Large Multimodal Model based Standardisation of Pathology Reports with Confidence and their Prognostic Significance

Pathology reports are rich in clinical and pathological details but are often presented in free-text format. The unstructured nature of these reports presents a significant challenge limiting the accessibility of their content. In this work, we present a practical approach based on the use of large multimodal models (LMMs) for automatically extracting information from scanned images of pathology reports with the goal of generating a standardised report specifying the value of different fields along with estimated confidence about the accuracy of the extracted fields. The proposed approach overcomes limitations of existing methods which do not assign confidence scores to extracted fields limiting their practical use. The proposed framework uses two stages of prompting a Large Multimodal Model (LMM) for information extraction and validation. The framework generalises to textual reports from multiple medical centres as well as scanned images of legacy pathology reports. We show that the estimated confidence is an effective indicator of the accuracy of the extracted information that can be used to select only accurately extracted fields. We also show the prognostic significance of structured and unstructured data from pathology reports and show that the automatically extracted field values significant prognostic value for patient stratification. The framework is available for evaluation via the URL: https://labieb.dcs.warwick.ac.uk/.

CoNIC Challenge: Pushing the Frontiers of Nuclear Detection, Segmentation, Classification and Counting

Nuclear detection, segmentation and morphometric profiling are essential in helping us further understand the relationship between histology and patient outcome. To drive innovation in this area, we setup a community-wide challenge using the largest available dataset of its kind to assess nuclear segmentation and cellular composition. Our challenge, named CoNIC, stimulated the development of reproducible algorithms for cellular recognition with real-time result inspection on public leaderboards. We conducted an extensive post-challenge analysis based on the top-performing models using 1,658 whole-slide images of colon tissue. With around 700 million detected nuclei per model, associated features were used for dysplasia grading and survival analysis, where we demonstrated that the challenge's improvement over the previous state-of-the-art led to significant boosts in downstream performance. Our findings also suggest that eosinophils and neutrophils play an important role in the tumour microevironment. We release challenge models and WSI-level results to foster the development of further methods for biomarker discovery.

One Model is All You Need: Multi-Task Learning Enables Simultaneous Histology Image Segmentation and Classification

The recent surge in performance for image analysis of digitised pathology slides can largely be attributed to the advance of deep learning. Deep models can be used to initially localise various structures in the tissue and hence facilitate the extraction of interpretable features for biomarker discovery. However, these models are typically trained for a single task and therefore scale poorly as we wish to adapt the model for an increasing number of different tasks. Also, supervised deep learning models are very data hungry and therefore rely on large amounts of training data to perform well. In this paper we present a multi-task learning approach for segmentation and classification of nuclei, glands, lumen and different tissue regions that leverages data from multiple independent data sources. While ensuring that our tasks are aligned by the same tissue type and resolution, we enable simultaneous prediction with a single network. As a result of feature sharing, we also show that the learned representation can be used to improve downstream tasks, including nuclear classification and signet ring cell detection. As part of this work, we use a large dataset consisting of over 600K objects for segmentation and 440K patches for classification and make the data publicly available. We use our approach to process the colorectal subset of TCGA, consisting of 599 whole-slide images, to localise 377 million, 900K and 2.1 million nuclei, glands and lumen respectively. We make this resource available to remove a major barrier in the development of explainable models for computational pathology.

Deep Learning based Prediction of MSI in Colorectal Cancer via Prediction of the Status of MMR Markers

An accurate diagnosis and profiling of tumour are critical to the best treatment choices for cancer patients. In addition to the cancer type and its aggressiveness, molecular heterogeneity also plays a vital role in treatment selection. MSI or MMR deficiency is one of the well-studied aberrations in terms of molecular changes. Colorectal cancer patients with MMR deficiency respond well to immunotherapy, hence assessment of the relevant molecular markers can assist clinicians in making optimal treatment selections for patients. Immunohistochemistry is one of the ways for identifying these molecular changes which requires additional sections of tumour tissue. Introduction of automated methods that can predict MSI or MMR status from a target image without the need for additional sections can substantially reduce the cost associated with it. In this work, we present our work on predicting MSI status in a two-stage process using a single target slide either stained with CK818 or H\&E. First, we train a multi-headed convolutional neural network model where each head is responsible for predicting one of the MMR protein expressions. To this end, we perform registration of MMR slides to the target slide as a pre-processing step. In the second stage, statistical features computed from the MMR prediction maps are used for the final MSI prediction. Our results demonstrate that MSI classification can be improved on incorporating fine-grained MMR labels in comparison to the previous approaches in which coarse labels (MSI/MSS) are utilised.

Towards Launching AI Algorithms for Cellular Pathology into Clinical & Pharmaceutical Orbits

Computational Pathology (CPath) is an emerging field concerned with the study of tissue pathology via computational algorithms for the processing and analysis of digitized high-resolution images of tissue slides. Recent deep learning based developments in CPath have successfully leveraged sheer volume of raw pixel data in histology images for predicting target parameters in the domains of diagnostics, prognostics, treatment sensitivity and patient stratification -- heralding the promise of a new data-driven AI era for both histopathology and oncology. With data serving as the fuel and AI as the engine, CPath algorithms are poised to be ready for takeoff and eventual launch into clinical and pharmaceutical orbits. In this paper, we discuss CPath limitations and associated challenges to enable the readers distinguish hope from hype and provide directions for future research to overcome some of the major challenges faced by this budding field to enable its launch into the two orbits.

