xCG: Explainable Cell Graphs for Survival Prediction in Non-Small Cell Lung Cancer

Understanding how deep learning models predict oncology patient risk can provide critical insights into disease progression, support clinical decision-making, and pave the way for trustworthy and data-driven precision medicine. Building on recent advances in the spatial modeling of the tumor microenvironment using graph neural networks, we present an explainable cell graph (xCG) approach for survival prediction. We validate our model on a public cohort of imaging mass cytometry (IMC) data for 416 cases of lung adenocarcinoma. We explain survival predictions in terms of known phenotypes on the cell level by computing risk attributions over cell graphs, for which we propose an efficient grid-based layer-wise relevance propagation (LRP) method. Our ablation studies highlight the importance of incorporating the cancer stage and model ensembling to improve the quality of risk estimates. Our xCG method, together with the IMC data, is made publicly available to support further research.

The Clever Hans Effect in Unsupervised Learning

Unsupervised learning has become an essential building block of AI systems. The representations it produces, e.g. in foundation models, are critical to a wide variety of downstream applications. It is therefore important to carefully examine unsupervised models to ensure not only that they produce accurate predictions, but also that these predictions are not "right for the wrong reasons", the so-called Clever Hans (CH) effect. Using specially developed Explainable AI techniques, we show for the first time that CH effects are widespread in unsupervised learning. Our empirical findings are enriched by theoretical insights, which interestingly point to inductive biases in the unsupervised learning machine as a primary source of CH effects. Overall, our work sheds light on unexplored risks associated with practical applications of unsupervised learning and suggests ways to make unsupervised learning more robust.

AI-based Anomaly Detection for Clinical-Grade Histopathological Diagnostics

While previous studies have demonstrated the potential of AI to diagnose diseases in imaging data, clinical implementation is still lagging behind. This is partly because AI models require training with large numbers of examples only available for common diseases. In clinical reality, however, only few diseases are common, whereas the majority of diseases are less frequent (long-tail distribution). Current AI models overlook or misclassify these diseases. We propose a deep anomaly detection approach that only requires training data from common diseases to detect also all less frequent diseases. We collected two large real-world datasets of gastrointestinal biopsies, which are prototypical of the problem. Herein, the ten most common findings account for approximately 90% of cases, whereas the remaining 10% contained 56 disease entities, including many cancers. 17 million histological images from 5,423 cases were used for training and evaluation. Without any specific training for the diseases, our best-performing model reliably detected a broad spectrum of infrequent ("anomalous") pathologies with 95.0% (stomach) and 91.0% (colon) AUROC and generalized across scanners and hospitals. By design, the proposed anomaly detection can be expected to detect any pathological alteration in the diagnostic tail of gastrointestinal biopsies, including rare primary or metastatic cancers. This study establishes the first effective clinical application of AI-based anomaly detection in histopathology that can flag anomalous cases, facilitate case prioritization, reduce missed diagnoses and enhance the general safety of AI models, thereby driving AI adoption and automation in routine diagnostics and beyond.

RudolfV: A Foundation Model by Pathologists for Pathologists

Histopathology plays a central role in clinical medicine and biomedical research. While artificial intelligence shows promising results on many pathological tasks, generalization and dealing with rare diseases, where training data is scarce, remains a challenge. Distilling knowledge from unlabeled data into a foundation model before learning from, potentially limited, labeled data provides a viable path to address these challenges. In this work, we extend the state of the art of foundation models for digital pathology whole slide images by semi-automated data curation and incorporating pathologist domain knowledge. Specifically, we combine computational and pathologist domain knowledge (1) to curate a diverse dataset of 103k slides corresponding to 750 million image patches covering data from different fixation, staining, and scanning protocols as well as data from different indications and labs across the EU and US, (2) for grouping semantically similar slides and tissue patches, and (3) to augment the input images during training. We evaluate the resulting model on a set of public and internal benchmarks and show that although our foundation model is trained with an order of magnitude less slides, it performs on par or better than competing models. We expect that scaling our approach to more data and larger models will further increase its performance and capacity to deal with increasingly complex real world tasks in diagnostics and biomedical research.

DiffInfinite: Large Mask-Image Synthesis via Parallel Random Patch Diffusion in Histopathology

We present DiffInfinite, a hierarchical diffusion model that generates arbitrarily large histological images while preserving long-range correlation structural information. Our approach first generates synthetic segmentation masks, subsequently used as conditions for the high-fidelity generative diffusion process. The proposed sampling method can be scaled up to any desired image size while only requiring small patches for fast training. Moreover, it can be parallelized more efficiently than previous large-content generation methods while avoiding tiling artefacts. The training leverages classifier-free guidance to augment a small, sparsely annotated dataset with unlabelled data. Our method alleviates unique challenges in histopathological imaging practice: large-scale information, costly manual annotation, and protective data handling. The biological plausibility of DiffInfinite data is validated in a survey by ten experienced pathologists as well as a downstream segmentation task. Furthermore, the model scores strongly on anti-copying metrics which is beneficial for the protection of patient data.

