising results for grading prostate cancer. Howev…
Classification of Gleason Grading in Prostate Cancer Histopathology Images Using Deep Learning Techniques: YOLO, Vision Transformers, and Vision Mamba
School of Computer Engineering, Iran University of Science and Technology（伊朗科学技术大学计算机工程学院）；School of Electrical Engineering, Iran University of Science and Technology（伊朗科学技术大学电气工程学院）；School of Electrical Engineering, Shahrood Branch, Islamic Azad University（伊斯兰阿扎德大学沙赫鲁德分校电气工程学院）；Medical Sciences and Technologies Department, Science and Research Branch, Islamic Azad University（伊斯兰阿扎德大学科学研究分支医学科学与技术部门）
The Gleason grading system using histological images is the most powerful diagnostic and prognostic predictor of prostate cancer. The current standard inspection is evaluating Gleason H&E-stained histopathology images by pathologists. However, it is complicated, time-consuming, and subject to observers. Deep learning (DL) based-methods that automatically learn image features and achieve higher generalization ability have attracted significant attention. However, challenges remain especially using DL to train the whole slide image (WSI), a predominant clinical source in the current diagnostic s…
Purpose: In this work, we present a collaboration to create a validation dataset of pathologist annotations for algorithms that process whole slide images (WSIs). We focus on data collection and evaluation of algorithm performance in the context of estimating the density of stromal tumor infiltrating lymphocytes (sTILs) in breast cancer. Methods: We digitized 64 glass slides of hematoxylin- and eosin-stained ductal carcinoma core biopsies prepared at a single clinical site. We created training materials and workflows to crowdsource pathologist image annotations on two modes: an optical microsc…
Facebook（脸书）；Stanford University School of Medicine（斯坦福大学医学院）；Stanford University（斯坦福大学）；VA Palo Alto Health Care System（帕洛阿尔托退伍军人医疗保健系统）
Prostate cancer is the second deadliest cancer for American men. While Magnetic Resonance Imaging (MRI) is increasingly used to guide targeted biopsies for prostate cancer diagnosis, its utility remains limited due to high rates of false positives and false negatives as well as low inter-reader agreements. Machine learning methods to detect and localize cancer on prostate MRI can help standardize radiologist interpretations. However, existing machine learning methods vary not only in model architecture, but also in the ground truth labeling strategies used for model training. In this study, we…
Brigham and Women's Hospital（布莱根和妇女医院）；Harvard Medical School（哈佛医学院）；Johns Hopkins School of Medicine（约翰斯·霍普金斯大学医学院）
Histology-based grade classification is clinically important for many cancer types in stratifying patients distinct treatment groups. In prostate cancer, the Gleason score is a grading system used to measure the aggressiveness of prostate cancer from the spatial organization of cells and the distribution of glands. However, the subjective interpretation of Gleason score often suffers from large interobserver and intraobserver variability. Previous work in deep learning-based objective Gleason grading requires manual pixel-level annotation. In this work, we propose a weakly-supervised approach …
Northumbria University at Newcastle（纽卡斯尔诺森比亚大学）；College of Computer and Information Sciences, King Saud University（沙特国王大学计算机与信息科学学院）
Colorectal and prostate cancers are the most common types of cancer in men worldwide. To diagnose colorectal and prostate cancer, a pathologist performs a histological analysis on needle biopsy samples. This manual process is time-consuming and error-prone, resulting in high intra and interobserver variability, which affects diagnosis reliability. This study aims to develop an automatic computerized system for diagnosing colorectal and prostate tumors by using images of biopsy samples to reduce time and diagnosis error rates associated with human analysis. We propose a CNN model for classifyin…
Radboud University Medical Center（拉德堡德大学医学中心）；Linköping University（林雪平大学）
Prostate cancer is the most prevalent cancer among men in Western countries, with 1.1 million new diagnoses every year. The gold standard for the diagnosis of prostate cancer is a pathologists' evaluation of prostate tissue. To potentially assist pathologists deep-learning-based cancer detection systems have been developed. Many of the state-of-the-art models are patch-based convolutional neural networks, as the use of entire scanned slides is hampered by memory limitations on accelerator cards. Patch-based systems typically require detailed, pixel-level annotations for effective training. How…
