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Aubreville M, Stathonikos N, Bertram CA, Klopfleisch R, Ter Hoeve N, Ciompi F, Wilm F, Marzahl C, Donovan TA, Maier A, Breen J, Ravikumar N, Chung Y, Park J, Nateghi R, Pourakpour F, Fick RHJ, Ben Hadj S, Jahanifar M, Shephard A, Dexl J, Wittenberg T, Kondo S, Lafarge MW, Koelzer VH, Liang J, Wang Y, Long X, Liu J, Razavi S, Khademi A, Yang S, Wang X, Erber R, Klang A, Lipnik K, Bolfa P, Dark MJ, Wasinger G, Veta M, Breininger K. Mitosis domain generalization in histopathology images - The MIDOG challenge. Med Image Anal 2023; 84:102699. [PMID: 36463832 DOI: 10.1016/j.media.2022.102699] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/28/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Abstract
The density of mitotic figures (MF) within tumor tissue is known to be highly correlated with tumor proliferation and thus is an important marker in tumor grading. Recognition of MF by pathologists is subject to a strong inter-rater bias, limiting its prognostic value. State-of-the-art deep learning methods can support experts but have been observed to strongly deteriorate when applied in a different clinical environment. The variability caused by using different whole slide scanners has been identified as one decisive component in the underlying domain shift. The goal of the MICCAI MIDOG 2021 challenge was the creation of scanner-agnostic MF detection algorithms. The challenge used a training set of 200 cases, split across four scanning systems. As test set, an additional 100 cases split across four scanning systems, including two previously unseen scanners, were provided. In this paper, we evaluate and compare the approaches that were submitted to the challenge and identify methodological factors contributing to better performance. The winning algorithm yielded an F1 score of 0.748 (CI95: 0.704-0.781), exceeding the performance of six experts on the same task.
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Affiliation(s)
| | | | - Christof A Bertram
- Institute of Pathology, University of Veterinary Medicine, Vienna, Austria
| | - Robert Klopfleisch
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | | | - Francesco Ciompi
- Computational Pathology Group, Radboud UMC, Nijmegen, The Netherlands
| | - Frauke Wilm
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christian Marzahl
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Taryn A Donovan
- Department of Anatomic Pathology, Schwarzman Animal Medical Center, NY, USA
| | - Andreas Maier
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jack Breen
- CISTIB Center for Computational Imaging and Simulation Technologies in Biomedicine, School of Computing, University of Leeds, Leeds, UK
| | - Nishant Ravikumar
- CISTIB Center for Computational Imaging and Simulation Technologies in Biomedicine, School of Computing, University of Leeds, Leeds, UK
| | - Youjin Chung
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jinah Park
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Ramin Nateghi
- Electrical and Electronics Engineering Department, Shiraz University of Technology, Shiraz, Iran
| | - Fattaneh Pourakpour
- Iranian Brain Mapping Biobank (IBMB), National Brain Mapping Laboratory (NBML), Tehran, Iran
| | | | | | - Mostafa Jahanifar
- Tissue Image Analytics Centre, Department of Computer Science, University of Warwick, Warwick, UK
| | - Adam Shephard
- Tissue Image Analytics Centre, Department of Computer Science, University of Warwick, Warwick, UK
| | - Jakob Dexl
- Fraunhofer-Institute for Integrated Circuits IIS, Erlangen, Germany
| | | | | | - Maxime W Lafarge
