Development of multiple AI pipelines that predict neoadjuvant chemotherapy response of breast cancer using H&E-stained tissues

In recent years, the treatment of breast cancer has advanced dramatically and neoadjuvant chemotherapy (NAC) has become a common treatment method, especially for locally advanced breast cancer. However, other than the subtype of breast cancer, no clear factor indicating sensitivity to NAC has been identified. In this study, we attempted to use artificial intelligence (AI) to predict the effect of preoperative chemotherapy from hematoxylin and eosin images of pathological tissue obtained from needle biopsies prior to chemotherapy. Application of AI to pathological images typically uses a single machine-learning model such as support vector machines (SVMs) or deep convolutional neural networks (CNNs). However, cancer tissues are extremely diverse and learning with a realistic number of cases limits the prediction accuracy of a single model. In this study, we propose a novel pipeline system that uses three independent models each focusing on different characteristics of cancer atypia. Our system uses a CNN model to learn structural atypia from image patches and SVM and random forest models to learn nuclear atypia from fine-grained nuclear features extracted by image analysis methods. It was able to predict the NAC response with 95.15% accuracy on a test set of 103 unseen cases. We believe that this AI pipeline system will contribute to the adoption of personalized medicine in NAC therapy for breast cancer.

Quantitative diagnosis of breast tumors by morphometric classification of microenvironmental myoepithelial cells using a machine learning approach

Machine learning systems have recently received increased attention for their broad applications in several fields. In this study, we show for the first time that histological types of breast tumors can be classified using subtle morphological differences of microenvironmental myoepithelial cell nuclei without any direct information about neoplastic tumor cells. We quantitatively measured 11661 nuclei on the four histological types: normal cases, usual ductal hyperplasia and low/high grade ductal carcinoma in situ (DCIS). Using a machine learning system, we succeeded in classifying the four histological types with 90.9% accuracy. Electron microscopy observations suggested that the activity of typical myoepithelial cells in DCIS was lowered. Through these observations as well as meta-analytic database analyses, we developed a paracrine cross-talk-based biological mechanism of DCIS progressing to invasive cancer. Our observations support novel approaches in clinical computational diagnostics as well as in therapy development against progression.

Pathological Diagnosis of Gastric Cancers with a Novel Computerized Analysis System

Background:

Recent studies of molecular biology have provided great advances for diagnostic molecular pathology. Automated diagnostic systems with computerized scanning for sampled cells in fluids or smears are now widely utilized. Automated analysis of tissue sections is, however, very difficult because they exhibit a complex mixture of overlapping malignant tumor cells, benign host-derived cells, and extracellular materials. Thus, traditional histological diagnosis is still the most powerful method for diagnosis of diseases.

Methods:

We have developed a novel computer-assisted pathology system for rapid, automated histological analysis of hematoxylin and eosin (H and E)-stained sections. It is a multistage recognition system patterned after methods that human pathologists use for diagnosis but harnessing machine learning and image analysis. The system first analyzes an entire H and E-stained section (tissue) at low resolution to search suspicious areas for cancer and then the selected areas are analyzed at high resolution to confirm the initial suspicion.

Results:

After training the pathology system with gastric tissues samples, we examined its performance using other 1905 gastric tissues. The system's accuracy in detecting malignancies was shown to be almost equal to that of conventional diagnosis by expert pathologists.

Conclusions:

Our novel computerized analysis system provides a support for histological diagnosis, which is useful for screening and quality control. We consider that it could be extended to be applicable to many other carcinomas after learning normal and malignant forms of various tissues. Furthermore, we expect it to contribute to the development of more objective grading systems, immunohistochemical staining systems, and fluorescent-stained image analysis systems.

Mitotic figure recognition: agreement among pathologists and computerized detector

Despite the prognostic importance of mitotic count as one of the components of the Bloom – Richardson grade [3], several studies ([2, 9, 10]) have found that pathologists’ agreement on the mitotic grade is fairly modest. Collecting a set of more than 4,200 candidate mitotic figures, we evaluate pathologists' agreement on individual figures, and train a computerized system for mitosis detection, comparing its performance to the classifications of three pathologists. The system’s and the pathologists’ classifications are based on evaluation of digital micrographs of hematoxylin and eosin stained breast tissue. On figures where the majority of pathologists agree on a classification, we compare the performance of the trained system to that of the individual pathologists. We find that the level of agreement of the pathologists ranges from slight to moderate, with strong biases, and that the system performs competitively in rating the ground truth set. This study is a step towards automatic mitosis count to accelerate a pathologist's work and improve reproducibility.

Mitotic index of invasive breast carcinoma. Achieving clinically meaningful precision and evaluating tertial cutoffs

CONTEXT

Mitotic figure counts are related to breast cancer behavior but have not been sufficiently reproducible to be accepted for clinical decision-making.

OBJECTIVE

To improve reproducibility and accuracy of the mitotic count.

DESIGN

Mitotic index (MI) was defined as the mitotic cell count per 10 high-power fields (HPFs), an area 0.183 mm(2). Two to 6 replicate sets of 10 HPFs were counted from 328 invasive breast carcinomas. Standard errors and coefficients of variation for mean MI were compared with expected results predicted by the binomial distribution.

