Advancements in Oncology with Artificial Intelligence—A Review Article

Trends in management and outcomes of colon cancer in the United States over 15 years: Analysis of the National Cancer Database

Management of colon cancer has changed over the last few decades. We assessed the trends in management and outcomes using the US National Cancer Database (NCDB). A retrospective analysis of all patients with colonic adenocarcinoma between 2005 and 2019 was conducted. The cohort was divided into three equal time periods: Period 1 (2005-2009), Period 2 (2010-2014), and Period 3 (2015-2019) to examine treatment and outcomes trends. The primary outcome was 5-year overall survival (OS). The study included 923,275 patients. A significant increase in patients with stage IV disease was noted in Period 3 compared to Period 1 (47.9% vs. 27.9%, respectively), whereas a reciprocal reduction was seen in patients with locally advanced disease (stage II: 20.8%-12%; stage III: 14.5%-7.7%). Use of immunotherapy significantly increased from 0.3% to 7.6%. Mean 5-year OS increased (43.6 vs. 42.1 months) despite the increase in metastatic disease and longer time from diagnosis to definitive surgery (7 vs. 14 days). A reduction in 30-day readmission (5.1%-4.2%), 30- (3.9%-2.8%), and 90-day mortality (7.1%-5%) was seen. Laparoscopic and robotic surgery increased from 45.8% to 53.1% and 2.9% to 12.7%, respectively. Median postoperative length of hospital stay decreased by 2 days. Rate of positive resection margins (7.2%-6%) and median number of examined lymph nodes (14-16) also improved. Minimally invasive surgery and immunotherapy for colon cancer significantly increased in recent years. Patient outcomes including OS improved over time.

Radiomics Machine Learning Analysis of Clear Cell Renal Cell Carcinoma for Tumour Grade Prediction Based on Intra-Tumoural Sub-Region Heterogeneity

BACKGROUND

Renal cancers are among the top ten causes of cancer-specific mortality, of which the ccRCC subtype is responsible for most cases. The grading of ccRCC is important in determining tumour aggressiveness and clinical management.

OBJECTIVES

The objectives of this research were to predict the WHO/ISUP grade of ccRCC pre-operatively and characterise the heterogeneity of tumour sub-regions using radiomics and ML models, including comparison with pre-operative biopsy-determined grading in a sub-group.

METHODS

Data were obtained from multiple institutions across two countries, including 391 patients with pathologically proven ccRCC. For analysis, the data were separated into four cohorts. Cohorts 1 and 2 included data from the respective institutions from the two countries, cohort 3 was the combined data from both cohort 1 and 2, and cohort 4 was a subset of cohort 1, for which both the biopsy and subsequent histology from resection (partial or total nephrectomy) were available. 3D image segmentation was carried out to derive a voxel of interest (VOI) mask. Radiomics features were then extracted from the contrast-enhanced images, and the data were normalised. The Pearson correlation coefficient and the XGBoost model were used to reduce the dimensionality of the features. Thereafter, 11 ML algorithms were implemented for the purpose of predicting the ccRCC grade and characterising the heterogeneity of sub-regions in the tumours.

RESULTS

For cohort 1, the 50% tumour core and 25% tumour periphery exhibited the best performance, with an average AUC of 77.9% and 78.6%, respectively. The 50% tumour core presented the highest performance in cohorts 2 and 3, with average AUC values of 87.6% and 76.9%, respectively. With the 25% periphery, cohort 4 showed AUC values of 95.0% and 80.0% for grade prediction when using internal and external validation, respectively, while biopsy histology had an AUC of 31.0% for the classification with the final grade of resection histology as a reference standard. The CatBoost classifier was the best for each of the four cohorts with an average AUC of 80.0%, 86.5%, 77.0% and 90.3% for cohorts 1, 2, 3 and 4 respectively.

CONCLUSIONS

Radiomics signatures combined with ML have the potential to predict the WHO/ISUP grade of ccRCC with superior performance, when compared to pre-operative biopsy. Moreover, tumour sub-regions contain useful information that should be analysed independently when determining the tumour grade. Therefore, it is possible to distinguish the grade of ccRCC pre-operatively to improve patient care and management.