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jingtang Liang
- School of Life Science and Technology, Xidian University, Shannxi, China
| | - Yubo Wang
- School of Life Science and Technology, Xidian University, Shannxi, China
| | - Xi Long
- Histo Pathology Diagnostic Center, Shanghai, China
| | - Jingxin Liu
- Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Salar Razavi
- Image Analysis in Medicine Lab (IAMLAB), Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON, Canada
| | - April Khademi
- Image Analysis in Medicine Lab (IAMLAB), Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON, Canada
| | - Sen Yang
- Tencent AI Lab, Shenzhen 518057, China
| | - Xiyue Wang
- College of Computer Science, Sichuan University, Chengdu 610065, China
| | - Ramona Erber
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Andrea Klang
- Institute of Pathology, University of Veterinary Medicine, Vienna, Austria
| | - Karoline Lipnik
- Institute of Pathology, University of Veterinary Medicine, Vienna, Austria
| | - Pompei Bolfa
- Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
| | - Michael J Dark
- College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Gabriel Wasinger
- Department of Pathology, General Hospital of Vienna, Medical University of Vienna, Vienna, Austria
| | - Mitko Veta
- Medical Image Analysis Group, TU Eindhoven, Eindhoven, The Netherlands
| | - Katharina Breininger
- Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Loménie N, Bertrand C, Fick RH, Ben Hadj S, Tayart B, Tilmant C, Farré I, Azdad SZ, Dahmani S, Dequen G, Feng M, Xu K, Li Z, Prevot S, Bergeron C, Bataillon G, Devouassoux-Shisheboran M, Glaser C, Delaune A, Valmary-Degano S, Bertheau P. Can AI predict epithelial lesion categories via automated analysis of cervical biopsies: The TissueNet challenge? J Pathol Inform 2022; 13:100149. [PMID: 36605109 PMCID: PMC9808029 DOI: 10.1016/j.jpi.2022.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 12/26/2022] Open
Abstract
The French Society of Pathology (SFP) organized its first data challenge in 2020 with the help of the Health Data Hub (HDH). The organization of this event first consisted of recruiting nearly 5000 cervical biopsy slides obtained from 20 pathology centers. After ensuring that patients did not refuse to include their slides in the project, the slides were anonymized, digitized, and annotated by expert pathologists, and finally uploaded to a data challenge platform for competitors from around the world. Competing teams had to develop algorithms that could distinguish 4 diagnostic classes in cervical epithelial lesions. Among the many submissions from competitors, the best algorithms achieved an overall score close to 95%. The final part of the competition lasted only 6 weeks, and the goal of SFP and HDH is now to allow for the collection to be published in open access for the scientific community. In this report, we have performed a "post-competition analysis" of the results. We first described the algorithmic pipelines of 3 top competitors. We then analyzed several difficult cases that even the top competitors could not predict correctly. A medical committee of several expert pathologists looked for possible explanations for these erroneous results by reviewing the images, and we present their findings here targeted for a large audience of pathologists and data scientists in the field of digital pathology.
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Affiliation(s)
- Nicolas Loménie
- LIPADE, UFR Mathématiques-Informatiques, Université Paris Cité, 45 rue des Saints-Pères, 75006 Paris, France,Corresponding author.