RESULTS

The boundaries for MI that separated the data into equal thirds (tertials) were 1.14 and 5.33. Standard errors and coefficients of variation for MI followed distributions predicted by binomial probability. Mean coefficient of variation was 147% for the low tertial, 72% for the midtertial, and 34.6% for the upper tertial.

CONCLUSIONS

Standard errors for MI based on a single count of 10 HPFs are too broad and coefficients of variation too large to be acceptable for clinical use. This is explained as a binomial probability effect, possibly with a contribution from tumor heterogeneity. Errors can be reduced in proportion to the square root of the number of sets of 10 HPFs counted. Tertial cutoffs of MI of the Nottingham system currently used in breast carcinoma grading are too high to be applicable to the population we studied. We recommend validation of cutoffs before they are applied to a particular population of breast carcinomas. Counting 5 sets of 10 HPFs is necessary to accurately rank carcinomas with low MIs.

A board system for high-speed image analysis and neural networks

Two ANNA neural-network chips are integrated on a 6U VME board, to serve as a high-speed platform for a wide variety of algorithms used in neural-network applications as well as in image analysis. The system can implement neural networks of variable sizes and architectures, but can also be used for filtering and feature extraction tasks that are based on convolutions. The board contains a controller implemented with field programmable gate arrays (FPGA's), memory, and bus interfaces, all designed to support the high compute power of the ANNA chips. This new system is designed for maximum speed and is roughly 10 times faster than a previous board. The system has been tested for such tasks as text location, character recognition, and noise removal as well as for emulating cellular neural networks (CNN's). A sustained speed of up to two billion connections per second (GC/s) and a recognition speed of 1000 characters per second has been measured.

Ethics-committee authorization in Germany

On 9 August 1994 the German legislature revised the German Drug Law (AMG). Included in the revision is a passage requiring, for the first time, that the sponsors and investigators of clinical studies involving human subjects first obtain the approval of an ethics committee before carrying out such studies. According to the legislation, which takes effect on 17 August 1995, approval is to come from 'an independent ethics committee, set up and administered according to state law [emphasis added]' (1). Although it is clear according to the text that the 16 federal states have been empowered to establish ethics committees within their jurisdictions, this does not mean that the state governments are free to transfer exclusive authority in the matter to their respective medical associations, a step that would effectively abolish Germany's private ethics committees. First, the legislation does not rule out the authorization of private ethics committees. Second, as legal scholars attest, the exclusive control of ethics committees by the medical associations would constitute an illegal monopoly. Third, it is arguable that medical-association ethics committees fail to meet the one prior federal requirement, that of independence. There is a great deal of confusion in Germany today about which kinds of ethics committees (public and/or private) the states will sanction before 17 August 1995. In an attempt to sort things out we present a brief explanation of how ther came to be two kinds of ethics committees in Germany, review the legal battle between the two over the issue of authorization, point out how the German legislature, in passing the recent bill, has missed an opportunity to clarify the issue and, finally suggest why the administration of ethics committees by the medical associations may be incompatible with the requirement that ethics committees be independent.

[Eye surgery in Sudan]

A seven-week stay in the Sudan in the winter of 1988/89 revealed the ophthalmological problems of this Third World country. As a result of the catastrophic shortage of local doctors, many cases of eye disease have progressed to terminal stages. Of 990 patients examined, 80% were unilaterally or bilaterally blind. The three main causes of blindness were cataract, trachoma, and glaucoma. The most effective treatment for these conditions was surgery. Operable cases were identified by a simple examination method, and a total of 330 operations were performed, of which 63% were for cataract and 21% for trichiasis. Trabeculectomy was performed in 9% of the cases in order to prevent absolute glaucoma. Owing to the many technical, personnel, and specific local problems complicated surgical methods were inappropriate. As in war surgery, the methods applied had to be simple and fast. In order to achieve any success it was necessary to abandon perfectionist western methods and adapt to locally available facilities. In the author's view, a well-prepared assignment of this kind can be a useful experience for any ophthalmologist.

Spontaneous osteo-arthritis of the knee-joint in C57BL mice receiving chronic oral treatment with NSAID's or prednisone

In a statistically planned study based on quantitative radiography, treatment for 25-26 weeks with the 2 NSAIDs, diclofenac sodium, or indomethacin (both 0.5 and 1.5 mg/kg p.o. daily), or prednisone (6 mg/kg p.o.) had no influence on the progression of spontaneous osteo-arthritis of the knee-joint of the C57BL mouse, by comparison with placebo-treated controls.

