Maximilian Alber

Miriam Hägele, Johannes Eschrich, Lukas Ruff et al.

In this paper, we present a deep learning segmentation approach to classify and quantify the two most prevalent primary liver cancers - hepatocellular carcinoma and intrahepatic cholangiocarcinoma - from hematoxylin and eosin (H&E) stained whole slide images. While semantic segmentation of medical images typically requires costly pixel-level annotations by domain experts, there often exists additional information which is routinely obtained in clinical diagnostics but rarely utilized for model training. We propose to leverage such weak information from patient diagnoses by deriving complementary labels that indicate to which class a sample cannot belong to. To integrate these labels, we formulate a complementary loss for segmentation. Motivated by the medical application, we demonstrate for general segmentation tasks that including additional patches with solely weak complementary labels during model training can significantly improve the predictive performance and robustness of a model. On the task of diagnostic differentiation between hepatocellular carcinoma and intrahepatic cholangiocarcinoma, we achieve a balanced accuracy of 0.91 (CI 95%: 0.86 - 0.95) at case level for 165 hold-out patients. Furthermore, we also show that leveraging complementary labels improves the robustness of segmentation and increases performance at case level.

Maaike Galama, Nina Kozar-Gillan, Christina Embacher et al.

The tumor microenvironment (TME) plays a central role in cancer progression, treatment response, and patient outcomes, yet large-scale, consistent, and quantitative TME characterization from routine hematoxylin and eosin (H&E)-stained histopathology remains scarce. We introduce OpenTME, an open-access dataset of pre-computed TME profiles derived from 3,634 H&E-stained whole-slide images across five cancer types (bladder, breast, colorectal, liver, and lung cancer) from The Cancer Genome Atlas (TCGA). All outputs were generated using Atlas H&E-TME, an AI-powered application built on the Atlas family of pathology foundation models, which performs tissue quality control, tissue segmentation, cell detection and classification, and spatial neighborhood analysis, yielding over 4,500 quantitative readouts per slide at cell-level resolution. OpenTME is available for non-commercial academic research on Hugging Face. We will continue to expand OpenTME over time and anticipate it will serve as a resource for biomarker discovery, spatial biology research, and the development of computational methods for TME analysis.

Maximilian Alber, Timo Milbich, Alexandra Carpen-Amarie et al.

Pathology foundation models substantially advanced the possibilities in computational pathology -- yet tradeoffs in terms of performance, robustness, and computational requirements remained, which limited their clinical deployment. In this report, we present Atlas 2, Atlas 2-B, and Atlas 2-S, three pathology vision foundation models which bridge these shortcomings by showing state-of-the-art performance in prediction performance, robustness, and resource efficiency in a comprehensive evaluation across eighty public benchmarks. Our models were trained on the largest pathology foundation model dataset to date comprising 5.5 million histopathology whole slide images, collected from three medical institutions Charité - Universtätsmedizin Berlin, LMU Munich, and Mayo Clinic.

Maximilian Alber

Deep neural networks successfully pervaded many applications domains and are increasingly used in critical decision processes. Understanding their workings is desirable or even required to further foster their potential as well as to access sensitive domains like medical applications or autonomous driving. One key to this broader usage of explaining frameworks is the accessibility and understanding of respective software. In this work we introduce software and application patterns for explanation techniques that aim to explain individual predictions of neural networks. We discuss how to code well-known algorithms efficiently within deep learning software frameworks and describe how to embed algorithms in downstream implementations. Building on this we show how explanation methods can be used in applications to understand predictions for miss-classified samples, to compare algorithms or networks, and to examine the focus of networks. Furthermore, we review available open-source packages and discuss challenges posed by complex and evolving neural network structures to explanation algorithm development and implementations.

Jonas Dippel, Barbara Feulner, Tobias Winterhoff et al.

Artificial intelligence has started to transform histopathology impacting clinical diagnostics and biomedical research. However, while many computational pathology approaches have been proposed, most current AI models are limited with respect to generalization, application variety, and handling rare diseases. Recent efforts introduced self-supervised foundation models to address these challenges, yet existing approaches do not leverage pathologist knowledge by design. In this study, we present a novel approach to designing foundation models for computational pathology, incorporating pathologist expertise, semi-automated data curation, and a diverse dataset from over 15 laboratories, including 58 tissue types, and encompassing 129 different histochemical and immunohistochemical staining modalities. We demonstrate that our model "RudolfV" surpasses existing state-of-the-art foundation models across different benchmarks focused on tumor microenvironment profiling, biomarker evaluation, and reference case search while exhibiting favorable robustness properties. Our study shows how domain-specific knowledge can increase the efficiency and performance of pathology foundation models and enable novel application areas.

Maximilian Alber, Stephan Tietz, Jonas Dippel et al.