| | | | | | | | | | | | | | | | - Samy Dahmani
- Algoscope, 9 rue Gaspard Monge, 60200 Compiègne, France
| | - Gilles Dequen
- Laboratoire Modélisation, Information, Systèmes (MIS), Université de Picardie Jules Verne, 80080 Amiens, France
| | | | - Kele Xu
- Tongji University, Shanghai, China
| | - Zimu Li
- Tongji University, Shanghai, China
| | - Sophie Prevot
- Pathologie, CHU Bicêtre, APHP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | | | | | - Mojgan Devouassoux-Shisheboran
- Centre de Pathologie Sud des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du grand Revoyet, 69495 Pierre Bénite Cedex, France
| | - Claire Glaser
- Pathologie, CHG Versailles, 177 Rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - Agathe Delaune
- Plateforme de données de santé - Health Data Hub, 9 rue Georges Pitard, 75015 Paris, France
| | - Séverine Valmary-Degano
- Pathologie, Université Grenoble Alpes, Inserm U1209, CNRS UMR5309, Institute for Advanced Biosciences, CHU, Grenoble 38000, France
| | - Philippe Bertheau
- Pathologie, CHU Saint-Louis, APHP, Université Paris Cité, 1 avenue Claude Vellefaux, 75010 Paris, France
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Bertrand C, Lang SC, Petit SS, Villa I, Fick R, Hadj SB. TUMORAL AWARE DEEP LEARNING ALGORITHM FOR AUTOMATIC KI67 SCORING. J Pathol Inform 2022. [DOI: 10.1016/j.jpi.2022.100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Fick RHJ, Tayart B, Bertrand C, Lang SC, Rey T, Ciompi F, Tilmant C, Farre I, Hadj SB. A Partial Label-Based Machine Learning Approach For Cervical Whole-Slide Image Classification: The Winning TissueNet Solution . Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:2127-2131. [PMID: 34891709 DOI: 10.1109/embc46164.2021.9631009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cervical cancer is the fourth most common cancer in women worldwide. To determine early treatment for patients, it is critical to accurately classify the cervical intraepithelial lesion status based on a microscopic biopsy. Lesion classification is a 4-class problem, with biopsies being designated as benign or increasingly malignant as class 1-3, with 3 being invasive cancer. Unfortunately, traditional biopsy analysis by a pathologist is time-consuming and subject to intra- and inter-observer variability. For this reason, it is of interest to develop automatic analysis pipelines to classify lesion status directly from a digitalized whole slide image (WSI). The recent TissueNet Challenge was organized to find the best automatic detection pipeline for this task, using a dataset of 1015 annotated WSI slides. In this work, we present our winning end-to-end solution for cervical slide classification composed of a two-step classification model: First, we classify individual slide patches using an ensemble CNN, followed by an SVM-based slide classification using statistical features of the aggregated patch-level predictions. Importantly, we present the key innovation of our approach, which is a novel partial label-based loss function that allows us to supplement the supervised WSI patch annotations with weakly supervised patches based on the WSI class. This led to us not requiring additional expert tissue annotation, while still reaching the winning score of 94.7%. Our approach is a step towards the clinical inclusion of automatic pipelines for cervical cancer treatment planning.Clinical relevance- The explanation of the winning Tis-sueNet AI algorithm for automated cervical cancer classification, which may provide insights for the next generation of computer assisted tools in digital pathology.
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Ilié M, Beaulande M, Ben Hadj S, Chamorey E, Schiappa R, Long-Mira E, Lassalle S, Butori C, Cohen C, Leroy S, Guérin O, Mouroux J, Marquette CH, Pomerol JF, Erb G, Hofman V, Hofman P. Chromogenic Multiplex Immunohistochemistry Reveals Modulation of the Immune Microenvironment Associated with Survival in Elderly Patients with Lung Adenocarcinoma. Cancers (Basel) 2018; 10:cancers10090326. [PMID: 30216999 PMCID: PMC6162494 DOI: 10.3390/cancers10090326] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 01/01/2023] Open
Abstract
With underrepresentation of elderly patients with lung adenocarcinoma (LADC) in anti-PD-1/PD-L1 clinical trials, better understanding of the interplay of PD-L1 and tumor-associated immune cells (TAICs) could assist clinicians in stratifying these patients for immunotherapy. One hundred and one patients with LADCs, stratified by age, were included for analysis of PD-L1 expression and density of TAICs expressing CD4, CD8, and CD33, by using multiplex chromogenic immunohistochemistry (IHC) assays and automated digital quantification. The CD4+/CD8+ ratio was significantly higher in elderly patients. In patients <75 years, the density of CD4+, CD8+, and PD-L1 in TAICs showed a positive significant correlation with PD-L1 expression in tumor cells (TCs), while a lower correlation was observed in the elderly population. In the latter, a high CD4+/CD8+ ratio, and combined PD-L1 expression ≥1% TCs with a low CD8+ density, low CD33+ density, and a high CD4+ density correlated to worse overall survival. We identified differences according to age in the CD4+/CD8+ ratio and in correlation between PD-L1 expression and the density of TAICs in LADC patients. Distinct groups of tumor microenvironments had an impact on the OS of elderly patients with LADC.