Quantitative radiographic diagnosis of osteo-arthritis of the knee-joint in the C57BL mouse

Comparative histopathological and radiographic investigations in the C57BL mouse model of spontaneous osteo-arthritis of the knee-joint indicate that there is a relation between quantitative radiographic diagnosis and semiquantitative histopathological diagnosis. Statistical analysis based on a set of quantitative radiographic parameters of the mouse knee-joint shows that the greater part of the radiographic information reflecting the histopathological degree of the osteo-arthritis is contained in the projection areas of the lateral and medial meniscus: progression of the osteo-arthritic process is accompanied with enlargement of the menisci. On the basis of these observations, a radiography score for the osteo-arthritis has been constructed, which consists of a weighted sum of the - suitably transformed - projection areas of the lateral and medial meniscus. In addition to the size of the menisci, the width of the joint space is also a useful quantitative parameter of osteo-arthritis of the mouse knee-joint.

[Secondary implantation of the Omnifit II]

In this paper the author discusses the problems of secondary intraocular lens implantation with the Kelman Omnifit II lens following intracapsular cataract extraction. Indication, surgical technique, and complications are described. In 13 cases unilateral and in three cases bilateral implantations were performed. The results, after an average follow-up period of two years, were good in 18 cases. In one complicated case corneal decompensation occurred after a lens dislocation. The continuing good visual acuity results and low incidence of implant-related intraocular problems in this series suggest that anterior chamber IOLs are a safe and effective means of correcting surgical aphakia.

Electronic neural network chips

This paper reviews two custom electronic circuits that implement some simple models of neural function. The circuits include a thin-film array of read-only resistive synapses and an array of programmable synapses and amplifiers serving as electronic neurons. Circuit performance and architecture are discussed.

[Hepatitis B infection: studies on endemic disease in the closed ward of a psychiatric hospital]

Following the occurrence of 3 cases of icteric hepatitis in the period August 1980 to January 1981 in a closed male ward for mentally retarded patients in a psychiatric institution, the present study was undertaken to determine the type, investigate the source and reconstruct the sequence of viral infection, and to make recommendations for its containment. For this purpose, serologic markers for HAV and HBV (including anti HBcIgM) were determined and serum transaminase (AST) measured in March 1981 in all 24 patients (mean age 40) and in the 39 members of the medical, nursing and housekeeping staff (mean age 39). Subsequently, HAV and HBV serologies were repeated after 6 and 9 months respectively. The propositus (B.F.) and the two subsequent cases with overt hepatitis (F.P. and K.E.) showed the serologic constellation of positive HBs, HBe and anti HBcIgM, together with elevated AST levels (600, 800 and 200 I.U. respectively) at the time of clinical illness, consistent with an acute HBV infection. Since 7 (18%) among the staff members were immune to HBV (positive anti HBs and anti HBc) and the remainder sero-negative; the remaining 6, however, showed evidence of active viral replication (S. P. and K. E.), viral infection (F. P. and J. L.) or incomplete immune response (B.F. and G.H.). During the 9 months' follow-up their serologic status did not change, with the exception of 2 (F.P. and B.F.), in whom HBs disappeared. The incidence of anti HAV in patients was 42% and in the staff 44%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Asthenopia in clinical practice: a comparative study of complaints, clinical findings and results of therapy in asthenopic patients (author's transl)]

A study was carried out by seven ophthalmologists practising in the Berne region on 473 patients complaining of eye strain. Medical histories were taken by questionnaire, refraction was done and phoria measured, followed by therapy in accordance with the physician's opinion. In 380 cases, glasses were prescribed, including prismatic glasses for 14 patients. In 123 cases, local medical therapy was instituted. The statistica evaluation of pre-treatment findings and results of therapy, was carried out using a computer. The principial complaints before treatment were eyestrain and visual disturbances, followed by conjunctival irritation and headache. Women complained more about headaches, men more about visual disturbances. A majority of the patients with visual disturbances needed minus lenses, while for the treatment of headaches mostly plus lenses were needed. In patients with conjunctival irritation local medical treatment resulted in additional relief of symptoms. Cylindric correction had only a minor influence on the result of therapy. Heterophoric patients did not have more complaints than orthophoric ones, and results with spectacles without prisms were the same as in orthophoric patients.

Quantitative analysis of intracerebral recordings in epilepsia partialis continua

A 14-year-old female with epilepsia partialis continua was explored stereo-electroencephalographically (SEEG). SEEG, EEG and EMG were recorded synchronously on a 32-channel machine and stored on magnetic tape for off-line analysis. The beginning of the myoclonus was used as trigger for the analysis of the intracerebral activity, which was analysed by averaging. Thereby the generating potentials of the jerks became evident. They had different maxima and latencies relative to the facial and hand muscles: that for m. orbicularis oculi was located in the precentral gyrus, the beginning of its positive deflection was 17 msec earlier than the muscle action potential; that for the thenar muscles had a latency of 24 msec, appeared at first in the premotor cortex and with a slight delay, but with greater amplitude in the corona radiata and capsula interna. Stimulation of the lateral area 4 elicited myoclonus which corresponded to the spontaneous one in distribution and latency. Stimulation of the thalamic VL nucleus had no effect. During deep sleep the frequency of the myoclonus was diminished. REM sleep was preceded and followed by a definite increase of jerking. The pattern, topography and latency of the generating potentials in waking and sleeping were very similar. In this way quantitative evidence of the neocortical origin of Epc is given and therefore a precise delineation of the epileptogenic focus.