Joel Saltz

Saumya Gupta, Xiaoling Hu, James Kaan et al.

Deep learning methods have achieved impressive performance for multi-class medical image segmentation. However, they are limited in their ability to encode topological interactions among different classes (e.g., containment and exclusion). These constraints naturally arise in biomedical images and can be crucial in improving segmentation quality. In this paper, we introduce a novel topological interaction module to encode the topological interactions into a deep neural network. The implementation is completely convolution-based and thus can be very efficient. This empowers us to incorporate the constraints into end-to-end training and enrich the feature representation of neural networks. The efficacy of the proposed method is validated on different types of interactions. We also demonstrate the generalizability of the method on both proprietary and public challenge datasets, in both 2D and 3D settings, as well as across different modalities such as CT and Ultrasound. Code is available at: https://github.com/TopoXLab/TopoInteraction

Jingwei Zhang, Saarthak Kapse, Ke Ma et al.

Whole slide image (WSI) classification is a critical task in computational pathology, requiring the processing of gigapixel-sized images, which is challenging for current deep-learning methods. Current state of the art methods are based on multi-instance learning schemes (MIL), which usually rely on pretrained features to represent the instances. Due to the lack of task-specific annotated data, these features are either obtained from well-established backbones on natural images, or, more recently from self-supervised models pretrained on histopathology. However, both approaches yield task-agnostic features, resulting in performance loss compared to the appropriate task-related supervision, if available. In this paper, we show that when task-specific annotations are limited, we can inject such supervision into downstream task training, to reduce the gap between fully task-tuned and task agnostic features. We propose Prompt-MIL, an MIL framework that integrates prompts into WSI classification. Prompt-MIL adopts a prompt tuning mechanism, where only a small fraction of parameters calibrates the pretrained features to encode task-specific information, rather than the conventional full fine-tuning approaches. Extensive experiments on three WSI datasets, TCGA-BRCA, TCGA-CRC, and BRIGHT, demonstrate the superiority of Prompt-MIL over conventional MIL methods, achieving a relative improvement of 1.49%-4.03% in accuracy and 0.25%-8.97% in AUROC while using fewer than 0.3% additional parameters. Compared to conventional full fine-tuning approaches, we fine-tune less than 1.3% of the parameters, yet achieve a relative improvement of 1.29%-13.61% in accuracy and 3.22%-27.18% in AUROC and reduce GPU memory consumption by 38%-45% while training 21%-27% faster. Our code is available at https://github.com/cvlab-stonybrook/PromptMIL.

Jingwei Zhang, Xin Zhang, Ke Ma et al.

Histopathology whole slide images (WSIs) play a very important role in clinical studies and serve as the gold standard for many cancer diagnoses. However, generating automatic tools for processing WSIs is challenging due to their enormous sizes. Currently, to deal with this issue, conventional methods rely on a multiple instance learning (MIL) strategy to process a WSI at patch level. Although effective, such methods are computationally expensive, because tiling a WSI into patches takes time and does not explore the spatial relations between these tiles. To tackle these limitations, we propose a locally supervised learning framework which processes the entire slide by exploring the entire local and global information that it contains. This framework divides a pre-trained network into several modules and optimizes each module locally using an auxiliary model. We also introduce a random feature reconstruction unit (RFR) to preserve distinguishing features during training and improve the performance of our method by 1% to 3%. Extensive experiments on three publicly available WSI datasets: TCGA-NSCLC, TCGA-RCC and LKS, highlight the superiority of our method on different classification tasks. Our method outperforms the state-of-the-art MIL methods by 2% to 5% in accuracy, while being 7 to 10 times faster. Additionally, when dividing it into eight modules, our method requires as little as 20% of the total gpu memory required by end-to-end training. Our code is available at https://github.com/cvlab-stonybrook/local_learning_wsi.

Jakub R. Kaczmarzyk, Alan O'Callaghan, Fiona Inglis et al.

The field of digital pathology has seen a proliferation of deep learning models in recent years. Despite substantial progress, it remains rare for other researchers and pathologists to be able to access models published in the literature and apply them to their own images. This is due to difficulties in both sharing and running models. To address these concerns, we introduce WSInfer: a new, open-source software ecosystem designed to make deep learning for pathology more streamlined and accessible. WSInfer comprises three main elements: 1) a Python package and command line tool to efficiently apply patch-based deep learning inference to whole slide images; 2) a QuPath extension that provides an alternative inference engine through user-friendly and interactive software, and 3) a model zoo, which enables pathology models and metadata to be easily shared in a standardized form. Together, these contributions aim to encourage wider reuse, exploration, and interrogation of deep learning models for research purposes, by putting them into the hands of pathologists and eliminating a need for coding experience when accessed through QuPath. The WSInfer source code is hosted on GitHub and documentation is available at https://wsinfer.readthedocs.io.

Jingwei Zhang, Saarthak Kapse, Ke Ma et al.

