More than 144 000 Australians were diagnosed with cancer in 2019. The majority will first present to their GP symptomatically, even for cancer for which screening programs exist. Diagnosing cancer in primary care is challenging due to the non-specific nature of cancer symptoms and its low prevalence. Understanding the epidemiology of cancer symptoms and patterns of presentation in patient's medical history from primary care data could be important to improve earlier detection and cancer outcomes. As past medical data about a patient can be incomplete, irregular or missing, this creates additional challenges when attempting to use the patient's history for any new diagnosis. Our research aims to investigate the opportunities in a patient's pathology history available to a GP, initially focused on the results within the frequently ordered full blood count to determine relevance to a future high-risk cancer prognosis, and treatment outcome. We investigated how past pathology test results can lead to deriving features that can be used to predict cancer outcomes, with emphasis on patients at risk of not surviving the cancer within 2-year period. This initial work focuses on patients with lung cancer, although the methodology can be applied to other types of cancer and other data within the medical record. Our findings indicate that even in cases of incomplete or obscure patient history, hematological measures can be useful in generating features relevant for predicting cancer risk and survival. The results strongly indicate to add the use of pathology test data for potential high-risk cancer diagnosis, and the utilize additional pathology metrics or other primary care datasets even more for similar purposes.
Benchmarking Pathology Foundation Models for Breast Cancer Survival Prediction
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet（卡罗林斯卡研究所医学流行病学与生物统计学系）；Department of Engineering Science, University of Oxford（牛津大学工程科学系）；Division of Oncology, Department of Clinical Sciences Lund, Lund University（卢德大学临床科学系肿瘤学系）；Oxford Suzhou Centre for Advanced Research, University of Oxford（牛津大学苏州先进研究中心）
CoC: Chain-of-Cancer based on Cross-Modal Autoregressive Traction for Survival Prediction
The Hong Kong University of Science and Technology (Guangzhou)（香港科技大学（广州））；Xi'an Jiaotong University（西安交通大学）；The Hong Kong Polytechnic University（香港理工大学）；The Hong Kong University of Science and Technology（香港科技大学）
Politecnico di Milano（米兰理工大学）；Technische Universität Dresden（德累斯顿工业大学）
Survival analysis studies time-modeling techniques for an event of interest occurring for a population. Survival analysis found widespread applications in healthcare, engineering, and social sciences. However, the data needed to train survival models are often distributed, incomplete, censored, and confidential. In this context, federated learning can be exploited to tremendously improve the quality of the models trained on distributed data while preserving user privacy. However, federated survival analysis is still in its early development, and there is no common benchmarking dataset to test …
Vanderbilt University（范德堡大学）；Vanderbilt University Medical Center（范德堡大学医学中心）
Integrating cross-department multi-modal data (e.g., radiological, pathological, genomic, and clinical data) is ubiquitous in brain cancer diagnosis and survival prediction. To date, such an integration is typically conducted by human physicians (and panels of experts), which can be subjective and semi-quantitative. Recent advances in multi-modal deep learning, however, have opened a door to leverage such a process to a more objective and quantitative manner. Unfortunately, the prior arts of using four modalities on brain cancer survival prediction are limited by a "complete modalities" settin…
Predicting Breast Cancer Survival: A Survival Analysis Approach Using Log Odds and Clinical Variables
Federal College of Animal Health and Production Technology（联邦动物卫生与生产技术学院）；Universidad Mayor de San Andres（圣安德烈斯大学）；National University of Computer & Emerging Sciences-FAST（国立计算机与新兴科学大学（FAST大学））；University of Khartoum（喀土穆大学）；University of Jazan（贾赞大学）；New York Institute of Technology（纽约理工学院）；Khalifa Gull Nawaz Teaching Hospital（哈利法·古尔·纳瓦兹教学医院）
Genentech（基因泰克）；University of Central Florida（中佛罗里达大学）
The integration of multi-modal data, such as pathological images and genomic data, is essential for understanding cancer heterogeneity and complexity for personalized treatments, as well as for enhancing survival predictions. Despite the progress made in integrating pathology and genomic data, most existing methods cannot mine the complex inter-modality relations thoroughly. Additionally, identifying explainable features from these models that govern preclinical discovery and clinical prediction is crucial for cancer diagnosis, prognosis, and therapeutic response studies. We propose PONET- a n…
Pathology-genomic fusion via biologically informed cross-modality graph learning for survival analysis
Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences（中国科学院深圳先进技术研究院）；Beijing Tiantan Hospital, Capital Medical University（首都医科大学附属北京天坛医院）；First Affiliated Hospital of Zhengzhou University（郑州大学第一附属医院）