Barriers and facilitators of artificial intelligence conception and implementation for breast imaging diagnosis in clinical practice: a scoping review

OBJECTIVE

Although artificial intelligence (AI) has demonstrated promise in enhancing breast cancer diagnosis, the implementation of AI algorithms in clinical practice encounters various barriers. This scoping review aims to identify these barriers and facilitators to highlight key considerations for developing and implementing AI solutions in breast cancer imaging.

METHOD

A literature search was conducted from 2012 to 2022 in six databases (PubMed, Web of Science, CINHAL, Embase, IEEE, and ArXiv). The articles were included if some barriers and/or facilitators in the conception or implementation of AI in breast clinical imaging were described. We excluded research only focusing on performance, or with data not acquired in a clinical radiology setup and not involving real patients.

RESULTS

A total of 107 articles were included. We identified six major barriers related to data (B1), black box and trust (B2), algorithms and conception (B3), evaluation and validation (B4), legal, ethical, and economic issues (B5), and education (B6), and five major facilitators covering data (F1), clinical impact (F2), algorithms and conception (F3), evaluation and validation (F4), and education (F5).

CONCLUSION

This scoping review highlighted the need to carefully design, deploy, and evaluate AI solutions in clinical practice, involving all stakeholders to yield improvement in healthcare.

CLINICAL RELEVANCE STATEMENT

The identification of barriers and facilitators with suggested solutions can guide and inform future research, and stakeholders to improve the design and implementation of AI for breast cancer detection in clinical practice.

KEY POINTS

• Six major identified barriers were related to data; black-box and trust; algorithms and conception; evaluation and validation; legal, ethical, and economic issues; and education. • Five major identified facilitators were related to data, clinical impact, algorithms and conception, evaluation and validation, and education. • Coordinated implication of all stakeholders is required to improve breast cancer diagnosis with AI.

Traditional, complementary, and integrative medicine and artificial intelligence: Novel opportunities in healthcare

The convergence of traditional, complementary, and integrative medicine (TCIM) with artificial intelligence (AI) is a promising frontier in healthcare. TCIM is a patient-centric approach that combines conventional medicine with complementary therapies, emphasizing holistic well-being. AI can revolutionize healthcare through data-driven decision-making and personalized treatment plans. This article explores how AI technologies can complement and enhance TCIM, aligning with the shared objectives of researchers from both fields in improving patient outcomes, enhancing care quality, and promoting holistic wellness. This integration of TCIM and AI introduces exciting opportunities but also noteworthy challenges. AI may augment TCIM by assisting in early disease detection, providing personalized treatment plans, predicting health trends, and enhancing patient engagement. Challenges at the intersection of AI and TCIM include data privacy and security, regulatory complexities, maintaining the human touch in patient-provider relationships, and mitigating bias in AI algorithms. Patients' trust, informed consent, and legal accountability are all essential considerations. Future directions in AI-enhanced TCIM include advanced personalized medicine, understanding the efficacy of herbal remedies, and studying patient-provider interactions. Research on bias mitigation, patient acceptance, and trust in AI-driven TCIM healthcare is crucial. In this article, we outlined that the merging of TCIM and AI holds great promise in enhancing healthcare delivery, personalizing treatment plans, preventive care, and patient engagement. Addressing challenges and fostering collaboration between AI experts, TCIM practitioners, and policymakers, however, is vital to harnessing the full potential of this integration.

A novel MRI-based deep learning networks combined with attention mechanism for predicting CDKN2A/B homozygous deletion status in IDH-mutant astrocytoma

OBJECTIVES

To develop a high-accuracy MRI-based deep learning method for predicting cyclin-dependent kinase inhibitor 2A/B (CDKN2A/B) homozygous deletion status in isocitrate dehydrogenase (IDH)-mutant astrocytoma.

