Jiguang Wang

Yingxue Xu, Yihui Wang, Fengtao Zhou et al.

Remarkable strides in computational pathology have been made in the task-agnostic foundation model that advances the performance of a wide array of downstream clinical tasks. Despite the promising performance, there are still several challenges. First, prior works have resorted to either vision-only or image-caption data, disregarding pathology reports with more clinically authentic information from pathologists and gene expression profiles which respectively offer distinct knowledge for versatile clinical applications. Second, the current progress in pathology FMs predominantly concentrates on the patch level, where the restricted context of patch-level pretraining fails to capture whole-slide patterns. Even recent slide-level FMs still struggle to provide whole-slide context for patch representation. In this study, for the first time, we develop a pathology foundation model incorporating three levels of modalities: pathology slides, pathology reports, and gene expression data, which resulted in 26,169 slide-level modality pairs from 10,275 patients across 32 cancer types, amounting to over 116 million pathological patch images. To leverage these data for CPath, we propose a novel whole-slide pretraining paradigm that injects the multimodal whole-slide context into the patch representation, called Multimodal Self-TAught PRetraining (mSTAR). The proposed paradigm revolutionizes the pretraining workflow for CPath, enabling the pathology FM to acquire the whole-slide context. To the best of our knowledge, this is the first attempt to incorporate three modalities at the whole-slide context for enhancing pathology FMs. To systematically evaluate the capabilities of mSTAR, we built the largest spectrum of oncological benchmark, spanning 7 categories of oncological applications in 15 types of 97 practical oncological tasks.

Jiabo Ma, Zhengrui Guo, Fengtao Zhou et al.

Foundation models pretrained on large-scale datasets are revolutionizing the field of computational pathology (CPath). The generalization ability of foundation models is crucial for the success in various downstream clinical tasks. However, current foundation models have only been evaluated on a limited type and number of tasks, leaving their generalization ability and overall performance unclear. To address this gap, we established a most comprehensive benchmark to evaluate the performance of off-the-shelf foundation models across six distinct clinical task types, encompassing a total of 72 specific tasks, including slide-level classification, survival prediction, ROI-tissue classification, ROI retrieval, visual question answering, and report generation. Our findings reveal that existing foundation models excel at certain task types but struggle to effectively handle the full breadth of clinical tasks. To improve the generalization of pathology foundation models, we propose a unified knowledge distillation framework consisting of both expert and self-knowledge distillation, where the former allows the model to learn from the knowledge of multiple expert models, while the latter leverages self-distillation to enable image representation learning via local-global alignment. Based on this framework, we curated a dataset of 96,000 whole slide images (WSIs) and developed a Generalizable Pathology Foundation Model (GPFM). This advanced model was trained on a substantial dataset comprising 190 million images extracted from approximately 72,000 publicly available slides, encompassing 34 major tissue types. Evaluated on the established benchmark, GPFM achieves an impressive average rank of 1.6, with 42 tasks ranked 1st, while the second-best model, UNI, attains an average rank of 3.7, with only 6 tasks ranked 1st.

Yuting He, Fuxiang Huang, Xinrui Jiang et al.

Foundation model, which is pre-trained on broad data and is able to adapt to a wide range of tasks, is advancing healthcare. It promotes the development of healthcare artificial intelligence (AI) models, breaking the contradiction between limited AI models and diverse healthcare practices. Much more widespread healthcare scenarios will benefit from the development of a healthcare foundation model (HFM), improving their advanced intelligent healthcare services. Despite the impending widespread deployment of HFMs, there is currently a lack of clear understanding about how they work in the healthcare field, their current challenges, and where they are headed in the future. To answer these questions, a comprehensive and deep survey of the challenges, opportunities, and future directions of HFMs is presented in this survey. It first conducted a comprehensive overview of the HFM including the methods, data, and applications for a quick grasp of the current progress. Then, it made an in-depth exploration of the challenges present in data, algorithms, and computing infrastructures for constructing and widespread application of foundation models in healthcare. This survey also identifies emerging and promising directions in this field for future development. We believe that this survey will enhance the community's comprehension of the current progress of HFM and serve as a valuable source of guidance for future development in this field. The latest HFM papers and related resources are maintained on our website: https://github.com/YutingHe-list/Awesome-Foundation-Models-for-Advancing-Healthcare.

Zhidong Yang, Xiuhui Shi, Wei Ba et al.

Whole slide image (WSI) analysis has emerged as an increasingly essential technique in computational pathology. Recent advances in the pathology foundation models (FMs) have demonstrated significant advantages in deriving meaningful patch-level or slide-level multi-scale features from WSIs. However, current pathology FMs have exhibited substantial heterogeneity caused by diverse private training datasets and different network architectures. This heterogeneity introduces performance variability when we utilize the features from different FMs in the downstream tasks. To fully explore the advantages of multiple FMs effectively, in this work, we propose a novel framework for the fusion of multi-scale heterogeneous pathology FMs, called FuseCPath, yielding a model with a superior ensemble performance. The main contributions of our framework can be summarized as follows: (i) To guarantee the representativeness of the training patches, we propose a multi-view clustering-based method to filter out the discriminative patches via multiple FMs' embeddings. (ii) To effectively fuse the patch-level FMs, we devise a cluster-level re-embedding strategy to online capture patch-level local features. (iii) To effectively fuse the slide-level FMs, we devise a collaborative distillation strategy to explore the connections between slide-level FMs. Extensive experiments demonstrate that the proposed FuseCPath achieves state-of-the-art performance across multiple tasks on diverse datasets.

Fengtao Zhou, Yingxue Xu, Yanfen Cui et al.

Gastric cancer (GC) is a prevalent malignancy worldwide, ranking as the fifth most common cancer with over 1 million new cases and 700 thousand deaths in 2020. Locally advanced gastric cancer (LAGC) accounts for approximately two-thirds of GC diagnoses, and neoadjuvant chemotherapy (NACT) has emerged as the standard treatment for LAGC. However, the effectiveness of NACT varies significantly among patients, with a considerable subset displaying treatment resistance. Ineffective NACT not only leads to adverse effects but also misses the optimal therapeutic window, resulting in lower survival rate. However, existing multimodal learning methods assume the availability of all modalities for each patient, which does not align with the reality of clinical practice. The limited availability of modalities for each patient would cause information loss, adversely affecting predictive accuracy. In this study, we propose an incomplete multimodal data integration framework for GC (iMD4GC) to address the challenges posed by incomplete multimodal data, enabling precise response prediction and survival analysis. Specifically, iMD4GC incorporates unimodal attention layers for each modality to capture intra-modal information. Subsequently, the cross-modal interaction layers explore potential inter-modal interactions and capture complementary information across modalities, thereby enabling information compensation for missing modalities. To evaluate iMD4GC, we collected three multimodal datasets for GC study: GastricRes (698 cases) for response prediction, GastricSur (801 cases) for survival analysis, and TCGA-STAD (400 cases) for survival analysis. The scale of our datasets is significantly larger than previous studies. The iMD4GC achieved impressive performance with an 80.2% AUC on GastricRes, 71.4% C-index on GastricSur, and 66.1% C-index on TCGA-STAD, significantly surpassing other compared methods.