Machine learning-based multimodal prognostic models integrating pathology images and high-throughput omic data for overall survival prediction in cancer: a systematic review
Leeds Teaching Hospitals NHS Trust（利兹教学医院国民医疗服务信托）；University of Leeds（利兹大学）；Linköping University（林雪平大学）
Respiratory failure is the one of major causes of death in critical care unit. During the outbreak of COVID-19, critical care units experienced an extreme shortage of mechanical ventilation because of respiratory failure related syndromes. To help this, the early mortality risk prediction in patients who suffer respiratory failure can provide timely support for clinical treatment and resource management. In the study, we propose a dynamic modeling approach for early mortality risk prediction of the respiratory failure patients based on the first 24 hours ICU physiological data. Our proposed mo…
Learning good representation of giga-pixel level whole slide pathology images (WSI) for downstream tasks is critical. Previous studies employ multiple instance learning (MIL) to represent WSIs as bags of sampled patches because, for most occasions, only slide-level labels are available, and only a tiny region of the WSI is disease-positive area. However, WSI representation learning still remains an open problem due to: (1) patch sampling on a higher resolution may be incapable of depicting microenvironment information such as the relative position between the tumor cells and surrounding tissue…
Memorial Sloan Kettering Cancer Center（纪念斯隆·凯特琳癌症中心）
Accurate and robust cell nuclei classification is the cornerstone for a wider range of tasks in digital and Computational Pathology. However, most machine learning systems require extensive labeling from expert pathologists for each individual problem at hand, with no or limited abilities for knowledge transfer between datasets and organ sites. In this paper we implement and evaluate a variety of deep neural network models and model ensembles for nuclei classification in renal cell cancer (RCC) and prostate cancer (PCa). We propose a convolutional neural network system based on residual learni…
With the ever-growing complexity of primary health care system, proactive patient failure management is an effective way to enhancing the availability of health care resource. One key enabler is the dynamic prediction of time-to-event outcomes. Conventional explanatory statistical approach lacks the capability of making precise individual level prediction, while the data adaptive binary predictors does not provide nominal survival curves for biologically plausible survival analysis. The purpose of this article is to elucidate that the knowledge of explanatory survival analysis can significantl…
Equitable Survival Prediction: A Fairness-Aware Survival Modeling (FASM) Approach
Duke-NUS Medical School（杜克-新加坡国立大学医学院）；Duke University School of Medicine（杜克大学医学院）；Duke AI Health（杜克人工智能健康中心）；Mass General Brigham（麻省总医院布里格姆）；Harvard Medical School（哈佛医学院）；National University of Singapore（新加坡国立大学）
Deep Survival Analysis for Competing Risk Modeling with Functional Covariates and Missing Data Imputation
Department of Quantitative Health Science, Cleveland Clinic, Cleveland OH, USA（定量健康科学系，克利夫兰诊所）；Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland OH, USA（呼吸与重症医学科，克利夫兰诊所）；Department of Statistics, Purdue University, Lafayette IN, USA（统计系，普渡大学）
University of California, Santa Barbara（加利福尼亚大学圣巴巴拉分校）；Feinberg School of Medicine, Northwestern University（西北大学范伯格医学院）
Survival analysis is a technique to predict the times of specific outcomes, and is widely used in predicting the outcomes for intensive care unit (ICU) trauma patients. Recently, deep learning models have drawn increasing attention in healthcare. However, there is a lack of deep learning methods that can model the relationship between measurements, clinical notes and mortality outcomes. In this paper we introduce BERTSurv, a deep learning survival framework which applies Bidirectional Encoder Representations from Transformers (BERT) as a language representation model on unstructured clinical n…
DPsurv: Dual-Prototype Evidential Fusion for Uncertainty-Aware and Interpretable Whole-Slide Image Survival Prediction
National University of Singapore；National University of Singapore Guangzhou Research Translation；Innovation Institute；Imperial College London；Peking Union Medical College Hospital, Chinese Academy of Medical Sciences \& Peking Union Medical College；Hunan University；Institute of High Performance Computing, Agency for Science, Technology；Research (A STAR)
University Paris Descartes（巴黎笛卡尔大学）；Institut Hypercube（超立方体研究所）；Montreal Institute for Learning Algorithms（蒙特利尔学习算法研究所）；École Polytechnique de Montréal（蒙特利尔理工学院）
An accurate model of patient-specific kidney graft survival distributions can help to improve shared-decision making in the treatment and care of patients. In this paper, we propose a deep learning method that directly models the survival function instead of estimating the hazard function to predict survival times for graft patients based on the principle of multi-task learning. By learning to jointly predict the time of the event, and its rank in the cox partial log likelihood framework, our deep learning approach outperforms, in terms of survival time prediction quality and concordance index…