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Affiliation(s)
- Marius Ilié
- Laboratory of Clinical and Experimental Pathology, Université Côte d'Azur, CHU Nice, FHU OncoAge, Pasteur Hospital, 06000 Nice, France.
- CNRS, INSERM, IRCAN, FHU OncoAge, Université Côte d'Azur, Team 4, 06000 Nice, France.
- Hospital-Integrated Biobank (BB-0033-00025), CHU Nice, FHU OncoAge, Université Côte d'Azur, 06000 Nice, France.
| | - Mélanie Beaulande
- EMEA-LATAM Division, Roche Diagnostics France, 38240 Meylan, France.
| | - Saima Ben Hadj
- Imaging Analysis, Tribvn Healthcare, 92320 Châtillon, France.
| | - Emmanuel Chamorey
- Biostatistics Unit, FHU OncoAge, Antoine Lacassagne Comprehensive Cancer Center, 06189 Nice, France.
| | - Renaud Schiappa
- Biostatistics Unit, FHU OncoAge, Antoine Lacassagne Comprehensive Cancer Center, 06189 Nice, France.
| | - Elodie Long-Mira
- Laboratory of Clinical and Experimental Pathology, Université Côte d'Azur, CHU Nice, FHU OncoAge, Pasteur Hospital, 06000 Nice, France.
- CNRS, INSERM, IRCAN, FHU OncoAge, Université Côte d'Azur, Team 4, 06000 Nice, France.
| | - Sandra Lassalle
- Laboratory of Clinical and Experimental Pathology, Université Côte d'Azur, CHU Nice, FHU OncoAge, Pasteur Hospital, 06000 Nice, France.
- CNRS, INSERM, IRCAN, FHU OncoAge, Université Côte d'Azur, Team 4, 06000 Nice, France.
| | - Catherine Butori
- Laboratory of Clinical and Experimental Pathology, Université Côte d'Azur, CHU Nice, FHU OncoAge, Pasteur Hospital, 06000 Nice, France.
| | - Charlotte Cohen
- Department of Thoracic Surgery, FHU OncoAge, CHU Nice, Université Côte d'Azur, 06000 Nice, France.
| | - Sylvie Leroy
- Department of Pulmonary Medicine and Thoracic Oncology, Pasteur Hospital, Université Côte d'Azur, CHU Nice, FHU OncoAge, 06000 Nice, France.
| | - Olivier Guérin
- Department of Geriatric Medicine, Cimiez Hospital, Université Côte d'Azur, CHU Nice, FHU OncoAge, 06000 Nice, France.
| | - Jérôme Mouroux
- Department of Thoracic Surgery, FHU OncoAge, CHU Nice, Université Côte d'Azur, 06000 Nice, France.
| | - Charles-Hugo Marquette
- Department of Pulmonary Medicine and Thoracic Oncology, Pasteur Hospital, Université Côte d'Azur, CHU Nice, FHU OncoAge, 06000 Nice, France.
| | | | - Gilles Erb
- EMEA-LATAM Division, Roche Diagnostics France, 38240 Meylan, France.
| | - Véronique Hofman
- Laboratory of Clinical and Experimental Pathology, Université Côte d'Azur, CHU Nice, FHU OncoAge, Pasteur Hospital, 06000 Nice, France.
- CNRS, INSERM, IRCAN, FHU OncoAge, Université Côte d'Azur, Team 4, 06000 Nice, France.
- Hospital-Integrated Biobank (BB-0033-00025), CHU Nice, FHU OncoAge, Université Côte d'Azur, 06000 Nice, France.
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, Université Côte d'Azur, CHU Nice, FHU OncoAge, Pasteur Hospital, 06000 Nice, France.