METHODS

Multiparametric brain MRI data and corresponding genomic information of 234 subjects (111 positives for CDKN2A/B homozygous deletion and 123 negatives for CDKN2A/B homozygous deletion) were obtained from The Cancer Imaging Archive (TCIA) and The Cancer Genome Atlas (TCGA) respectively. Two independent multi-sequence networks (ResFN-Net and FN-Net) are built on the basis of ResNet and ConvNeXt network combined with attention mechanism to classify CDKN2A/B homozygous deletion status using MR images including contrast-enhanced T1-weighted imaging (CE-T1WI) and T2-weighted imaging (T2WI). The performance of the network is summarized by three-way cross-validation; ROC analysis is also performed.

RESULTS

The average cross-validation accuracy (ACC) of ResFN-Net is 0.813. The average cross-validation area under curve (AUC) of ResFN-Net is 0.8804. The average cross-validation ACC and AUC of FN-Net is 0.9236 and 0.9704, respectively. Comparing all sequence combinations of the two networks (ResFN-Net and FN-Net), the sequence combination of CE-T1WI and T2WI performed the best, and the ACC and AUC were 0.8244, 0.8975 and 0.8971, 0.9574, respectively.

CONCLUSIONS

The FN-Net deep learning networks based on ConvNeXt network achieved promising performance for predicting CDKN2A/B homozygous deletion status of IDH-mutant astrocytoma.

CLINICAL RELEVANCE STATEMENT

A novel deep learning network (FN-Net) based on preoperative MRI was developed to predict the CDKN2A/B homozygous deletion status. This network has the potential to be a practical tool for the noninvasive characterization of CDKN2A/B in glioma to support personalized classification and treatment planning.

KEY POINTS

• CDKN2A/B homozygous deletion status is an important marker for glioma grading and prognosis. • An MRI-based deep learning approach was developed to predict CDKN2A/B homozygous deletion status. • The predictive performance based on ConvNeXt network was better than that of ResNet network.

Artificial Intelligence in the Advanced Diagnosis of Bladder Cancer-Comprehensive Literature Review and Future Advancement

Artificial intelligence is highly regarded as the most promising future technology that will have a great impact on healthcare across all specialties. Its subsets, machine learning, deep learning, and artificial neural networks, are able to automatically learn from massive amounts of data and can improve the prediction algorithms to enhance their performance. This area is still under development, but the latest evidence shows great potential in the diagnosis, prognosis, and treatment of urological diseases, including bladder cancer, which are currently using old prediction tools and historical nomograms. This review focuses on highly significant and comprehensive literature evidence of artificial intelligence in the management of bladder cancer and investigates the near introduction in clinical practice.

Medical imaging and multimodal artificial intelligence models for streamlining and enhancing cancer care: opportunities and challenges

INTRODUCTION

Artificial intelligence (AI) has the potential to transform oncologic care. There have been significant developments in AI applications in medical imaging and increasing interest in multimodal models. These are likely to enable improved oncologic care through more precise diagnosis, increasingly in a more personalized and less invasive manner. In this review, we provide an overview of the current state and challenges that clinicians, administrative personnel and policy makers need to be aware of and mitigate for the technology to reach its full potential.

AREAS COVERED

The article provides a brief targeted overview of AI, a high-level review of the current state and future potential AI applications in diagnostic radiology and to a lesser extent digital pathology, focusing on oncologic applications. This is followed by a discussion of emerging approaches, including multimodal models. The article concludes with a discussion of technical, regulatory challenges and infrastructure needs for AI to realize its full potential.

EXPERT OPINION

There is a large volume of promising research, and steadily increasing commercially available tools using AI. For the most advanced and promising precision diagnostic applications of AI to be used clinically, robust and comprehensive quality monitoring systems and informatics platforms will likely be required.

