Novel Clinical-Grade Prostate Cancer Detection and Grading Model: Development and Prospective Validation Using Real World Data, with Performance Assessment on IHC Requested Cases

Artificial intelligence may assist healthcare systems in meeting increasing demand for pathology services while maintaining diagnostic quality and reducing turnaround time and costs. We aimed to investigate the performance of an institutionally developed system for prostate cancer detection, grading, and workflow optimization and to contrast this with commercial alternatives. From August 2021 to March 2023, we scanned 21,396 slides from 1,147 patients with positive biopsies. We developed models for cancer detection, grading, and screening of equivocal cases for IHC ordering. We compared a task-specific model trained using the PANDA dataset of prostate cancer biopsies with one built using features extracted by the general-purpose histology foundation model, UNI and compare their performance in an unfiltered prospectively collected dataset that reflects our patient population (1737 slides,95 patients). We evaluated the contributions of a bespoke model designed to improve sensitivity in detecting small cancer foci and scoring of broader patterns observed at lower resolution. We found high concordance between the developed systems and pathologist reference in detection (AUC 98.5, sensitivity 95.0, and specificity 97.8), ISUP grading (quadratic Cohen's kappa 0.869), grade group 3 or higher (AUC 97.5, sensitivity 94.9, specificity 96.6) and comparable to published data from commercial systems. Screening could reduce IHC ordering for equivocal cases by 44.5% with an overall error rate of 1.8% (1.4% false positive, 0.4% false negative rates). Institutions like academic medical centers that have high scanning volumes and report abstraction capabilities can develop accurate computational pathology models for internal use. These models have the potential to aid in quality control role and to improve workflow in the pathology lab to help meet future challenges in prostate cancer diagnosis.

A Probabilistic Hadamard U-Net for MRI Bias Field Correction

Magnetic field inhomogeneity correction remains a challenging task in MRI analysis. Most established techniques are designed for brain MRI by supposing that image intensities in the identical tissue follow a uniform distribution. Such an assumption cannot be easily applied to other organs, especially those that are small in size and heterogeneous in texture (large variations in intensity), such as the prostate. To address this problem, this paper proposes a probabilistic Hadamard U-Net (PHU-Net) for prostate MRI bias field correction. First, a novel Hadamard U-Net (HU-Net) is introduced to extract the low-frequency scalar field, multiplied by the original input to obtain the prototypical corrected image. HU-Net converts the input image from the time domain into the frequency domain via Hadamard transform. In the frequency domain, high-frequency components are eliminated using the trainable filter (scaling layer), hard-thresholding layer, and sparsity penalty. Next, a conditional variational autoencoder is used to encode possible bias field-corrected variants into a low-dimensional latent space. Random samples drawn from latent space are then incorporated with a prototypical corrected image to generate multiple plausible images. Experimental results demonstrate the effectiveness of PHU-Net in correcting bias-field in prostate MRI with a fast inference speed. It has also been shown that prostate MRI segmentation accuracy improves with the high-quality corrected images from PHU-Net. The code will be available in the final version of this manuscript.