Dense prediction tasks such as segmentation and detection of pathological entities hold crucial clinical value in computational pathology workflows. However, obtaining dense annotations on large cohorts is usually tedious and expensive. Contrastive learning (CL) is thus often employed to leverage large volumes of unlabeled data to pre-train the backbone network. To boost CL for dense prediction, some studies have proposed variations of dense matching objectives in pre-training. However, our analysis shows that employing existing dense matching strategies on histopathology images enforces invariance among incorrect pairs of dense features and, thus, is imprecise. To address this, we propose a precise location-based matching mechanism that utilizes the overlapping information between geometric transformations to precisely match regions in two augmentations. Extensive experiments on two pretraining datasets (TCGA-BRCA, NCT-CRC-HE) and three downstream datasets (GlaS, CRAG, BCSS) highlight the superiority of our method in semantic and instance segmentation tasks. Our method outperforms previous dense matching methods by up to 7.2% in average precision for detection and 5.6% in average precision for instance segmentation tasks. Additionally, by using our matching mechanism in the three popular contrastive learning frameworks, MoCo-v2, VICRegL, and ConCL, the average precision in detection is improved by 0.7% to 5.2%, and the average precision in segmentation is improved by 0.7% to 4.0%, demonstrating generalizability. Our code is available at https://github.com/cvlab-stonybrook/PLM_SSL.

Jakub R. Kaczmarzyk, Tahsin M. Kurc, Shahira Abousamra et al.

Histopathology remains the gold standard for diagnosis of various cancers. Recent advances in computer vision, specifically deep learning, have facilitated the analysis of histopathology images for various tasks, including immune cell detection and microsatellite instability classification. The state-of-the-art for each task often employs base architectures that have been pretrained for image classification on ImageNet. The standard approach to develop classifiers in histopathology tends to focus narrowly on optimizing models for a single task, not considering the aspects of modeling innovations that improve generalization across tasks. Here we present ChampKit (Comprehensive Histopathology Assessment of Model Predictions toolKit): an extensible, fully reproducible benchmarking toolkit that consists of a broad collection of patch-level image classification tasks across different cancers. ChampKit enables a way to systematically document the performance impact of proposed improvements in models and methodology. ChampKit source code and data are freely accessible at https://github.com/kaczmarj/champkit .

Minh-Quan Le, Alexandros Graikos, Srikar Yellapragada et al.

Synthesizing high-resolution images from intricate, domain-specific information remains a significant challenge in generative modeling, particularly for applications in large-image domains such as digital histopathology and remote sensing. Existing methods face critical limitations: conditional diffusion models in pixel or latent space cannot exceed the resolution on which they were trained without losing fidelity, and computational demands increase significantly for larger image sizes. Patch-based methods offer computational efficiency but fail to capture long-range spatial relationships due to their overreliance on local information. In this paper, we introduce a novel conditional diffusion model in infinite dimensions, $\infty$-Brush for controllable large image synthesis. We propose a cross-attention neural operator to enable conditioning in function space. Our model overcomes the constraints of traditional finite-dimensional diffusion models and patch-based methods, offering scalability and superior capability in preserving global image structures while maintaining fine details. To our best knowledge, $\infty$-Brush is the first conditional diffusion model in function space, that can controllably synthesize images at arbitrary resolutions of up to $4096\times4096$ pixels. The code is available at https://github.com/cvlab-stonybrook/infinity-brush.

Jingwei Zhang, Ke Ma, Saarthak Kapse et al.

Semantic segmentations of pathological entities have crucial clinical value in computational pathology workflows. Foundation models, such as the Segment Anything Model (SAM), have been recently proposed for universal use in segmentation tasks. SAM shows remarkable promise in instance segmentation on natural images. However, the applicability of SAM to computational pathology tasks is limited due to the following factors: (1) lack of comprehensive pathology datasets used in SAM training and (2) the design of SAM is not inherently optimized for semantic segmentation tasks. In this work, we adapt SAM for semantic segmentation by introducing trainable class prompts, followed by further enhancements through the incorporation of a pathology encoder, specifically a pathology foundation model. Our framework, SAM-Path enhances SAM's ability to conduct semantic segmentation in digital pathology without human input prompts. Through experiments on two public pathology datasets, the BCSS and the CRAG datasets, we demonstrate that the fine-tuning with trainable class prompts outperforms vanilla SAM with manual prompts and post-processing by 27.52% in Dice score and 71.63% in IOU. On these two datasets, the proposed additional pathology foundation model further achieves a relative improvement of 5.07% to 5.12% in Dice score and 4.50% to 8.48% in IOU.

Shahira Abousamra, Rajarsi Gupta, Tahsin Kurc et al.

In digital pathology, the spatial context of cells is important for cell classification, cancer diagnosis and prognosis. To model such complex cell context, however, is challenging. Cells form different mixtures, lineages, clusters and holes. To model such structural patterns in a learnable fashion, we introduce several mathematical tools from spatial statistics and topological data analysis. We incorporate such structural descriptors into a deep generative model as both conditional inputs and a differentiable loss. This way, we are able to generate high quality multi-class cell layouts for the first time. We show that the topology-rich cell layouts can be used for data augmentation and improve the performance of downstream tasks such as cell classification.

George Teodoro, Tony Pan, Tahsin M. Kurc et al.