CoNIC: Colon Nuclei Identification and Counting Challenge 2022

Nuclear segmentation, classification and quantification within Haematoxylin & Eosin stained histology images enables the extraction of interpretable cell-based features that can be used in downstream explainable models in computational pathology (CPath). However, automatic recognition of different nuclei is faced with a major challenge in that there are several different types of nuclei, some of them exhibiting large intra-class variability. To help drive forward research and innovation for automatic nuclei recognition in CPath, we organise the Colon Nuclei Identification and Counting (CoNIC) Challenge. The challenge encourages researchers to develop algorithms that perform segmentation, classification and counting of nuclei within the current largest known publicly available nuclei-level dataset in CPath, containing around half a million labelled nuclei. Therefore, the CoNIC challenge utilises over 10 times the number of nuclei as the previous largest challenge dataset for nuclei recognition. It is important for algorithms to be robust to input variation if we wish to deploy them in a clinical setting. Therefore, as part of this challenge we will also test the sensitivity of each submitted algorithm to certain input variations.

Lizard: A Large-Scale Dataset for Colonic Nuclear Instance Segmentation and Classification

The development of deep segmentation models for computational pathology (CPath) can help foster the investigation of interpretable morphological biomarkers. Yet, there is a major bottleneck in the success of such approaches because supervised deep learning models require an abundance of accurately labelled data. This issue is exacerbated in the field of CPath because the generation of detailed annotations usually demands the input of a pathologist to be able to distinguish between different tissue constructs and nuclei. Manually labelling nuclei may not be a feasible approach for collecting large-scale annotated datasets, especially when a single image region can contain thousands of different cells. However, solely relying on automatic generation of annotations will limit the accuracy and reliability of ground truth. Therefore, to help overcome the above challenges, we propose a multi-stage annotation pipeline to enable the collection of large-scale datasets for histology image analysis, with pathologist-in-the-loop refinement steps. Using this pipeline, we generate the largest known nuclear instance segmentation and classification dataset, containing nearly half a million labelled nuclei in H&E stained colon tissue. We have released the dataset and encourage the research community to utilise it to drive forward the development of downstream cell-based models in CPath.

Semantic annotation for computational pathology: Multidisciplinary experience and best practice recommendations

Recent advances in whole slide imaging (WSI) technology have led to the development of a myriad of computer vision and artificial intelligence (AI) based diagnostic, prognostic, and predictive algorithms. Computational Pathology (CPath) offers an integrated solution to utilize information embedded in pathology WSIs beyond what we obtain through visual assessment. For automated analysis of WSIs and validation of machine learning (ML) models, annotations at the slide, tissue and cellular levels are required. The annotation of important visual constructs in pathology images is an important component of CPath projects. Improper annotations can result in algorithms which are hard to interpret and can potentially produce inaccurate and inconsistent results. Despite the crucial role of annotations in CPath projects, there are no well-defined guidelines or best practices on how annotations should be carried out. In this paper, we address this shortcoming by presenting the experience and best practices acquired during the execution of a large-scale annotation exercise involving a multidisciplinary team of pathologists, ML experts and researchers as part of the Pathology image data Lake for Analytics, Knowledge and Education (PathLAKE) consortium. We present a real-world case study along with examples of different types of annotations, diagnostic algorithm, annotation data dictionary and annotation constructs. The analyses reported in this work highlight best practice recommendations that can be used as annotation guidelines over the lifecycle of a CPath project.

Meta-SVDD: Probabilistic Meta-Learning for One-Class Classification in Cancer Histology Images

To train a robust deep learning model, one usually needs a balanced set of categories in the training data. The data acquired in a medical domain, however, frequently contains an abundance of healthy patients, versus a small variety of positive, abnormal cases. Moreover, the annotation of a positive sample requires time consuming input from medical domain experts. This scenario would suggest a promise for one-class classification type approaches. In this work we propose a general one-class classification model for histology, that is meta-trained on multiple histology datasets simultaneously, and can be applied to new tasks without expensive re-training. This model could be easily used by pathology domain experts, and potentially be used for screening purposes.

Context-Aware Convolutional Neural Network for Grading of Colorectal Cancer Histology Images

Digital histology images are amenable to the application of convolutional neural network (CNN) for analysis due to the sheer size of pixel data present in them. CNNs are generally used for representation learning from small image patches (e.g. 224x224) extracted from digital histology images due to computational and memory constraints. However, this approach does not incorporate high-resolution contextual information in histology images. We propose a novel way to incorporate larger context by a context-aware neural network based on images with a dimension of 1,792x1,792 pixels. The proposed framework first encodes the local representation of a histology image into high dimensional features then aggregates the features by considering their spatial organization to make a final prediction. The proposed method is evaluated for colorectal cancer grading and breast cancer classification. A comprehensive analysis of some variants of the proposed method is presented. Our method outperformed the traditional patch-based approaches, problem-specific methods, and existing context-based methods quantitatively by a margin of 3.61%. Code and dataset related information is available at this link: https://tia-lab.github.io/Context-Aware-CNN