Weakly supervised deep learning model with size constraint for prostate cancer detection in multiparametric MRI and generalization to unseen domains

Fully supervised deep models have shown promising performance for many medical segmentation tasks. Still, the deployment of these tools in clinics is limited by the very timeconsuming collection of manually expert-annotated data. Moreover, most of the state-ofthe-art models have been trained and validated on moderately homogeneous datasets. It is known that deep learning methods are often greatly degraded by domain or label shifts and are yet to be built in such a way as to be robust to unseen data or label distributions. In the clinical setting, this problematic is particularly relevant as the deployment institutions may have different scanners or acquisition protocols than those from which the data has been collected to train the model. In this work, we propose to address these two challenges on the detection of clinically significant prostate cancer (csPCa) from bi-parametric MRI. We evaluate the method proposed by (Kervadec et al., 2018), which introduces a size constaint loss to produce fine semantic cancer lesions segmentations from weak circle scribbles annotations. Performance of the model is based on two public (PI-CAI and Prostate158) and one private databases. First, we show that the model achieves on-par performance with strong fully supervised baseline models, both on in-distribution validation data and unseen test images. Second, we observe a performance decrease for both fully supervised and weakly supervised models when tested on unseen data domains. This confirms the crucial need for efficient domain adaptation methods if deep learning models are aimed to be deployed in a clinical environment. Finally, we show that ensemble predictions from multiple trainings increase generalization performance.

ProstAttention-Net: A deep attention model for prostate cancer segmentation by aggressiveness in MRI scans

Multiparametric magnetic resonance imaging (mp-MRI) has shown excellent results in the detection of prostate cancer (PCa). However, characterizing prostate lesions aggressiveness in mp-MRI sequences is impossible in clinical practice, and biopsy remains the reference to determine the Gleason score (GS). In this work, we propose a novel end-to-end multi-class network that jointly segments the prostate gland and cancer lesions with GS group grading. After encoding the information on a latent space, the network is separated in two branches: 1) the first branch performs prostate segmentation 2) the second branch uses this zonal prior as an attention gate for the detection and grading of prostate lesions. The model was trained and validated with a 5-fold cross-validation on an heterogeneous series of 219 MRI exams acquired on three different scanners prior prostatectomy. In the free-response receiver operating characteristics (FROC) analysis for clinically significant lesions (defined as GS > 6) detection, our model achieves 69.0% $\pm$14.5% sensitivity at 2.9 false positive per patient on the whole prostate and 70.8% $\pm$14.4% sensitivity at 1.5 false positive when considering the peripheral zone (PZ) only. Regarding the automatic GS group