Leveraging weak complementary labels to improve semantic segmentation of hepatocellular carcinoma and cholangiocarcinoma in H&E-stained slides

In this paper, we present a deep learning segmentation approach to classify and quantify the two most prevalent primary liver cancers - hepatocellular carcinoma and intrahepatic cholangiocarcinoma - from hematoxylin and eosin (H&E) stained whole slide images. While semantic segmentation of medical images typically requires costly pixel-level annotations by domain experts, there often exists additional information which is routinely obtained in clinical diagnostics but rarely utilized for model training. We propose to leverage such weak information from patient diagnoses by deriving complementary labels that indicate to which class a sample cannot belong to. To integrate these labels, we formulate a complementary loss for segmentation. Motivated by the medical application, we demonstrate for general segmentation tasks that including additional patches with solely weak complementary labels during model training can significantly improve the predictive performance and robustness of a model. On the task of diagnostic differentiation between hepatocellular carcinoma and intrahepatic cholangiocarcinoma, we achieve a balanced accuracy of 0.91 (CI 95%: 0.86 - 0.95) at case level for 165 hold-out patients. Furthermore, we also show that leveraging complementary labels improves the robustness of segmentation and increases performance at case level.

Exposing Outlier Exposure: What Can Be Learned From Few, One, and Zero Outlier Images

Traditionally anomaly detection (AD) is treated as an unsupervised problem utilizing only normal samples due to the intractability of characterizing everything that looks unlike the normal data. However, it has recently been found that unsupervised image anomaly detection can be drastically improved through the utilization of huge corpora of random images to represent anomalousness; a technique which is known as Outlier Exposure. In this paper we show that specialized AD learning methods seem actually superfluous and huge corpora of data expendable. For a common AD benchmark on ImageNet, standard classifiers and semi-supervised one-class methods trained to discern between normal samples and just a few random natural images are able to outperform the current state of the art in deep AD, and only one useful outlier sample is sufficient to perform competitively. We investigate this phenomenon and reveal that one-class methods are more robust towards the particular choice of training outliers. Furthermore, we find that a simple classifier based on representations from CLIP, a recent foundation model, achieves state-of-the-art results on CIFAR-10 and also outperforms all previous AD methods on ImageNet without any training samples (i.e., in a zero-shot setting).

Deep Anomaly Detection by Residual Adaptation

Deep anomaly detection is a difficult task since, in high dimensions, it is hard to completely characterize a notion of "differentness" when given only examples of normality. In this paper we propose a novel approach to deep anomaly detection based on augmenting large pretrained networks with residual corrections that adjusts them to the task of anomaly detection. Our method gives rise to a highly parameter-efficient learning mechanism, enhances disentanglement of representations in the pretrained model, and outperforms all existing anomaly detection methods including other baselines utilizing pretrained networks. On the CIFAR-10 one-versus-rest benchmark, for example, our technique raises the state of the art from 96.1 to 99.0 mean AUC.

Geometric Disentanglement by Random Convex Polytopes

Finding and analyzing meaningful representations of data is the purpose of machine learning. The idea of representation learning is to extract representations from the data itself, e.g., by utilizing deep neural networks. In this work, we examine representation learning from a geometric perspective. Especially, we focus on the convexity of classes and clusters as a natural and desirable representation property, for which robust and scalable measures are still lacking. To address this, we propose a new approach called Random Polytope Descriptor that allows a convex description of data points based on the construction of random convex polytopes. This ties in with current methods for statistical disentanglement. We demonstrate the use of our technique on well-known deep learning methods for representation learning. Specifically we find that popular regularization variants such as the Variational Autoencoder can destroy crucial information that is relevant for tasks such as out-of-distribution detection.

A Unifying Review of Deep and Shallow Anomaly Detection

Deep learning approaches to anomaly detection have recently improved the state of the art in detection performance on complex datasets such as large collections of images or text. These results have sparked a renewed interest in the anomaly detection problem and led to the introduction of a great variety of new methods. With the emergence of numerous such methods, including approaches based on generative models, one-class classification, and reconstruction, there is a growing need to bring methods of this field into a systematic and unified perspective. In this review we aim to identify the common underlying principles as well as the assumptions that are often made implicitly by various methods. In particular, we draw connections between classic 'shallow' and novel deep approaches and show how this relation might cross-fertilize or extend both directions. We further provide an empirical assessment of major existing methods that is enriched by the use of recent explainability techniques, and present specific worked-through examples together with practical advice. Finally, we outline critical open challenges and identify specific paths for future research in anomaly detection.