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Zerbe N, Schwen LO, Geißler C, Wiesemann K, Bisson T, Boor P, Carvalho R, Franz M, Jansen C, Kiehl TR, Lindequist B, Pohlan NC, Schmell S, Strohmenger K, Zakrzewski F, Plass M, Takla M, Küster T, Homeyer A, Hufnagl P. Joining forces for pathology diagnostics with AI assistance: The EMPAIA initiative. J Pathol Inform 2024; 15:100387. [PMID: 38984198 PMCID: PMC11231750 DOI: 10.1016/j.jpi.2024.100387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/28/2024] [Indexed: 07/11/2024] Open
Abstract
Over the past decade, artificial intelligence (AI) methods in pathology have advanced substantially. However, integration into routine clinical practice has been slow due to numerous challenges, including technical and regulatory hurdles in translating research results into clinical diagnostic products and the lack of standardized interfaces. The open and vendor-neutral EMPAIA initiative addresses these challenges. Here, we provide an overview of EMPAIA's achievements and lessons learned. EMPAIA integrates various stakeholders of the pathology AI ecosystem, i.e., pathologists, computer scientists, and industry. In close collaboration, we developed technical interoperability standards, recommendations for AI testing and product development, and explainability methods. We implemented the modular and open-source EMPAIA Platform and successfully integrated 14 AI-based image analysis apps from eight different vendors, demonstrating how different apps can use a single standardized interface. We prioritized requirements and evaluated the use of AI in real clinical settings with 14 different pathology laboratories in Europe and Asia. In addition to technical developments, we created a forum for all stakeholders to share information and experiences on digital pathology and AI. Commercial, clinical, and academic stakeholders can now adopt EMPAIA's common open-source interfaces, providing a unique opportunity for large-scale standardization and streamlining of processes. Further efforts are needed to effectively and broadly establish AI assistance in routine laboratory use. To this end, a sustainable infrastructure, the non-profit association EMPAIA International, has been established to continue standardization and support broad implementation and advocacy for an AI-assisted digital pathology future.
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Affiliation(s)
- Norman Zerbe
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - Lars Ole Schwen
- Fraunhofer Institute for Digital Medicine MEVIS, Max-von-Laue-Straße 2, 28359 Bremen, Germany
| | - Christian Geißler
- Technische Universität Berlin, DAI-Labor, Ernst-Reuter-Platz 7, 10587 Berlin, Germany
| | | | - Tom Bisson
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Boor
- Institute of Pathology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Rita Carvalho
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - Michael Franz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - Christoph Jansen
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - Tim-Rasmus Kiehl
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - Björn Lindequist
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - Nora Charlotte Pohlan
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - Sarah Schmell
- Institute of Pathology, Carl Gustav Carus University Hospital Dresden (UKD), TU Dresden (TUD), Fetscherstraße 74, 01307 Dresden, Germany
| | - Klaus Strohmenger
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
| | - Falk Zakrzewski
- Institute of Pathology, Carl Gustav Carus University Hospital Dresden (UKD), TU Dresden (TUD), Fetscherstraße 74, 01307 Dresden, Germany
| | - Markus Plass
- Medical University of Graz, Diagnostic and Research Center for Molecular BioMedicine, Diagnostic & Research Institute of Pathology, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Michael Takla
- Vitasystems GmbH, Gottlieb-Daimler-Straße 8, 68165 Mannheim, Germany
| | - Tobias Küster
- Technische Universität Berlin, DAI-Labor, Ernst-Reuter-Platz 7, 10587 Berlin, Germany
| | - André Homeyer
- Fraunhofer Institute for Digital Medicine MEVIS, Max-von-Laue-Straße 2, 28359 Bremen, Germany
| | - Peter Hufnagl
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany
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Is EE, Menekseoglu AK. Comparative performance of artificial intelligence models in rheumatology board-level questions: evaluating Google Gemini and ChatGPT-4o. Clin Rheumatol 2024:10.1007/s10067-024-07154-5. [PMID: 39340572 DOI: 10.1007/s10067-024-07154-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 09/18/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024]