Recent advances in digital pathology have demonstrated the effectiveness of foundation models across diverse applications. In this report, we present Atlas, a novel vision foundation model based on the RudolfV approach. Our model was trained on a dataset comprising 1.2 million histopathology whole slide images, collected from two medical institutions: Mayo Clinic and Charité - Universtätsmedizin Berlin. Comprehensive evaluations show that Atlas achieves state-of-the-art performance across twenty-one public benchmark datasets, even though it is neither the largest model by parameter count nor by training dataset size.

Jonah Kömen, Edwin D. de Jong, Julius Hense et al.

Biomedical Foundation Models (FMs) are rapidly transforming AI-enabled healthcare research and entering clinical validation. However, their susceptibility to learning non-biological technical features -- including variations in surgical/endoscopic techniques, laboratory procedures, and scanner hardware -- poses risks for clinical deployment. We present the first systematic investigation of pathology FM robustness to non-biological features. Our work (i) introduces measures to quantify FM robustness, (ii) demonstrates the consequences of limited robustness, and (iii) proposes a framework for FM robustification to mitigate these issues. Specifically, we developed PathoROB, a robustness benchmark with three novel metrics, including the robustness index, and four datasets covering 28 biological classes from 34 medical centers. Our experiments reveal robustness deficits across all 20 evaluated FMs, and substantial robustness differences between them. We found that non-robust FM representations can cause major diagnostic downstream errors and clinical blunders that prevent safe clinical adoption. Using more robust FMs and post-hoc robustification considerably reduced (but did not yet eliminate) the risk of such errors. This work establishes that robustness evaluation is essential for validating pathology FMs before clinical adoption and demonstrates that future FM development must integrate robustness as a core design principle. PathoROB provides a blueprint for assessing robustness across biomedical domains, guiding FM improvement efforts towards more robust, representative, and clinically deployable AI systems that prioritize biological information over technical artifacts.

Alexander Möllers, Julius Hense, Florian Schulz et al.

In histopathology, pathologists examine both tissue architecture at low magnification and fine-grained morphology at high magnification. Yet, the performance of pathology foundation models across magnifications and the effect of magnification sampling during training remain poorly understood. We model magnification sampling as a multi-source domain adaptation problem and develop a simple theoretical framework that reveals systematic trade-offs between sampling strategies. We show that the widely used discrete uniform sampling of magnifications (0.25, 0.5, 1.0, 2.0 mpp) leads to degradation at intermediate magnifications. We introduce continuous magnification sampling, which removes gaps in magnification coverage while preserving performance at standard scales. Further, we derive sampling distributions that optimize representation quality across magnification scales. To evaluate these strategies, we introduce two new benchmarks (TCGA-MS, BRACS-MS) with appropriate metrics. Our experiments show that continuous sampling substantially improves over discrete sampling at intermediate magnifications, with gains of up to 4 percentage points in balanced classification accuracy, and that optimized distributions can further improve performance. Finally, we evaluate current histopathology foundation models, finding that magnification is a primary driver of performance variation across models. Our work paves the way towards future pathology foundation models that perform reliably across magnifications.

Marvin Sextro, Gabriel Dernbach, Kai Standvoss et al.

Understanding how deep learning models predict oncology patient risk can provide critical insights into disease progression, support clinical decision-making, and pave the way for trustworthy and data-driven precision medicine. Building on recent advances in the spatial modeling of the tumor microenvironment using graph neural networks, we present an explainable cell graph (xCG) approach for survival prediction. We validate our model on a public cohort of imaging mass cytometry (IMC) data for 416 cases of lung adenocarcinoma. We explain survival predictions in terms of known phenotypes on the cell level by computing risk attributions over cell graphs, for which we propose an efficient grid-based layer-wise relevance propagation (LRP) method. Our ablation studies highlight the importance of incorporating the cancer stage and model ensembling to improve the quality of risk estimates. Our xCG method, together with the IMC data, is made publicly available to support further research.

Jonas Dippel, Niklas Prenißl, Julius Hense et al.

While previous studies have demonstrated the potential of AI to diagnose diseases in imaging data, clinical implementation is still lagging behind. This is partly because AI models require training with large numbers of examples only available for common diseases. In clinical reality, however, only few diseases are common, whereas the majority of diseases are less frequent (long-tail distribution). Current AI models overlook or misclassify these diseases. We propose a deep anomaly detection approach that only requires training data from common diseases to detect also all less frequent diseases. We collected two large real-world datasets of gastrointestinal biopsies, which are prototypical of the problem. Herein, the ten most common findings account for approximately 90% of cases, whereas the remaining 10% contained 56 disease entities, including many cancers. 17 million histological images from 5,423 cases were used for training and evaluation. Without any specific training for the diseases, our best-performing model reliably detected a broad spectrum of infrequent ("anomalous") pathologies with 95.0% (stomach) and 91.0% (colon) AUROC and generalized across scanners and hospitals. By design, the proposed anomaly detection can be expected to detect any pathological alteration in the diagnostic tail of gastrointestinal biopsies, including rare primary or metastatic cancers. This study establishes the first effective clinical application of AI-based anomaly detection in histopathology that can flag anomalous cases, facilitate case prioritization, reduce missed diagnoses and enhance the general safety of AI models, thereby driving AI adoption and automation in routine diagnostics and beyond.