AutoScore-Survival: Developing interpretable machine learning-based time-to-event scores with right-censored survival data
Duke-NUS Medical School（杜克-新加坡国立大学医学院）；Duke University（杜克大学）；Singapore General Hospital（新加坡中央医院）；National University of Singapore（新加坡国立大学）；Singapore Health Services（新加坡保健服务集团）
Accurate and transparent prediction of cancer survival times on the level of individual patients can inform and improve patient care and treatment practices. In this paper, we design a model that concurrently learns to accurately predict patient-specific survival distributions and to explain its predictions in terms of patient attributes such as clinical tests or assessments. Our model is flexible and based on a recurrent network, can handle various modalities of data including temporal measurements, and yet constructs and uses simple explanations in the form of patient- and time-specific line…
Clinical decision-making in oncology involves multimodal data such as radiology scans, molecular profiling, histopathology slides, and clinical factors. Despite the importance of these modalities individually, no deep learning framework to date has combined them all to predict patient prognosis. Here, we predict the overall survival (OS) of glioma patients from diverse multimodal data with a Deep Orthogonal Fusion (DOF) model. The model learns to combine information from multiparametric MRI exams, biopsy-based modalities (such as H&E slide images and/or DNA sequencing), and clinical variables …
We present a machine learning pipeline and model that uses the entire uncurated EHR for prediction of in-hospital mortality at arbitrary time intervals, using all available chart, lab and output events, without the need for pre-processing or feature engineering. Data for more than 45,000 American ICU patients from the MIMIC-III database were used to develop an ICU mortality prediction model. All chart, lab and output events were treated by the model in the same manner inspired by Natural Language Processing (NLP). Patient events were discretized by percentile and mapped to learnt embeddings be…
Brigham and Women’s Hospital（布里格姆妇女医院）；Harvard Medical School（哈佛医学院）；Broad Institute of Harvard and MIT（哈佛-麻省理工学院布罗德研究所）；Department of Pathology（病理系）；Northwell Health（诺斯韦尔健康）；Department of Biomedical Informatics（生物医学信息学系）；Dana-Farber Cancer Institute（达纳-法伯癌症研究所）；Cancer Program（癌症项目）；Cancer Data Science（癌症数据科学）
Deep Learning-based computational pathology algorithms have demonstrated profound ability to excel in a wide array of tasks that range from characterization of well known morphological phenotypes to predicting non-human-identifiable features from histology such as molecular alterations. However, the development of robust, adaptable, and accurate deep learning-based models often rely on the collection and time-costly curation large high-quality annotated training data that should ideally come from diverse sources and patient populations to cater for the heterogeneity that exists in such dataset…
Ortho Biomed Inc.（奥索生物医学公司）；University of Toronto（多伦多大学）；Worcester Polytechnic Institute (WPI)（伍斯特理工学院（WPI））；University Health Network（大学健康网络）
The aim of survival analysis in healthcare is to estimate the probability of occurrence of an event, such as a patient's death in an intensive care unit (ICU). Recent developments in deep neural networks (DNNs) for survival analysis show the superiority of these models in comparison with other well-known models in survival analysis applications. Ensuring the reliability and explainability of deep survival models deployed in healthcare is a necessity. Since DNN models often behave like a black box, their predictions might not be easily trusted by clinicians, especially when predictions are cont…
Accurate models of patient survival probabilities provide important information to clinicians prescribing care for life-threatening and terminal ailments. A recently developed class of models - known as individual survival distributions (ISDs) - produces patient-specific survival functions that offer greater descriptive power of patient outcomes than was previously possible. Unfortunately, at the time of writing, ISD models almost universally lack uncertainty quantification. In this paper, we demonstrate that an existing method for estimating simultaneous prediction intervals from samples can …
Texas A&M University（德克萨斯农工大学）；Department of Industrial and Systems Engineering（工业与系统工程系）；Heart, Artery, and Vein Center of Fresno（弗雷斯诺心脏、动脉和静脉中心）
Accuracies of survival models for life expectancy prediction as well as critical-care applications are significantly compromised due to the sparsity of samples and extreme imbalance between the survival (usually, the majority) and mortality class sizes. While a recent random survival forest (RSF) model overcomes the limitations of the proportional hazard assumption, an imbalance in the data results in an underestimation (overestimation) of the hazard of the mortality (survival) classes. A balanced random survival forests (BRSF) model, based on training the RSF model with data generated from a …