Abstract
OBJECTIVES This study evaluates the performance of AI models, ChatGPT-4o and Google Gemini, in answering rheumatology board-level questions, comparing their effectiveness, reliability, and applicability in clinical practice. METHOD A cross-sectional study was conducted using 420 rheumatology questions from the BoardVitals question bank, excluding 27 visual data questions. Both artificial intelligence models categorized the questions according to difficulty (easy, medium, hard) and answered them. In addition, the reliability of the answers was assessed by asking the questions a second time. The accuracy, reliability, and difficulty categorization of the AI models' response to the questions were analyzed. RESULTS ChatGPT-4o answered 86.9% of the questions correctly, significantly outperforming Google Gemini's 60.2% accuracy (p < 0.001). When the questions were asked a second time, the success rate was 86.7% for ChatGPT-4o and 60.5% for Google Gemini. Both models mainly categorized questions as medium difficulty. ChatGPT-4o showed higher accuracy in various rheumatology subfields, notably in Basic and Clinical Science (p = 0.028), Osteoarthritis (p = 0.023), and Rheumatoid Arthritis (p < 0.001). CONCLUSIONS ChatGPT-4o significantly outperformed Google Gemini in rheumatology board-level questions. This demonstrates the success of ChatGPT-4o in situations requiring complex and specialized knowledge related to rheumatological diseases. The performance of both AI models decreased as the question difficulty increased. This study demonstrates the potential of AI in clinical applications and suggests that its use as a tool to assist clinicians may improve healthcare efficiency in the future. Future studies using real clinical scenarios and real board questions are recommended. Key Points •ChatGPT-4o significantly outperformed Google Gemini in answering rheumatology board-level questions, achieving 86.9% accuracy compared to Google Gemini's 60.2%. •For both AI models, the correct answer rate decreased as the question difficulty increased. •The study demonstrates the potential for AI models to be used in clinical practice as a tool to assist clinicians and improve healthcare efficiency.
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Affiliation(s)
- Enes Efe Is
- Department of Physical Medicine and Rehabilitation, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Seyrantepe Campus, Cumhuriyet ve Demokrasi Avenue, Istanbul, Turkey.
| | - Ahmet Kivanc Menekseoglu
- Department of Physical Medicine and Rehabilitation, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Syrykh C, DI Proietto V, Brion E, Copie-Bergman C, Jardin F, Dartigues P, Gaulard P, Jo Molina T, Briere J, Oberic L, Haioun C, Tilly H, Maussion C, Morel M, Schiratti JB, Laurent C. MYC Rearrangement Prediction from LYSA Whole Slide Images in Large B-cell Lymphoma: A Multi-centric Validation of Self-supervised Deep Learning Models. Mod Pathol 2024:100610. [PMID: 39265953 DOI: 10.1016/j.modpat.2024.100610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 07/25/2024] [Accepted: 09/03/2024] [Indexed: 09/14/2024]
Abstract
Large B-cell lymphoma (LBCL) is a heterogeneous lymphoid malignancy in which MYC gene rearrangement (MYC-R) is associated with a poor prognosis, prompting the recommendation for more intensive treatment. MYC-R detection relies on fluorescence in situ hybridization (FISH) method which is time consuming, expensive and not available in all laboratories. Automating MYC-R detection on hematoxylin and eosin (HE) stained whole slide images (WSI) of LBCL would decrease the need for costly molecular testing and improve pathologists' productivity. We developed an interpretable deep learning (DL) algorithm to detect MYC-R considering recent advances in self-supervised learning and providing an extensive comparison of seven feature extractors and six multiple instance learning models, themselves. Four different multicentric cohorts, including 1 247 LBCL patients, were used for training and validation. The best DL model reached an average ROC AUC score of 81.9% during cross-validation on the largest LBCL cohort, and ROC AUC scores ranging from 62.2% to 74.5% when evaluated on other unseen cohorts. In addition, we demonstrated that using this model as a pre-screening tool (with a false-negative rate of 0%), FISH testing would be avoided in 35% of cases. This work demonstrates the feasibility of developing a medical device to efficiently detect MYC gene rearrangement on HE WSI in daily practice.