AI-Based Glioma Grading for a Trustworthy Diagnosis: An Analytical Pipeline for Improved Reliability

Glioma is the most common type of tumor in humans originating in the brain. According to the World Health Organization, gliomas can be graded on a four-stage scale, ranging from the most benign to the most malignant. The grading of these tumors from image information is a far from trivial task for radiologists and one in which they could be assisted by machine-learning-based decision support. However, the machine learning analytical pipeline is also fraught with perils stemming from different sources, such as inadvertent data leakage, adequacy of 2D image sampling, or classifier assessment biases. In this paper, we analyze a glioma database sourced from multiple datasets using a simple classifier, aiming to obtain a reliable tumor grading and, on the way, we provide a few guidelines to ensure such reliability. Our results reveal that by focusing on the tumor region of interest and using data augmentation techniques we significantly enhanced the accuracy and confidence in tumor classifications. Evaluation on an independent test set resulted in an AUC-ROC of 0.932 in the discrimination of low-grade gliomas from high-grade gliomas, and an AUC-ROC of 0.893 in the classification of grades 2, 3, and 4. The study also highlights the importance of providing, beyond generic classification performance, measures of how reliable and trustworthy the model's output is, thus assessing the model's certainty and robustness.

Microfluidic Technology, Artificial Intelligence, and Biosensors As Advanced Technologies in Cancer Screening: A Review Article

Cancer screening techniques aim to detect premalignant lesions and enable early intervention to delay the onset of cancer while keeping incidence constant. Technology advancements have led to the development of powerful tools such as microfluidic technology, artificial intelligence, machine learning algorithms, and electrochemical biosensors to aid in early cancer detection. Non-invasive cancer screening methods like virtual colonoscopy and endoscopic ultrasonography have also been developed to provide comprehensive pictures of organs and detect cancer early. This review article provides an overview of recent advances in cancer screening in microfluidic technology, artificial intelligence, and biomarkers through a narrative literature search. Microfluidic devices enable easy handling of sub-microliter volumes and have become a promising tool for cancer detection, drug screening, and modeling angiogenesis and metastasis in cancer research. Machine learning and artificial intelligence have shown high accuracy in oncology-related diagnostic imaging, reducing the manual steps in lesion detection and providing standardized and accurate results, with potential for global standardization in areas like colon polyps, breast cancer, and primary and metastatic brain cancer. A biomarker-based cancer diagnosis is promising for early detection and effective therapy, and electrochemical biosensors integrated with nanoparticles offer multiplexing and amplification capabilities. Understanding these advanced technologies' basics, achievements, and challenges is crucial for advancing their use in oncology.

Platelet-Based Liquid Biopsies through the Lens of Machine Learning

Liquid biopsies offer minimally invasive diagnosis and monitoring of cancer disease. This biosource is often analyzed using sequencing, which generates highly complex data that can be used using machine learning tools. Nevertheless, validating the clinical applications of such methods is challenging. It requires: (a) using data from many patients; (b) verifying potential bias concerning sample collection; and (c) adding interpretability to the model. In this work, we have used RNA sequencing data of tumor-educated platelets (TEPs) and performed a binary classification (cancer vs. no-cancer). First, we compiled a large-scale dataset with more than a thousand donors. Further, we used different convolutional neural networks (CNNs) and boosting methods to evaluate the classifier performance. We have obtained an impressive result of 0.96 area under the curve. We then identified different clusters of splice variants using expert knowledge from the Kyoto Encyclopedia of Genes and Genomes (KEGG). Employing boosting algorithms, we identified the features with the highest predictive power. Finally, we tested the robustness of the models using test data from novel hospitals. Notably, we did not observe any decrease in model performance. Our work proves the great potential of using TEP data for cancer patient classification and opens the avenue for profound cancer diagnostics.

Molecular mechanisms augmenting resistance to current therapies in clinics among cervical cancer patients

Cervical cancer (CC) is the fourth leading cause of cancer death (~ 324,000 deaths annually) among women internationally, with 85% of these deaths reported in developing regions, particularly sub-Saharan Africa and Southeast Asia. Human papillomavirus (HPV) is considered the major driver of CC, and with the availability of the prophylactic vaccine, HPV-associated CC is expected to be eliminated soon. However, female patients with advanced-stage cervical cancer demonstrated a high recurrence rate (50-70%) within two years of completing radiochemotherapy. Currently, 90% of failures in chemotherapy are during the invasion and metastasis of cancers related to drug resistance. Although molecular target therapies have shown promising results in the lab, they have had little success in patients due to the tumor heterogeneity fueling resistance to these therapies and bypass the targeted signaling pathway. The last two decades have seen the emergence of immunotherapy, especially immune checkpoint blockade (ICB) therapies, as an effective treatment against metastatic tumors. Unfortunately, only a small subgroup of patients (< 20%) have benefited from this approach, reflecting disease heterogeneity and manifestation with primary or acquired resistance over time. Thus, understanding the mechanisms driving drug resistance in CC could significantly improve the quality of medical care for cancer patients and steer them to accurate, individualized treatment. The rise of artificial intelligence and machine learning has also been a pivotal factor in cancer drug discovery. With the advancement in such technology, cervical cancer screening and diagnosis are expected to become easier. This review will systematically discuss the different tumor-intrinsic and extrinsic mechanisms CC cells to adapt to resist current treatments and scheme novel strategies to overcome cancer drug resistance.

