Chengwei Shao

Zhilin Zheng, Xu Fang, Jiawen Yao et al.

Lymph node (LN) metastasis status is one of the most critical prognostic and cancer staging factors for patients with resectable pancreatic ductal adenocarcinoma (PDAC), or in general, for any types of solid malignant tumors. Preoperative prediction of LN metastasis from non-invasive CT imaging is highly desired, as it might be straightforwardly used to guide the following neoadjuvant treatment decision and surgical planning. Most studies only capture the tumor characteristics in CT imaging to implicitly infer LN metastasis and very few work exploit direct LN's CT imaging information. To the best of our knowledge, this is the first work to propose a fully-automated LN segmentation and identification network to directly facilitate the LN metastasis status prediction task. Nevertheless LN segmentation/detection is very challenging since LN can be easily confused with other hard negative anatomic structures (e.g., vessels) from radiological images. We explore the anatomical spatial context priors of pancreatic LN locations by generating a guiding attention map from related organs and vessels to assist segmentation and infer LN status. As such, LN segmentation is impelled to focus on regions that are anatomically adjacent or plausible with respect to the specific organs and vessels. The metastasized LN identification network is trained to classify the segmented LN instances into positives or negatives by reusing the segmentation network as a pre-trained backbone and padding a new classification head. More importantly, we develop a LN metastasis status prediction network that combines the patient-wise aggregation results of LN segmentation/identification and deep imaging features extracted from the tumor region. Extensive quantitative nested five-fold cross-validation is conducted on a discovery dataset of 749 patients with PDAC.

Chengying She, Chengwei Chen, Dongjie Fan et al.

Whole slide images (WSIs) classification represents a fundamental challenge in computational pathology, where multiple instance learning (MIL) has emerged as the dominant paradigm. Current state-of-the-art (SOTA) MIL methods rely on attention mechanisms, achieving good performance but requiring substantial computational resources due to quadratic complexity when processing hundreds of thousands of patches. To address this computational bottleneck, we introduce EfficientMIL, a novel linear-complexity MIL approach for WSIs classification with the patches selection module Adaptive Patch Selector (APS) that we designed, replacing the quadratic-complexity self-attention mechanisms in Transformer-based MIL methods with efficient sequence models including RNN-based GRU, LSTM, and State Space Model (SSM) Mamba. EfficientMIL achieves significant computational efficiency improvements while outperforming other MIL methods across multiple histopathology datasets. On TCGA-Lung dataset, EfficientMIL-Mamba achieved AUC of 0.976 and accuracy of 0.933, while on CAMELYON16 dataset, EfficientMIL-GRU achieved AUC of 0.990 and accuracy of 0.975, surpassing previous state-of-the-art methods. Extensive experiments demonstrate that APS is also more effective for patches selection than conventional selection strategies.