David J. Harrison

Georg Wölflein, Dyke Ferber, Asier R. Meneghetti et al.

Weakly supervised whole slide image classification is a key task in computational pathology, which involves predicting a slide-level label from a set of image patches constituting the slide. Constructing models to solve this task involves multiple design choices, often made without robust empirical or conclusive theoretical justification. To address this, we conduct a comprehensive benchmarking of feature extractors to answer three critical questions: 1) Is stain normalisation still a necessary preprocessing step? 2) Which feature extractors are best for downstream slide-level classification? 3) How does magnification affect downstream performance? Our study constitutes the most comprehensive evaluation of publicly available pathology feature extractors to date, involving more than 10,000 training runs across 14 feature extractors, 9 tasks, 5 datasets, 3 downstream architectures, 2 levels of magnification, and various preprocessing setups. Our findings challenge existing assumptions: 1) We observe empirically, and by analysing the latent space, that skipping stain normalisation and image augmentations does not degrade performance, while significantly reducing memory and computational demands. 2) We develop a novel evaluation metric to compare relative downstream performance, and show that the choice of feature extractor is the most consequential factor for downstream performance. 3) We find that lower-magnification slides are sufficient for accurate slide-level classification. Contrary to previous patch-level benchmarking studies, our approach emphasises clinical relevance by focusing on slide-level biomarker prediction tasks in a weakly supervised setting with external validation cohorts. Our findings stand to streamline digital pathology workflows by minimising preprocessing needs and informing the selection of feature extractors.

Haseeb Nazki, Ognjen Arandjelović, InHwa Um et al.

Histopathology relies on the analysis of microscopic tissue images to diagnose disease. A crucial part of tissue preparation is staining whereby a dye is used to make the salient tissue components more distinguishable. However, differences in laboratory protocols and scanning devices result in significant confounding appearance variation in the corresponding images. This variation increases both human error and the inter-rater variability, as well as hinders the performance of automatic or semi-automatic methods. In the present paper we introduce an unsupervised adversarial network to translate (and hence normalize) whole slide images across multiple data acquisition domains. Our key contributions are: (i) an adversarial architecture which learns across multiple domains with a single generator-discriminator network using an information flow branch which optimizes for perceptual loss, and (ii) the inclusion of an additional feature extraction network during training which guides the transformation network to keep all the structural features in the tissue image intact. We: (i) demonstrate the effectiveness of the proposed method firstly on H\&E slides of 120 cases of kidney cancer, as well as (ii) show the benefits of the approach on more general problems, such as flexible illumination based natural image enhancement and light source adaptation.

Georg Wölflein, Lucie Charlotte Magister, Pietro Liò et al.

Traditional supervised learning tasks require a label for every instance in the training set, but in many real-world applications, labels are only available for collections (bags) of instances. This problem setting, known as multiple instance learning (MIL), is particularly relevant in the medical domain, where high-resolution images are split into smaller patches, but labels apply to the image as a whole. Recent MIL models are able to capture correspondences between patches by employing self-attention, allowing them to weigh each patch differently based on all other patches in the bag. However, these approaches still do not consider the relative spatial relationships between patches within the larger image, which is especially important in computational pathology. To this end, we introduce a novel MIL model with distance-aware self-attention (DAS-MIL), which explicitly takes into account relative spatial information when modelling the interactions between patches. Unlike existing relative position representations for self-attention which are discrete, our approach introduces continuous distance-dependent terms into the computation of the attention weights, and is the first to apply relative position representations in the context of MIL. We evaluate our model on a custom MNIST-based MIL dataset that requires the consideration of relative spatial information, as well as on CAMELYON16, a publicly available cancer metastasis detection dataset, where we achieve a test AUROC score of 0.91. On both datasets, our model outperforms existing MIL approaches that employ absolute positional encodings, as well as existing relative position representation schemes applied to MIL. Our code is available at https://anonymous.4open.science/r/das-mil.

Craig Myles, In Hwa Um, Craig Marshall et al.

Cancer remains one of the leading causes of morbidity and mortality worldwide. Comprehensive datasets that combine histopathological images with genetic and survival data across various tumour sites are essential for advancing computational pathology and personalised medicine. We present SurGen, a dataset comprising 1,020 H&E-stained whole-slide images (WSIs) from 843 colorectal cancer cases. The dataset includes detailed annotations for key genetic mutations (KRAS, NRAS, BRAF) and mismatch repair status, as well as survival data for 426 cases. We illustrate SurGen's utility with a proof-of-concept model that predicts mismatch repair status directly from WSIs, achieving a test area under the receiver operating characteristic curve of 0.8273. These preliminary results underscore the dataset's potential to facilitate research in biomarker discovery, prognostic modelling, and advanced machine learning applications in colorectal cancer and beyond. SurGen offers a valuable resource for the scientific community, enabling studies that require high-quality WSIs linked with comprehensive clinical and genetic information on colorectal cancer. Our initial findings affirm the dataset's capacity to advance diagnostic precision and foster the development of personalised treatment strategies in colorectal oncology. Data available online: https://doi.org/10.6019/S-BIAD1285.

Jessica Cooper, In Hwa Um, Ognjen Arandjelović et al.

Multiplex immunofluorescence and immunohistochemistry benefit patients by allowing cancer pathologists to identify several proteins expressed on the surface of cells, enabling cell classification, better understanding of the tumour micro-environment, more accurate diagnoses, prognoses, and tailored immunotherapy based on the immune status of individual patients. However, they are expensive and time consuming processes which require complex staining and imaging techniques by expert technicians. Hoechst staining is much cheaper and easier to perform, but is not typically used in this case as it binds to DNA rather than to the proteins targeted by immunofluorescent techniques, and it was not previously thought possible to differentiate cells expressing these proteins based only on DNA morphology. In this work we show otherwise, training a deep convolutional neural network to identify cells expressing three proteins (T lymphocyte markers CD3 and CD8, and the B lymphocyte marker CD20) with greater than 90% precision and recall, from Hoechst 33342 stained tissue only. Our model learns previously unknown morphological features associated with expression of these proteins which can be used to accurately differentiate lymphocyte subtypes for use in key prognostic metrics such as assessment of immune cell infiltration,and thereby predict and improve patient outcomes without the need for costly multiplex immunofluorescence.

Jessica Cooper, Ognjen Arandjelović, David J Harrison

Understanding the predictions made by Artificial Intelligence (AI) systems is becoming more and more important as deep learning models are used for increasingly complex and high-stakes tasks. Saliency mapping -- a popular visual attribution method -- is one important tool for this, but existing formulations are limited by either computational cost or architectural constraints. We therefore propose Hierarchical Perturbation, a very fast and completely model-agnostic method for interpreting model predictions with robust saliency maps. Using standard benchmarks and datasets, we show that our saliency maps are of competitive or superior quality to those generated by existing model-agnostic methods -- and are over 20 times faster to compute.