Application of Artificial Intelligence in the Diagnosis, Treatment, and Prognostic Evaluation of Mediastinal Malignant Tumors

Artificial intelligence (AI), also known as machine intelligence, is widely utilized in the medical field, promoting medical advances. Malignant tumors are the critical focus of medical research and improvement of clinical diagnosis and treatment. Mediastinal malignancy is an important tumor that attracts increasing attention today due to the difficulties in treatment. Combined with artificial intelligence, challenges from drug discovery to survival improvement are constantly being overcome. This article reviews the progress of the use of AI in the diagnosis, treatment, and prognostic prospects of mediastinal malignant tumors based on current literature findings.

Future of Artificial Intelligence Applications in Cancer Care: A Global Cross-Sectional Survey of Researchers

Cancer significantly contributes to global mortality, with 9.3 million annual deaths. To alleviate this burden, the utilization of artificial intelligence (AI) applications has been proposed in various domains of oncology. However, the potential applications of AI and the barriers to its widespread adoption remain unclear. This study aimed to address this gap by conducting a cross-sectional, global, web-based survey of over 1000 AI and cancer researchers. The results indicated that most respondents believed AI would positively impact cancer grading and classification, follow-up services, and diagnostic accuracy. Despite these benefits, several limitations were identified, including difficulties incorporating AI into clinical practice and the lack of standardization in cancer health data. These limitations pose significant challenges, particularly regarding testing, validation, certification, and auditing AI algorithms and systems. The results of this study provide valuable insights for informed decision-making for stakeholders involved in AI and cancer research and development, including individual researchers and research funding agencies.

Integration of artificial intelligence and precision oncology in Latin America

Next-generation medicine encompasses different concepts related to healthcare models and technological developments. In Latin America and the Caribbean, healthcare systems are quite different between countries, and cancer control is known to be insufficient and inefficient considering socioeconomically discrepancies. Despite advancements in knowledge about the biology of different oncological diseases, the disease remains a challenge in terms of diagnosis, treatment, and prognosis for clinicians and researchers. With the development of molecular biology, better diagnosis methods, and therapeutic tools in the last years, artificial intelligence (AI) has become important, because it could improve different clinical scenarios: predicting clinically relevant parameters, cancer diagnosis, cancer research, and accelerating the growth of personalized medicine. The incorporation of AI represents an important challenge in terms of diagnosis, treatment, and prognosis for clinicians and researchers in cancer care. Therefore, some studies about AI in Latin America and the Caribbean are being conducted with the aim to improve the performance of AI in those countries. This review introduces AI in cancer care in Latin America and the Caribbean, and the advantages and promising results that it has shown in this socio-demographic context.

Connected-SegNets: A Deep Learning Model for Breast Tumor Segmentation from X-ray Images