Stephanie Brandl, David Lassner, Maximilian Alber

Word embeddings capture semantic relationships based on contextual information and are the basis for a wide variety of natural language processing applications. Notably these relationships are solely learned from the data and subsequently the data composition impacts the semantic of embeddings which arguably can lead to biased word vectors. Given qualitatively different data subsets, we aim to align the influence of single subsets on the resulting word vectors, while retaining their quality. In this regard we propose a criteria to measure the shift towards a single data subset and develop approaches to meet both objectives. We find that a weighted average of the two subset embeddings balances the influence of those subsets while word similarity performance decreases. We further propose a promising optimization approach to balance influences and quality of word embeddings.

Ann-Kathrin Dombrowski, Maximilian Alber, Christopher J. Anders et al.

Explanation methods aim to make neural networks more trustworthy and interpretable. In this paper, we demonstrate a property of explanation methods which is disconcerting for both of these purposes. Namely, we show that explanations can be manipulated arbitrarily by applying visually hardly perceptible perturbations to the input that keep the network's output approximately constant. We establish theoretically that this phenomenon can be related to certain geometrical properties of neural networks. This allows us to derive an upper bound on the susceptibility of explanations to manipulations. Based on this result, we propose effective mechanisms to enhance the robustness of explanations.

Maximilian Alber, Sebastian Lapuschkin, Philipp Seegerer et al.

In recent years, deep neural networks have revolutionized many application domains of machine learning and are key components of many critical decision or predictive processes. Therefore, it is crucial that domain specialists can understand and analyze actions and pre- dictions, even of the most complex neural network architectures. Despite these arguments neural networks are often treated as black boxes. In the attempt to alleviate this short- coming many analysis methods were proposed, yet the lack of reference implementations often makes a systematic comparison between the methods a major effort. The presented library iNNvestigate addresses this by providing a common interface and out-of-the- box implementation for many analysis methods, including the reference implementation for PatternNet and PatternAttribution as well as for LRP-methods. To demonstrate the versatility of iNNvestigate, we provide an analysis of image classifications for variety of state-of-the-art neural network architectures.

Maximilian Alber, Irwan Bello, Barret Zoph et al.

The back-propagation algorithm is the cornerstone of deep learning. Despite its importance, few variations of the algorithm have been attempted. This work presents an approach to discover new variations of the back-propagation equation. We use a domain specific lan- guage to describe update equations as a list of primitive functions. An evolution-based method is used to discover new propagation rules that maximize the generalization per- formance after a few epochs of training. We find several update equations that can train faster with short training times than standard back-propagation, and perform similar as standard back-propagation at convergence.

Pieter-Jan Kindermans, Sara Hooker, Julius Adebayo et al.

Saliency methods aim to explain the predictions of deep neural networks. These methods lack reliability when the explanation is sensitive to factors that do not contribute to the model prediction. We use a simple and common pre-processing step ---adding a constant shift to the input data--- to show that a transformation with no effect on the model can cause numerous methods to incorrectly attribute. In order to guarantee reliability, we posit that methods should fulfill input invariance, the requirement that a saliency method mirror the sensitivity of the model with respect to transformations of the input. We show, through several examples, that saliency methods that do not satisfy input invariance result in misleading attribution.

Pieter-Jan Kindermans, Kristof T. Schütt, Maximilian Alber et al.

DeConvNet, Guided BackProp, LRP, were invented to better understand deep neural networks. We show that these methods do not produce the theoretically correct explanation for a linear model. Yet they are used on multi-layer networks with millions of parameters. This is a cause for concern since linear models are simple neural networks. We argue that explanation methods for neural nets should work reliably in the limit of simplicity, the linear models. Based on our analysis of linear models we propose a generalization that yields two explanation techniques (PatternNet and PatternAttribution) that are theoretically sound for linear models and produce improved explanations for deep networks.

Maximilian Alber, Julian Zimmert, Urun Dogan et al.

Training of one-vs.-rest SVMs can be parallelized over the number of classes in a straight forward way. Given enough computational resources, one-vs.-rest SVMs can thus be trained on data involving a large number of classes. The same cannot be stated, however, for the so-called all-in-one SVMs, which require solving a quadratic program of size quadratically in the number of classes. We develop distributed algorithms for two all-in-one SVM formulations (Lee et al. and Weston and Watkins) that parallelize the computation evenly over the number of classes. This allows us to compare these models to one-vs.-rest SVMs on unprecedented scale. The results indicate superior accuracy on text classification data.