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Affiliation(s)
| | | | | | - Christiane Copie-Bergman
- LYSA (The Lymphoma Study Association) and LYSARC (The Lymphoma Academic Research Organisation), Pierre-Bénite, France
| | - Fabrice Jardin
- Department of Hematology and U1245, Henri Becquerel Center, IRIB, Normandy University, Rouen, France
| | - Peggy Dartigues
- Department of Pathology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Philippe Gaulard
- Department of Pathology, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; Mondor Institute for Biomedical Research, INSERM U955, Faculty of Medicine, University of Paris-Est Créteil, Créteil, France
| | - Thierry Jo Molina
- Department of Pathology, Necker Enfants Malades Hospital, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Institut Imagine, Unité INSERM 1163, Paris, France
| | - Josette Briere
- Department of Hematology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Diderot, Paris, France
| | - Lucie Oberic
- Department of Hematology, IUCT Oncopole, Toulouse, France
| | - Corine Haioun
- Department of Hematology, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Hervé Tilly
- Department of Hematology and U1245, Henri Becquerel Center, IRIB, Normandy University, Rouen, France
| | | | | | | | - Camille Laurent
- Department of Pathology, IUCT Oncopole, Toulouse, France; INSERM, U1037, Research Center In Cancer of Toulouse, laboratoire d'excellence TOUCAN, Toulouse, France.
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Menekşeoğlu AK, İş EE. Comparative performance of artificial ıntelligence models in physical medicine and rehabilitation board-level questions. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20240241. [PMID: 39045939 PMCID: PMC11262310 DOI: 10.1590/1806-9282.20240241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 07/25/2024]
Abstract
OBJECTİVES The aim of this study was to compare the performance of artificial intelligence models ChatGPT-3.5, ChatGPT-4, and Google Bard in answering Physical Medicine and Rehabilitation board-style questions, assessing their capabilities in medical education and potential clinical applications. METHODS A comparative cross-sectional study was conducted using the PMR100, an example question set for the American Board of Physical Medicine and Rehabilitation Part I exam, focusing on artificial intelligence models' ability to answer and categorize questions by difficulty. The study evaluated the artificial intelligence models and analyzed them for accuracy, reliability, and alignment with difficulty levels determined by physiatrists. RESULTS ChatGPT-4 led with a 74% success rate, followed by Bard at 66%, and ChatGPT-3.5 at 63.8%. Bard showed remarkable answer consistency, altering responses in only 1% of cases. The difficulty assessment by ChatGPT models closely matched that of physiatrists. The study highlighted nuanced differences in artificial intelligence models' performance across various Physical Medicine and Rehabilitation subfields. CONCLUSION The study illustrates the potential of artificial intelligence in medical education and clinical settings, with ChatGPT-4 showing a slight edge in performance. It emphasizes the importance of artificial intelligence as a supportive tool for physiatrists, despite the need for careful oversight of artificial intelligence-generated responses to ensure patient safety.
