Computational Mapping of Reactive Stroma in Prostate Cancer Yields Interpretable, Prognostic Biomarkers

Current histopathological grading of prostate cancer relies primarily on glandular architecture, largely overlooking the tumor microenvironment. Here, we present PROTAS, a deep learning framework that quantifies reactive stroma (RS) in routine hematoxylin and eosin (H&E) slides and links stromal morphology to underlying biology. PROTAS-defined RS is characterized by nuclear enlargement, collagen disorganization, and transcriptomic enrichment of contractile pathways. PROTAS detects RS robustly in the external Prostate, Lung, Colorectal, and Ovarian (PLCO) dataset and, using domain-adversarial training, generalizes to diagnostic biopsies. In head-to-head comparisons, PROTAS outperforms pathologists for RS detection, and spatial RS features predict biochemical recurrence independently of established prognostic variables (c-index 0.80). By capturing subtle stromal phenotypes associated with tumor progression, PROTAS provides an interpretable, scalable biomarker to refine risk stratification.

Histopathology Slide Indexing and Search: Are We There Yet?

The search and retrieval of digital histopathology slides is an important task that has yet to be solved. In this case study, we investigate the clinical readiness of three state-of-the-art histopathology slide search engines, Yottixel, SISH, and RetCCL, on three patients with solid tumors. We provide a qualitative assessment of each model's performance in providing retrieval results that are reliable and useful to pathologists. We found that all three image search engines fail to produce consistently reliable results and have difficulties in capturing granular and subtle features of malignancy, limiting their diagnostic accuracy. Based on our findings, we also propose a minimal set of requirements to further advance the development of accurate and reliable histopathology image search engines for successful clinical adoption.