Hongyan Gu

Marc Aubreville, Nikolas Stathonikos, Taryn A. Donovan et al.

Recognition of mitotic figures in histologic tumor specimens is highly relevant to patient outcome assessment. This task is challenging for algorithms and human experts alike, with deterioration of algorithmic performance under shifts in image representations. Considerable covariate shifts occur when assessment is performed on different tumor types, images are acquired using different digitization devices, or specimens are produced in different laboratories. This observation motivated the inception of the 2022 challenge on MItosis Domain Generalization (MIDOG 2022). The challenge provided annotated histologic tumor images from six different domains and evaluated the algorithmic approaches for mitotic figure detection provided by nine challenge participants on ten independent domains. Ground truth for mitotic figure detection was established in two ways: a three-expert consensus and an independent, immunohistochemistry-assisted set of labels. This work represents an overview of the challenge tasks, the algorithmic strategies employed by the participants, and potential factors contributing to their success. With an $F_1$ score of 0.764 for the top-performing team, we summarize that domain generalization across various tumor domains is possible with today's deep learning-based recognition pipelines. However, we also found that domain characteristics not present in the training set (feline as new species, spindle cell shape as new morphology and a new scanner) led to small but significant decreases in performance. When assessed against the immunohistochemistry-assisted reference standard, all methods resulted in reduced recall scores, but with only minor changes in the order of participants in the ranking.

Hongyan Gu, Mohammad Haeri, Shuo Ni et al.

This work presents a mitosis detection method with only one vanilla Convolutional Neural Network (CNN). Our method consists of two steps: given an image, we first apply a CNN using a sliding window technique to extract patches that have mitoses; we then calculate each extracted patch's class activation map to obtain the mitosis's precise location. To increase the model performance on high-domain-variance pathology images, we train the CNN with a data augmentation pipeline, a noise-tolerant loss that copes with unlabeled images, and a multi-rounded active learning strategy. In the MIDOG 2022 challenge, our approach, with an EfficientNet-b3 CNN model, achieved an overall F1 score of 0.7323 in the preliminary test phase, and 0.6847 in the final test phase (task 1). Our approach sheds light on the broader applicability of class activation maps for object detections in pathology images.

Hongyan Gu, Ellie Onstott, Wenzhong Yan et al.

Z-stack scanning is an emerging whole slide imaging technology that captures multiple focal planes alongside the z-axis of a glass slide. Because z-stacking can offer enhanced depth information compared to the single-layer whole slide imaging, this technology can be particularly useful in analyzing small-scaled histopathological patterns. However, its actual clinical impact remains debated with mixed results. To clarify this, we investigate the effect of z-stack scanning on artificial intelligence (AI) mitosis detection of meningiomas. With the same set of 22 Hematoxylin and Eosin meningioma glass slides scanned by three different digital pathology scanners, we tested the performance of three AI pipelines on both single-layer and z-stacked whole slide images (WSIs). Results showed that in all scanner-AI combinations, z-stacked WSIs significantly increased AI's sensitivity (+17.14%) on the mitosis detection with only a marginal impact on precision. Our findings provide quantitative evidence that highlights z-stack scanning as a promising technique for AI mitosis detection, paving the way for more reliable AI-assisted pathology workflows, which can ultimately benefit patient management.

Hongyan Gu, Zihan Yan, Ayesha Alvi et al.

The expansion of artificial intelligence (AI) in pathology tasks has intensified the demand for doctors' annotations in AI development. However, collecting high-quality annotations from doctors is costly and time-consuming, creating a bottleneck in AI progress. This study investigates eye-tracking as a cost-effective technology to collect doctors' behavioral data for AI training with a focus on the pathology task of mitosis detection. One major challenge in using eye-gaze data is the low signal-to-noise ratio, which hinders the extraction of meaningful information. We tackled this by levering the properties of inter-observer eye-gaze consistencies and creating eye-gaze labels from consistent eye-fixations shared by a group of observers. Our study involved 14 non-medical participants, from whom we collected eye-gaze data and generated eye-gaze labels based on varying group sizes. We assessed the efficacy of such eye-gaze labels by training Convolutional Neural Networks (CNNs) and comparing their performance to those trained with ground truth annotations and a heuristic-based baseline. Results indicated that CNNs trained with our eye-gaze labels closely followed the performance of ground-truth-based CNNs, and significantly outperformed the baseline. Although primarily focused on mitosis, we envision that insights from this study can be generalized to other medical imaging tasks.

Tengyou Xu, Haochen Yang, Xiang 'Anthony' Chen et al.

This abstract presents our solution (Team Westwood) for mitosis detection and atypical mitosis classification in the MItosis DOmain Generalization (MIDOG) 2025 challenge. For mitosis detection, we trained an nnUNetV2 for initial mitosis candidate screening with high sensitivity, followed by a random forest classifier ensembling predictions of three convolutional neural networks (CNNs): EfficientNet-b3, EfficientNet-b5, and EfficientNetV2-s. For the atypical mitosis classification, we trained another random forest classifier ensembling the predictions of three CNNs: EfficientNet-b3, EfficientNet-b5, and InceptionV3. On the preliminary test set, our solution achieved an F1 score of 0.7450 for track 1 mitosis detection, and a balanced accuracy of 0.8722 for track 2 atypical mitosis classification. On the final test set, our solution achieved an F1 score of 0.6972 for track 1 mitosis detection, and a balanced accuracy of 0.8242 for track 2 atypical mitosis classification.

Hongyan Gu, Jingbin Huang, Lauren Hung et al.

Despite the promises of data-driven artificial intelligence (AI), little is known about how we can bridge the gulf between traditional physician-driven diagnosis and a plausible future of medicine automated by AI. Specifically, how can we involve AI usefully in physicians' diagnosis workflow given that most AI is still nascent and error-prone (e.g., in digital pathology)? To explore this question, we first propose a series of collaborative techniques to engage human pathologists with AI given AI's capabilities and limitations, based on which we prototype Impetus - a tool where an AI takes various degrees of initiatives to provide various forms of assistance to a pathologist in detecting tumors from histological slides. We summarize observations and lessons learned from a study with eight pathologists and discuss recommendations for future work on human-centered medical AI systems.

Hongyan Gu, Yuan Liang, Yifan Xu et al.

Recent developments in AI have provided assisting tools to support pathologists' diagnoses. However, it remains challenging to incorporate such tools into pathologists' practice; one main concern is AI's insufficient workflow integration with medical decisions. We observed pathologists' examination and discovered that the main hindering factor to integrate AI is its incompatibility with pathologists' workflow. To bridge the gap between pathologists and AI, we developed a human-AI collaborative diagnosis tool -- xPath -- that shares a similar examination process to that of pathologists, which can improve AI's integration into their routine examination. The viability of xPath is confirmed by a technical evaluation and work sessions with twelve medical professionals in pathology. This work identifies and addresses the challenge of incorporating AI models into pathology, which can offer first-hand knowledge about how HCI researchers can work with medical professionals side-by-side to bring technological advances to medical tasks towards practical applications.