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Affiliation(s)
- Ahmet Kıvanç Menekşeoğlu
- University of Health Sciences, Kanuni Sultan Süleyman Education and Training Hospital, Department of Physical Medicine and Rehabilitation – İstanbul, Turkey
| | - Enes Efe İş
- University of Health Sciences, Sisli Etfal Education and Training Hospital, Department of Physical Medicine and Rehabilitation – İstanbul, Turkey
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McGenity C, Clarke EL, Jennings C, Matthews G, Cartlidge C, Freduah-Agyemang H, Stocken DD, Treanor D. Artificial intelligence in digital pathology: a systematic review and meta-analysis of diagnostic test accuracy. NPJ Digit Med 2024; 7:114. [PMID: 38704465 PMCID: PMC11069583 DOI: 10.1038/s41746-024-01106-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 04/12/2024] [Indexed: 05/06/2024] Open
Abstract
Ensuring diagnostic performance of artificial intelligence (AI) before introduction into clinical practice is essential. Growing numbers of studies using AI for digital pathology have been reported over recent years. The aim of this work is to examine the diagnostic accuracy of AI in digital pathology images for any disease. This systematic review and meta-analysis included diagnostic accuracy studies using any type of AI applied to whole slide images (WSIs) for any disease. The reference standard was diagnosis by histopathological assessment and/or immunohistochemistry. Searches were conducted in PubMed, EMBASE and CENTRAL in June 2022. Risk of bias and concerns of applicability were assessed using the QUADAS-2 tool. Data extraction was conducted by two investigators and meta-analysis was performed using a bivariate random effects model, with additional subgroup analyses also performed. Of 2976 identified studies, 100 were included in the review and 48 in the meta-analysis. Studies were from a range of countries, including over 152,000 whole slide images (WSIs), representing many diseases. These studies reported a mean sensitivity of 96.3% (CI 94.1-97.7) and mean specificity of 93.3% (CI 90.5-95.4). There was heterogeneity in study design and 99% of studies identified for inclusion had at least one area at high or unclear risk of bias or applicability concerns. Details on selection of cases, division of model development and validation data and raw performance data were frequently ambiguous or missing. AI is reported as having high diagnostic accuracy in the reported areas but requires more rigorous evaluation of its performance.
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Affiliation(s)
- Clare McGenity
- University of Leeds, Leeds, UK.
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Emily L Clarke
- University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Charlotte Jennings
- University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | | | | | - Darren Treanor
- University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Department of Clinical Pathology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Liu JTC, Chow SSL, Colling R, Downes MR, Farré X, Humphrey P, Janowczyk A, Mirtti T, Verrill C, Zlobec I, True LD. Engineering the future of 3D pathology. J Pathol Clin Res 2024; 10:e347. [PMID: 37919231 PMCID: PMC10807588 DOI: 10.1002/cjp2.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/06/2023] [Accepted: 10/15/2023] [Indexed: 11/04/2023]
Abstract
In recent years, technological advances in tissue preparation, high-throughput volumetric microscopy, and computational infrastructure have enabled rapid developments in nondestructive 3D pathology, in which high-resolution histologic datasets are obtained from thick tissue specimens, such as whole biopsies, without the need for physical sectioning onto glass slides. While 3D pathology generates massive datasets that are attractive for automated computational analysis, there is also a desire to use 3D pathology to improve the visual assessment of tissue histology. In this perspective, we discuss and provide examples of potential advantages of 3D pathology for the visual assessment of clinical specimens and the challenges of dealing with large 3D datasets (of individual or multiple specimens) that pathologists have not been trained to interpret. We discuss the need for artificial intelligence triaging algorithms and explainable analysis methods to assist pathologists or other domain experts in the interpretation of these novel, often complex, large datasets.
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Affiliation(s)
- Jonathan TC Liu
- Department of Mechanical EngineeringUniversity of WashingtonSeattleWAUSA
- Department of Laboratory Medicine & PathologyUniversity of Washington School of MedicineSeattleUSA
- Department of BioengineeringUniversity of WashingtonSeattleUSA
| | - Sarah SL Chow
- Department of Mechanical EngineeringUniversity of WashingtonSeattleWAUSA
| | | | | | | | - Peter Humphrey
- Department of UrologyYale School of MedicineNew HavenCTUSA
| | - Andrew Janowczyk
- Wallace H Coulter Department of Biomedical EngineeringEmory University and Georgia Institute of TechnologyAtlantaGAUSA