- CNRS, INSERM, IRCAN, FHU OncoAge, Université Côte d'Azur, Team 4, 06000 Nice, France.
- Hospital-Integrated Biobank (BB-0033-00025), CHU Nice, FHU OncoAge, Université Côte d'Azur, 06000 Nice, France.
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Hofman P, Beaulande M, Ben Hadj S, Erb G, Pomerol JF, Lassalle S, Butori C, Long E, Washetine K, Guerin O, Guigay J, Mouroux J, Leroy S, Marquette CH, Hofman V, Ilie M. Automated brightfield multiplex immunohistochemistry to quantify biomarkers related to immune senescence: Relationships with survival in non-small cell lung cancer patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e20500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20500 Background: Elderly patients have an eroded immune characterized by a progressive decline in immune surveillance that favors infection and cancer development. Tumor cells can escape immune surveillance by upregulating inhibitory immune checkpoint such as PD-L1. High expression of PD-L1 was reported in association with CD8+T-cell exhaustion and increased levels of CD33+ myeloid-derived suppressor cells. Although low CD4/CD8 ratio is associated with increased mortality, the status of the CD4+T-cells as a clinical marker of immunosenescence is less well characterized in the field of aging. The aim of this study was to determine the presence of immunosenescence biomarkers according to age in non-small cell lung cancer (NSCLC) patients and to evaluate them as predictive biomarkers of patients’ outcome. Methods: One hundred NSCLC patients, matched by age (50 patients < 70 years, 50 patients ≥70 years) were included. An automated 4-Plex optical IHC assay was developed on the Discovery ULTRA automated stainer using monoclonal antibodies PD-L1 (SP263), CD4, CD8, and CD33. The stained slides were scanned with Nanozoomer HT 2.0 Scanner, and analyzed with Calopix software. Results: The CD4/CD8 ratio and PD-L1 expression in tumor and immune cells were significantly lower in elderly NSCLC patients ≥70 years than in age-paired patients, while absolute count of CD33+ was increased. Patients with CD4/CD8 ratio higher than two, high PD-L1 density and low CD33+ frequency achieved increase in median disease-free survival. Conclusions: Distribution of PD-L1, CD4, CD8, and CD33 cells was influenced by age in NSCLC patients. The proportion of CD8 + CD28- T cells, CD4+ T cells and CD4/CD8 ratio may be used as predictive biomarkers of anti-PD-L1 therapy efficacy in NSCLC patients. The automated 4-Plex IHC assay together with its respective digital analysis could serve as a tool for further characterizing tumors and their microenvironment and provide a better understanding of which patients may benefit from immunotherapy.
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Affiliation(s)
- Paul Hofman
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, FHU OncoAge, University Côte d'Azur, Nice, France
| | | | | | - Gilles Erb
- Roche Diagnostics France, EMEA-LATAM division, Meylan, France
| | | | - Sandra Lassalle
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, FHU OncoAge, University Côte d'Azur, Nice, France
| | - Catherine Butori
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, FHU OncoAge, University Côte d'Azur, Nice, France
| | - Elodie Long
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, FHU OncoAge, University Côte d'Azur, Nice, France
| | - Kevin Washetine
- Hospital-Related Biobank (BB-0033-00025), FHU OncoAge, University Côte d’Azur, Nice, France
| | - Olivier Guerin
- Department of Geriatric Medicine, Cimiez Hospital, FHU Oncoage, University Côte d’Azur, Nice, France
| | - Joel Guigay
- Department of Medical Oncology, Antoine Lacassagne Comprehensive Cancer Centre, FHU Oncoage, Nice, France
| | | | - Sylvie Leroy
- Department of Pneumology, Pasteur Hospital, FHU Oncoage, Nice, France
| | | | - Veronique Hofman
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, FHU OncoAge, University Côte d'Azur, Nice, France
| | - Marius Ilie
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, FHU OncoAge, University Côte d'Azur, Nice, France
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