How Good Are We? Evaluating Cell AI Foundation Models in Kidney Pathology with Human-in-the-Loop Enrichment

Training AI foundation models has emerged as a promising large-scale learning approach for addressing real-world healthcare challenges, including digital pathology. While many of these models have been developed for tasks like disease diagnosis and tissue quantification using extensive and diverse training datasets, their readiness for deployment on some arguably simplest tasks, such as nuclei segmentation within a single organ (e.g., the kidney), remains uncertain. This paper seeks to answer this key question, "How good are we?", by thoroughly evaluating the performance of recent cell foundation models on a curated multi-center, multi-disease, and multi-species external testing dataset. Additionally, we tackle a more challenging question, "How can we improve?", by developing and assessing human-in-the-loop data enrichment strategies aimed at enhancing model performance while minimizing the reliance on pixel-level human annotation. To address the first question, we curated a multicenter, multidisease, and multispecies dataset consisting of 2,542 kidney whole slide images (WSIs). Three state-of-the-art (SOTA) cell foundation models-Cellpose, StarDist, and CellViT-were selected for evaluation. To tackle the second question, we explored data enrichment algorithms by distilling predictions from the different foundation models with a human-in-the-loop framework, aiming to further enhance foundation model performance with minimal human efforts. Our experimental results showed that all three foundation models improved over their baselines with model fine-tuning with enriched data. Interestingly, the baseline model with the highest F1 score does not yield the best segmentation outcomes after fine-tuning. This study establishes a benchmark for the development and deployment of cell vision foundation models tailored for real-world data applications.

Assessment of Cell Nuclei AI Foundation Models in Kidney Pathology

Cell nuclei instance segmentation is a crucial task in digital kidney pathology. Traditional automatic segmentation methods often lack generalizability when applied to unseen datasets. Recently, the success of foundation models (FMs) has provided a more generalizable solution, potentially enabling the segmentation of any cell type. In this study, we perform a large-scale evaluation of three widely used state-of-the-art (SOTA) cell nuclei foundation models (Cellpose, StarDist, and CellViT). Specifically, we created a highly diverse evaluation dataset consisting of 2,542 kidney whole slide images (WSIs) collected from both human and rodent sources, encompassing various tissue types, sizes, and staining methods. To our knowledge, this is the largest-scale evaluation of its kind to date. Our quantitative analysis of the prediction distribution reveals a persistent performance gap in kidney pathology. Among the evaluated models, CellViT demonstrated superior performance in segmenting nuclei in kidney pathology. However, none of the foundation models are perfect; a performance gap remains in general nuclei segmentation for kidney pathology.

Dataset Distillation in Medical Imaging: A Feasibility Study

Data sharing in the medical image analysis field has potential yet remains underappreciated. The aim is often to share datasets efficiently with other sites to train models effectively. One possible solution is to avoid transferring the entire dataset while still achieving similar model performance. Recent progress in data distillation within computer science offers promising prospects for sharing medical data efficiently without significantly compromising model effectiveness. However, it remains uncertain whether these methods would be applicable to medical imaging, since medical and natural images are distinct fields. Moreover, it is intriguing to consider what level of performance could be achieved with these methods. To answer these questions, we conduct investigations on a variety of leading data distillation methods, in different contexts of medical imaging. We evaluate the feasibility of these methods with extensive experiments in two aspects: 1) Assess the impact of data distillation across multiple datasets characterized by minor or great variations. 2) Explore the indicator to predict the distillation performance. Our extensive experiments across multiple medical datasets reveal that data distillation can significantly reduce dataset size while maintaining comparable model performance to that achieved with the full dataset, suggesting that a small, representative sample of images can serve as a reliable indicator of distillation success. This study demonstrates that data distillation is a viable method for efficient and secure medical data sharing, with the potential to facilitate enhanced collaborative research and clinical applications.