- Geneva University HospitalsGenevaSwitzerland
| | - Tuomas Mirtti
- Helsinki University Hospital and University of HelsinkiHelsinkiFinland
- Emory University School of MedicineAtlantaGAUSA
| | - Clare Verrill
- John Radcliffe HospitalUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Inti Zlobec
- Institute for Tissue Medicine and PathologyUniversity of BernBernSwitzerland
| | - Lawrence D True
- Department of Laboratory Medicine & PathologyUniversity of Washington School of MedicineSeattleUSA
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Al-Thelaya K, Gilal NU, Alzubaidi M, Majeed F, Agus M, Schneider J, Househ M. Applications of discriminative and deep learning feature extraction methods for whole slide image analysis: A survey. J Pathol Inform 2023; 14:100335. [PMID: 37928897 PMCID: PMC10622844 DOI: 10.1016/j.jpi.2023.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 11/07/2023] Open
Abstract
Digital pathology technologies, including whole slide imaging (WSI), have significantly improved modern clinical practices by facilitating storing, viewing, processing, and sharing digital scans of tissue glass slides. Researchers have proposed various artificial intelligence (AI) solutions for digital pathology applications, such as automated image analysis, to extract diagnostic information from WSI for improving pathology productivity, accuracy, and reproducibility. Feature extraction methods play a crucial role in transforming raw image data into meaningful representations for analysis, facilitating the characterization of tissue structures, cellular properties, and pathological patterns. These features have diverse applications in several digital pathology applications, such as cancer prognosis and diagnosis. Deep learning-based feature extraction methods have emerged as a promising approach to accurately represent WSI contents and have demonstrated superior performance in histology-related tasks. In this survey, we provide a comprehensive overview of feature extraction methods, including both manual and deep learning-based techniques, for the analysis of WSIs. We review relevant literature, analyze the discriminative and geometric features of WSIs (i.e., features suited to support the diagnostic process and extracted by "engineered" methods as opposed to AI), and explore predictive modeling techniques using AI and deep learning. This survey examines the advances, challenges, and opportunities in this rapidly evolving field, emphasizing the potential for accurate diagnosis, prognosis, and decision-making in digital pathology.
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Affiliation(s)
- Khaled Al-Thelaya
- Department of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Nauman Ullah Gilal
- Department of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Mahmood Alzubaidi
- Department of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Fahad Majeed
- Department of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Marco Agus
- Department of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Jens Schneider
- Department of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Mowafa Househ
- Department of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
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Chen CB, Wang Y, Fu X, Yang H. Recurrence Network Analysis of Histopathological Images for the Detection of Invasive Ductal Carcinoma in Breast Cancer. IEEE/ACM TRANSACTIONS ON COMPUTATIONAL BIOLOGY AND BIOINFORMATICS 2023; 20:3234-3244. [PMID: 37276118 DOI: 10.1109/tcbb.2023.3282798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The histopathological image analysis is one of the most crucial diagnostic procedures to identify Invasive ductal carcinoma (IDC) in breast cancers. However, this diagnosis process is currently time-consuming and heavily dependent on human expertise. Prior research has shown that different degrees of tumors present various microstructures in the histopathological images. However, very little has been done to utilize spatial recurrence features of microstructures for identifying IDC. This paper presents a novel recurrence analysis methodology for automatic image-guided IDC detection. We first utilize wavelet decomposition to delineate the subtle information in the images. Then, we model the patches with a weighted recurrence network approach to characterize the recurrence patterns of the histopathological images. Finally, we develop automated IDC detection models leveraging machine learning methods with spatial recurrence features extracted. The developed recurrence analysis models successfully characterize the complex microstructures of histopathological images and achieve the IDC detection performances of at least AUC = 0.96. This research developed a spatial recurrence analysis methodology to effectively identify IDC regions in histopathological images for BC. It shows a high potential to assist physicians in the decision-making process. The proposed methodology can further be applicable to image processing for other medical or biological applications.