Inspired by Connected-UNets, this study proposes a deep learning model, called Connected-SegNets, for breast tumor segmentation from X-ray images. In the proposed model, two SegNet architectures are connected with skip connections between their layers. Moreover, the cross-entropy loss function of the original SegNet has been replaced by the intersection over union (IoU) loss function in order to make the proposed model more robust against noise during the training process. As part of data preprocessing, a histogram equalization technique, called contrast limit adapt histogram equalization (CLAHE), is applied to all datasets to enhance the compressed regions and smooth the distribution of the pixels. Additionally, two image augmentation methods, namely rotation and flipping, are used to increase the amount of training data and to prevent overfitting. The proposed model has been evaluated on two publicly available datasets, specifically INbreast and the curated breast imaging subset of digital database for screening mammography (CBIS-DDSM). The proposed model has also been evaluated using a private dataset obtained from Cheng Hsin General Hospital in Taiwan. The experimental results show that the proposed Connected-SegNets model outperforms the state-of-the-art methods in terms of Dice score and IoU score. The proposed Connected-SegNets produces a maximum Dice score of 96.34% on the INbreast dataset, 92.86% on the CBIS-DDSM dataset, and 92.25% on the private dataset. Furthermore, the experimental results show that the proposed model achieves the highest IoU score of 91.21%, 87.34%, and 83.71% on INbreast, CBIS-DDSM, and the private dataset, respectively.

Diagnostic Strategies for Breast Cancer Detection: From Image Generation to Classification Strategies Using Artificial Intelligence Algorithms

Breast cancer is one the main death causes for women worldwide, as 16% of the diagnosed malignant lesions worldwide are its consequence. In this sense, it is of paramount importance to diagnose these lesions in the earliest stage possible, in order to have the highest chances of survival. While there are several works that present selected topics in this area, none of them present a complete panorama, that is, from the image generation to its interpretation. This work presents a comprehensive state-of-the-art review of the image generation and processing techniques to detect Breast Cancer, where potential candidates for the image generation and processing are presented and discussed. Novel methodologies should consider the adroit integration of artificial intelligence-concepts and the categorical data to generate modern alternatives that can have the accuracy, precision and reliability expected to mitigate the misclassifications.

An automated multi-modal graph-based pipeline for mouse genetic discovery

MOTIVATION

Our ability to identify causative genetic factors for mouse genetic models of human diseases and biomedical traits has been limited by the difficulties associated with identifying true causative factors, which are often obscured by the many false positive genetic associations produced by a GWAS.

RESULTS

To accelerate the pace of genetic discovery, we developed a graph neural network (GNN)-based automated pipeline (GNNHap) that could rapidly analyze mouse genetic model data and identify high probability causal genetic factors for analyzed traits. After assessing the strength of allelic associations with the strain response pattern; this pipeline analyzes 29M published papers to assess candidate gene-phenotype relationships; and incorporates the information obtained from a protein-protein interaction network and protein sequence features into the analysis. The GNN model produces markedly improved results relative to that of a simple linear neural network. We demonstrate that GNNHap can identify novel causative genetic factors for murine models of diabetes/obesity and for cataract formation, which were validated by the phenotypes appearing in previously analyzed gene knockout mice. The diabetes/obesity results indicate how characterization of the underlying genetic architecture enables new therapies to be discovered and tested by applying 'precision medicine' principles to murine models.

AVAILABILITY AND IMPLEMENTATION

The GNNHap source code is freely available at https://github.com/zqfang/gnnhap, and the new version of the HBCGM program is available at https://github.com/zqfang/haplomap.

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

Artificial intelligence in breast cancer imaging: risk stratification, lesion detection and classification, treatment planning and prognosis-a narrative review

The advent of artificial intelligence (AI) represents a real game changer in today's landscape of breast cancer imaging. Several innovative AI-based tools have been developed and validated in recent years that promise to accelerate the goal of real patient-tailored management. Numerous studies confirm that proper integration of AI into existing clinical workflows could bring significant benefits to women, radiologists, and healthcare systems. The AI-based approach has proved particularly useful for developing new risk prediction models that integrate multi-data streams for planning individualized screening protocols. Furthermore, AI models could help radiologists in the pre-screening and lesion detection phase, increasing diagnostic accuracy, while reducing workload and complications related to overdiagnosis. Radiomics and radiogenomics approaches could extrapolate the so-called imaging signature of the tumor to plan a targeted treatment. The main challenges to the development of AI tools are the huge amounts of high-quality data required to train and validate these models and the need for a multidisciplinary team with solid machine-learning skills. The purpose of this article is to present a summary of the most important AI applications in breast cancer imaging, analyzing possible challenges and new perspectives related to the widespread adoption of these new tools.