Jiadi Luo

Liangrui Pan, Jiadi Luo, Yuxuan Xiao et al.

Accurate intraoperative and postoperative diagnosis of spread through air spaces (STAS) is essential for guiding surgical decisions and postoperative management in lung cancer. However, histopathological assessment is labor-intensive and is prone to missed or incorrect diagnoses. We propose a Diffusion Attention Expert Model (DAEM) to detect STAS in frozen sections (FSs) and paraffin sections (PSs). Its diffusion attention expert module leverages full attention aggregation to learn multi-scale features from histopathological images, while a dual-branch architecture strengthens multi-scale feature representation. On an internal dataset, DAEM achieves AUCs of 0.8946 for FSs and 0.9112 for PSs. Validation on external multi-center datasets from eight institutions demonstrates strong generalizability and interpretability. Using tumor microenvironment (TME) features in PSs, we further enable semi-automatic measurement of STAS location and its distance from the primary tumor. Several quantitative TME metrics are identified as potential biomarkers for STAS, including micropapillary-type STAS. Overall, DAEM offers a clinically actionable framework for STAS assessment by enabling accurate and interpretable detection on FSs and PSs, supporting postoperative risk stratification through quantitative TME-based analysis.

Liangrui Pan, Qingchun Liang, Wenwu Zeng et al.

Spread through air spaces (STAS) is a distinct invasion pattern in lung cancer, crucial for prognosis assessment and guiding surgical decisions. Histopathology is the gold standard for STAS detection, yet traditional methods are subjective, time-consuming, and prone to misdiagnosis, limiting large-scale applications. We present VERN, an image analysis model utilizing a feature-interactive Siamese graph encoder to predict STAS from lung cancer histopathological images. VERN captures spatial topological features with feature sharing and skip connections to enhance model training. Using 1,546 histopathology slides, we built a large single-cohort STAS lung cancer dataset. VERN achieved an AUC of 0.9215 in internal validation and AUCs of 0.8275 and 0.8829 in frozen and paraffin-embedded test sections, respectively, demonstrating clinical-grade performance. Validated on a single-cohort and three external datasets, VERN showed robust predictive performance and generalizability, providing an open platform (http://plr.20210706.xyz:5000/) to enhance STAS diagnosis efficiency and accuracy.

Liangrui Pan, Xiaoyu Li, Yutao Dou et al.

Spread through air spaces (STAS) represents a newly identified aggressive pattern in lung cancer, which is known to be associated with adverse prognostic factors and complex pathological features. Pathologists currently rely on time consuming manual assessments, which are highly subjective and prone to variation. This highlights the urgent need for automated and precise diag nostic solutions. 2,970 lung cancer tissue slides are comprised from multiple centers, re-diagnosed them, and constructed and publicly released three lung cancer STAS datasets: STAS CSU (hospital), STAS TCGA, and STAS CPTAC. All STAS datasets provide corresponding pathological feature diagnoses and related clinical data. To address the bias, sparse and heterogeneous nature of STAS, we propose an scale-aware multiple instance learning(SMILE) method for STAS diagnosis of lung cancer. By introducing a scale-adaptive attention mechanism, the SMILE can adaptively adjust high attention instances, reducing over-reliance on local regions and promoting consistent detection of STAS lesions. Extensive experiments show that SMILE achieved competitive diagnostic results on STAS CSU, diagnosing 251 and 319 STAS samples in CPTAC andTCGA,respectively, surpassing clinical average AUC. The 11 open baseline results are the first to be established for STAS research, laying the foundation for the future expansion, interpretability, and clinical integration of computational pathology technologies. The datasets and code are available at https://anonymous.4open.science/r/IJCAI25-1DA1.

Liangrui Pan, xiaoyu Li, Guang Zhu et al.

Spread through air spaces (STAS) constitutes a novel invasive pattern in lung adenocarcinoma (LUAD), associated with tumor recurrence and diminished survival rates. However, large-scale STAS diagnosis in LUAD remains a labor-intensive endeavor, compounded by the propensity for oversight and misdiagnosis due to its distinctive pathological characteristics and morphological features. Consequently, there is a pressing clinical imperative to leverage deep learning models for STAS diagnosis. This study initially assembled histopathological images from STAS patients at the Second Xiangya Hospital and the Third Xiangya Hospital of Central South University, alongside the TCGA-LUAD cohort. Three senior pathologists conducted cross-verification annotations to construct the STAS-SXY, STAS-TXY, and STAS-TCGA datasets. We then propose a multi-pattern attention-aware multiple instance learning framework, named STAMP, to analyze and diagnose the presence of STAS across multi-center histopathology images. Specifically, the dual-branch architecture guides the model to learn STAS-associated pathological features from distinct semantic spaces. Transformer-based instance encoding and a multi-pattern attention aggregation modules dynamically selects regions closely associated with STAS pathology, suppressing irrelevant noise and enhancing the discriminative power of global representations. Moreover, a similarity regularization constraint prevents feature redundancy across branches, thereby improving overall diagnostic accuracy. Extensive experiments demonstrated that STAMP achieved competitive diagnostic results on STAS-SXY, STAS-TXY and STAS-TCGA, with AUCs of 0.8058, 0.8017, and 0.7928, respectively, surpassing the clinical level.