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9
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Moscalu M, Moscalu R, Dascălu CG, Țarcă V, Cojocaru E, Costin IM, Țarcă E, Șerban IL. Histopathological Images Analysis and Predictive Modeling Implemented in Digital Pathology-Current Affairs and Perspectives. Diagnostics (Basel) 2023; 13:2379. [PMID: 37510122 PMCID: PMC10378281 DOI: 10.3390/diagnostics13142379] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
In modern clinical practice, digital pathology has an essential role, being a technological necessity for the activity in the pathological anatomy laboratories. The development of information technology has majorly facilitated the management of digital images and their sharing for clinical use; the methods to analyze digital histopathological images, based on artificial intelligence techniques and specific models, quantify the required information with significantly higher consistency and precision compared to that provided by optical microscopy. In parallel, the unprecedented advances in machine learning facilitate, through the synergy of artificial intelligence and digital pathology, the possibility of diagnosis based on image analysis, previously limited only to certain specialties. Therefore, the integration of digital images into the study of pathology, combined with advanced algorithms and computer-assisted diagnostic techniques, extends the boundaries of the pathologist's vision beyond the microscopic image and allows the specialist to use and integrate his knowledge and experience adequately. We conducted a search in PubMed on the topic of digital pathology and its applications, to quantify the current state of knowledge. We found that computer-aided image analysis has a superior potential to identify, extract and quantify features in more detail compared to the human pathologist's evaluating possibilities; it performs tasks that exceed its manual capacity, and can produce new diagnostic algorithms and prediction models applicable in translational research that are able to identify new characteristics of diseases based on changes at the cellular and molecular level.
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Affiliation(s)
- Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Roxana Moscalu
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M139PT, UK
| | - Cristina Gena Dascălu
- Department of Preventive Medicine and Interdisciplinarity, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Viorel Țarcă
- Department of Preventive Medicine and Interdisciplinarity, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Elena Cojocaru
- Department of Morphofunctional Sciences I, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Ioana Mădălina Costin
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Elena Țarcă
- Department of Surgery II-Pediatric Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Ionela Lăcrămioara Șerban
- Department of Morpho-Functional Sciences II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
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Dehkharghanian T, Mu Y, Tizhoosh HR, Campbell CJV. Applied machine learning in hematopathology. Int J Lab Hematol 2023. [PMID: 37257440 DOI: 10.1111/ijlh.14110] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/12/2023] [Indexed: 06/02/2023]
Abstract
An increasing number of machine learning applications are being developed and applied to digital pathology, including hematopathology. The goal of these modern computerized tools is often to support diagnostic workflows by extracting and summarizing information from multiple data sources, including digital images of human tissue. Hematopathology is inherently multimodal and can serve as an ideal case study for machine learning applications. However, hematopathology also poses unique challenges compared to other pathology subspecialities when applying machine learning approaches. By modeling the pathologist workflow and thinking process, machine learning algorithms may be designed to address practical and tangible problems in hematopathology. In this article, we discuss the current trends in machine learning in hematopathology. We review currently available machine learning enabled medical devices supporting hematopathology workflows. We then explore current machine learning research trends of the field with a focus on bone marrow cytology and histopathology, and how adoption of new machine learning tools may be enabled through the transition to digital pathology.
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Affiliation(s)
- Taher Dehkharghanian
- Department of Nephrology, University Health Network, Toronto, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Youqing Mu
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Hamid R Tizhoosh
- Rhazes Lab, Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Clinton J V Campbell
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- William Osler Health System, Brampton, Ontario, Canada
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Khalaf K, Terrin M, Jovani M, Rizkala T, Spadaccini M, Pawlak KM, Colombo M, Andreozzi M, Fugazza A, Facciorusso A, Grizzi F, Hassan C, Repici A, Carrara S. A Comprehensive Guide to Artificial Intelligence in Endoscopic Ultrasound. J Clin Med 2023; 12:jcm12113757. [PMID: 37297953 DOI: 10.3390/jcm12113757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Endoscopic Ultrasound (EUS) is widely used for the diagnosis of bilio-pancreatic and gastrointestinal (GI) tract diseases, for the evaluation of subepithelial lesions, and for sampling of lymph nodes and solid masses located next to the GI tract. The role of Artificial Intelligence in healthcare in growing. This review aimed to provide an overview of the current state of AI in EUS from imaging to pathological diagnosis and training. METHODS AI algorithms can assist in lesion detection and characterization in EUS by analyzing EUS images and identifying suspicious areas that may require further clinical evaluation or biopsy sampling. Deep learning techniques, such as convolutional neural networks (CNNs), have shown great potential for tumor identification and subepithelial lesion (SEL) evaluation by extracting important features from EUS images and using them to classify or segment the images. RESULTS AI models with new features can increase the accuracy of diagnoses, provide faster diagnoses, identify subtle differences in disease presentation that may be missed by human eyes, and provide more information and insights into disease pathology. CONCLUSIONS The integration of AI in EUS images and biopsies has the potential to improve the diagnostic accuracy, leading to better patient outcomes and to a reduction in repeated procedures in case of non-diagnostic biopsies.