University of Maryland, Baltimore County（马里兰大学巴尔的摩县分校）
Survival analysis, time-to-event analysis, is an important problem in healthcare since it has a wide-ranging impact on patients and palliative care. Many survival analysis methods have assumed that the survival data is centrally available either from one medical center or by data sharing from multi-centers. However, the sensitivity of the patient attributes and the strict privacy laws have increasingly forbidden sharing of healthcare data. To address this challenge, the research community has looked at the solution of decentralized training and sharing of model parameters using the Federated L…
Brigham and Women’s Hospital（布莱根妇女医院）；Harvard Medical School（哈佛医学院）；Massachusetts General Hospital（麻省总医院）
Supervised learning tasks such as cancer survival prediction from gigapixel whole slide images (WSIs) are a critical challenge in computational pathology that requires modeling complex features of the tumor microenvironment. These learning tasks are often solved with deep multi-instance learning (MIL) models that do not explicitly capture intratumoral heterogeneity. We develop a novel variance pooling architecture that enables a MIL model to incorporate intratumoral heterogeneity into its predictions. Two interpretability tools based on representative patches are illustrated to probe the biolo…
University Hospital Bern（伯尔尼大学医院）；Auckland City Hospital（奥克兰市医院）；Swiss Institute of Bioinformatics（瑞士生物信息研究所）
Dynamic assessment of mortality risk in the intensive care unit (ICU) can be used to stratify patients, inform about treatment effectiveness or serve as part of an early-warning system. Static risk scoring systems, such as APACHE or SAPS, have recently been supplemented with data-driven approaches that track the dynamic mortality risk over time. Recent works have focused on enhancing the information delivered to clinicians even further by producing full survival distributions instead of point predictions or fixed horizon risks. In this work, we propose a non-parametric ensemble model, Weighted…
Mapping the landscape of histomorphological cancer phenotypes using self-supervised learning on unlabeled, unannotated pathology slides
University of Glasgow（格拉斯哥大学）；New York University School of Medicine（纽约大学医学院）；New York University Langone Health（纽约大学朗格尼医学中心）；Karolinska Institutet（卡罗林斯卡学院）；University College London Hospital（伦敦大学学院医院）
Mila-Quebec AI Institute（魁北克人工智能研究所Mila）；Dialogue Health Technologies Inc.（Dialogue健康科技公司）
The automation of the medical evidence acquisition and diagnosis process has recently attracted increasing attention in order to reduce the workload of doctors and democratize access to medical care. However, most works proposed in the machine learning literature focus solely on improving the prediction accuracy of a patient's pathology. We argue that this objective is insufficient to ensure doctors' acceptability of such systems. In their initial interaction with patients, doctors do not only focus on identifying the pathology a patient is suffering from; they instead generate a differential …
Stanford University School of Medicine（斯坦福大学医学院）；Center for Artificial Intelligence in Medicine & Imaging, Stanford Medical School（斯坦福医学院医学与成像人工智能中心）；Institute for Pathology and Cytology（病理与细胞学研究所）；University Hospital Bonn（波恩大学医院）；University Hospital Muenster（明斯特大学医院）
Histopathology is a reflection of the molecular changes and provides prognostic phenotypes representing the disease progression. In this study, we introduced feature scores generated from hematoxylin and eosin histology images based on deep learning (DL) models developed for prostate pathology. We demonstrated that these feature scores were significantly prognostic for time to event endpoints (biochemical recurrence and cancer-specific survival) and had simultaneously molecular biologic associations to relevant genomic alterations and molecular subtypes using already trained DL models that wer…
Proscia Inc.（Proscia 公司）；Boonshoft School of Medicine, Wright State University School of Medicine（莱特州立大学医学院布恩肖夫特医学院）；Dermatopathology Laboratory of Central States（中部各州皮肤病理学实验室）；University of Florida College of Medicine（佛罗里达大学医学院）；Cockerell Dermatopathology（科克雷尔皮肤病理学机构）；Sidney Kimmel Medical College at Thomas Jefferson University（托马斯杰斐逊大学西德尼·金梅尔医学院）
Standard of care diagnostic procedure for suspected skin cancer is microscopic examination of hematoxylin \& eosin stained tissue by a pathologist. Areas of high inter-pathologist discordance and rising biopsy rates necessitate higher efficiency and diagnostic reproducibility. We present and validate a deep learning system which classifies digitized dermatopathology slides into 4 categories. The system is developed using 5,070 images from a single lab, and tested on an uncurated set of 13,537 images from 3 test labs, using whole slide scanners manufactured by 3 different vendors. The system's …