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Affiliation(s)
- Kareem Khalaf
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Maria Terrin
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital IRCCS, Rozzano, 20089 Milan, Italy
| | - Manol Jovani
- Division of Gastroenterology, Maimonides Medical Center, SUNY Downstate University, Brooklyn, NY 11219, USA
| | - Tommy Rizkala
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital IRCCS, Rozzano, 20089 Milan, Italy
| | - Katarzyna M Pawlak
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital IRCCS, Rozzano, 20089 Milan, Italy
| | - Marta Andreozzi
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital IRCCS, Rozzano, 20089 Milan, Italy
| | - Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital IRCCS, Rozzano, 20089 Milan, Italy
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Fabio Grizzi
- Department of Immunology and Inflammation, Humanitas Research Hospital IRCCS, Rozzano, 20089 Milan, Italy
| | - Cesare Hassan
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital IRCCS, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital IRCCS, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20089 Milan, Italy
| | - Silvia Carrara
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital IRCCS, Rozzano, 20089 Milan, Italy
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Altini N, Puro E, Taccogna MG, Marino F, De Summa S, Saponaro C, Mattioli E, Zito FA, Bevilacqua V. Tumor Cellularity Assessment of Breast Histopathological Slides via Instance Segmentation and Pathomic Features Explainability. Bioengineering (Basel) 2023; 10:396. [PMID: 37106583 PMCID: PMC10135772 DOI: 10.3390/bioengineering10040396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/14/2023] [Accepted: 03/19/2023] [Indexed: 04/29/2023] Open
Abstract
The segmentation and classification of cell nuclei are pivotal steps in the pipelines for the analysis of bioimages. Deep learning (DL) approaches are leading the digital pathology field in the context of nuclei detection and classification. Nevertheless, the features that are exploited by DL models to make their predictions are difficult to interpret, hindering the deployment of such methods in clinical practice. On the other hand, pathomic features can be linked to an easier description of the characteristics exploited by the classifiers for making the final predictions. Thus, in this work, we developed an explainable computer-aided diagnosis (CAD) system that can be used to support pathologists in the evaluation of tumor cellularity in breast histopathological slides. In particular, we compared an end-to-end DL approach that exploits the Mask R-CNN instance segmentation architecture with a two steps pipeline, where the features are extracted while considering the morphological and textural characteristics of the cell nuclei. Classifiers that are based on support vector machines and artificial neural networks are trained on top of these features in order to discriminate between tumor and non-tumor nuclei. Afterwards, the SHAP (Shapley additive explanations) explainable artificial intelligence technique was employed to perform a feature importance analysis, which led to an understanding of the features processed by the machine learning models for making their decisions. An expert pathologist validated the employed feature set, corroborating the clinical usability of the model. Even though the models resulting from the two-stage pipeline are slightly less accurate than those of the end-to-end approach, the interpretability of their features is clearer and may help build trust for pathologists to adopt artificial intelligence-based CAD systems in their clinical workflow. To further show the validity of the proposed approach, it has been tested on an external validation dataset, which was collected from IRCCS Istituto Tumori "Giovanni Paolo II" and made publicly available to ease research concerning the quantification of tumor cellularity.
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Affiliation(s)
- Nicola Altini
- Department of Electrical and Information Engineering (DEI), Polytechnic University of Bari, Via Edoardo Orabona n. 4, 70126 Bari, Italy
| | - Emilia Puro
- Department of Electrical and Information Engineering (DEI), Polytechnic University of Bari, Via Edoardo Orabona n. 4, 70126 Bari, Italy
| | - Maria Giovanna Taccogna
- Department of Electrical and Information Engineering (DEI), Polytechnic University of Bari, Via Edoardo Orabona n. 4, 70126 Bari, Italy
| | - Francescomaria Marino
- Department of Electrical and Information Engineering (DEI), Polytechnic University of Bari, Via Edoardo Orabona n. 4, 70126 Bari, Italy
| | - Simona De Summa
- Molecular Diagnostics and Pharmacogenetics Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Via O. Flacco n. 65, 70124 Bari, Italy
| | - Concetta Saponaro
- Laboratory of Preclinical and Translational Research, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Via Padre Pio n. 1, 85028 Rionero in Vulture, Italy
| | - Eliseo Mattioli
- Pathology Department, IRCCS Istituto Tumori “Giovanni Paolo II”, Via O. Flacco n. 65, 70124 Bari, Italy
| | - Francesco Alfredo Zito
- Pathology Department, IRCCS Istituto Tumori “Giovanni Paolo II”, Via O. Flacco n. 65, 70124 Bari, Italy
| | - Vitoantonio Bevilacqua
- Department of Electrical and Information Engineering (DEI), Polytechnic University of Bari, Via Edoardo Orabona n. 4, 70126 Bari, Italy
- Apulian Bioengineering s.r.l., Via delle Violette n. 14, 70026 Modugno, Italy
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Michielli N, Caputo A, Scotto M, Mogetta A, Pennisi OAM, Molinari F, Balmativola D, Bosco M, Gambella A, Metovic J, Tota D, Carpenito L, Gasparri P, Salvi M. Stain normalization in digital pathology: Clinical multi-center evaluation of image quality. J Pathol Inform 2022; 13:100145. [PMID: 36268060 PMCID: PMC9577129 DOI: 10.1016/j.jpi.2022.100145] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 11/20/2022] Open
Abstract
In digital pathology, the final appearance of digitized images is affected by several factors, resulting in stain color and intensity variation. Stain normalization is an innovative solution to overcome stain variability. However, the validation of color normalization tools has been assessed only from a quantitative perspective, through the computation of similarity metrics between the original and normalized images. To the best of our knowledge, no works investigate the impact of normalization on the pathologist's evaluation. The objective of this paper is to propose a multi-tissue (i.e., breast, colon, liver, lung, and prostate) and multi-center qualitative analysis of a stain normalization tool with the involvement of pathologists with different years of experience. Two qualitative studies were carried out for this purpose: (i) a first study focused on the analysis of the perceived image quality and absence of significant image artifacts after the normalization process; (ii) a second study focused on the clinical score of the normalized image with respect to the original one. The results of the first study prove the high quality of the normalized image with a low impact artifact generation, while the second study demonstrates the superiority of the normalized image with respect to the original one in clinical practice. The normalization process can help both to reduce variability due to tissue staining procedures and facilitate the pathologist in the histological examination. The experimental results obtained in this work are encouraging and can justify the use of a stain normalization tool in clinical routine.
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Affiliation(s)
- Nicola Michielli
- Biolab, PolitoMed Lab, Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
| | - Alessandro Caputo
- Department of Medicine and Surgery, University Hospital of Salerno, Salerno, Italy
| | - Manuela Scotto
- Biolab, PolitoMed Lab, Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
| | - Alessandro Mogetta
- Biolab, PolitoMed Lab, Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
| | - Orazio Antonino Maria Pennisi
- Technology Transfer and Industrial Liaison Department, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
| | - Filippo Molinari
- Biolab, PolitoMed Lab, Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
| | - Davide Balmativola
- Pathology Unit, Humanitas Gradenigo Hospital, Corso Regina Margherita 8, 10153 Turin, Italy
| | - Martino Bosco
- Department of Pathology, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
| | - Alessandro Gambella
- Pathology Unit, Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy
| | - Jasna Metovic
- Pathology Unit, Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy
| | - Daniele Tota
- Pathology Unit, Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy
| | - Laura Carpenito
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- University of Milan, Milan, Italy
| | - Paolo Gasparri
- UOC di Anatomia Patologica, ASP Catania P.O. “Gravina”, Caltagirone, Italy
| | - Massimo Salvi
- Biolab, PolitoMed Lab, Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
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