We propose, implement, and experimentally evaluate a runtime middleware to support high-throughput execution on hybrid cluster machines of large-scale analysis applications. A hybrid cluster machine consists of computation nodes which have multiple CPUs and general purpose graphics processing units (GPUs). Our work targets scientific analysis applications in which datasets are processed in application-specific data chunks, and the processing of a data chunk is expressed as a hierarchical pipeline of operations. The proposed middleware system combines a bag-of-tasks style execution with coarse-grain dataflow execution. Data chunks and associated data processing pipelines are scheduled across cluster nodes using a demand driven approach, while within a node operations in a given pipeline instance are scheduled across CPUs and GPUs. The runtime system implements several optimizations, including performance aware task scheduling, architecture aware process placement, data locality conscious task assignment, and data prefetching and asynchronous data copy, to maximize utilization of the aggregate computing power of CPUs and GPUs and minimize data copy overheads. The application and performance benefits of the runtime middleware are demonstrated using an image analysis application, which is employed in a brain cancer study, on a state-of-the-art hybrid cluster in which each node has two 6-core CPUs and three GPUs. Our results show that implementing and scheduling application data processing as a set of fine-grain operations provide more opportunities for runtime optimizations and attain better performance than a coarser-grain, monolithic implementation. The proposed runtime system can achieve high-throughput processing of large datasets - we were able to process an image dataset consisting of 36,848 4Kx4K-pixel image tiles at about 150 tiles/second rate on 100 nodes.

Saarthak Kapse, Srijan Das, Jingwei Zhang et al.

We propose DiRL, a Diversity-inducing Representation Learning technique for histopathology imaging. Self-supervised learning techniques, such as contrastive and non-contrastive approaches, have been shown to learn rich and effective representations of digitized tissue samples with limited pathologist supervision. Our analysis of vanilla SSL-pretrained models' attention distribution reveals an insightful observation: sparsity in attention, i.e, models tends to localize most of their attention to some prominent patterns in the image. Although attention sparsity can be beneficial in natural images due to these prominent patterns being the object of interest itself, this can be sub-optimal in digital pathology; this is because, unlike natural images, digital pathology scans are not object-centric, but rather a complex phenotype of various spatially intermixed biological components. Inadequate diversification of attention in these complex images could result in crucial information loss. To address this, we leverage cell segmentation to densely extract multiple histopathology-specific representations, and then propose a prior-guided dense pretext task for SSL, designed to match the multiple corresponding representations between the views. Through this, the model learns to attend to various components more closely and evenly, thus inducing adequate diversification in attention for capturing context rich representations. Through quantitative and qualitative analysis on multiple tasks across cancer types, we demonstrate the efficacy of our method and observe that the attention is more globally distributed.

Mahmudul Hasan, Jakub R. Kaczmarzyk, David Paredes et al.

Understanding the impact of tumor biology on the composition of nearby cells often requires characterizing the impact of biologically distinct tumor regions. Biomarkers have been developed to label biologically distinct tumor regions, but challenges arise because of differences in the spatial extent and distribution of differentially labeled regions. In this work, we present a framework for systematically investigating the impact of distinct tumor regions on cells near the tumor borders, accounting their cross spatial distributions. We apply the framework to multiplex immunohistochemistry (mIHC) studies of pancreatic cancer and show its efficacy in demonstrating how biologically different tumor regions impact the immune response in the tumor microenvironment. Furthermore, we show that the proposed framework can be extended to largescale whole slide image analysis.

Rajarsi Gupta, Jakub Kaczmarzyk, Soma Kobayashi et al.

The combination of data analysis methods, increasing computing capacity, and improved sensors enable quantitative granular, multi-scale, cell-based analyses. We describe the rich set of application challenges related to tissue interpretation and survey AI methods currently used to address these challenges. We focus on a particular class of targeted human tissue analysis - histopathology - aimed at quantitative characterization of disease state, patient outcome prediction and treatment steering.

Erich Bremer, Tammy DiPrima, Joseph Balsamo et al.

Halcyon is a new pathology imaging analysis and feature management system based on W3C linked-data open standards and is designed to scale to support the needs for the voluminous production of features from deep-learning feature pipelines. Halcyon can support multiple users with a web-based UX with access to all user data over a standards-based web API allowing for integration with other processes and software systems. Identity management and data security is also provided.

Saarthak Kapse, Pushpak Pati, Srikar Yellapragada et al.

Pretraining a Multiple Instance Learning (MIL) aggregator enables the derivation of Whole Slide Image (WSI)-level embeddings from patch-level representations without supervision. While recent multimodal MIL pretraining approaches leveraging auxiliary modalities have demonstrated performance gains over unimodal WSI pretraining, the acquisition of these additional modalities necessitates extensive clinical profiling. This requirement increases costs and limits scalability in existing WSI datasets lacking such paired modalities. To address this, we propose Gigapixel Vision-Concept Knowledge Contrastive pretraining (GECKO), which aligns WSIs with a Concept Prior derived from the available WSIs. First, we derive an inherently interpretable concept prior by computing the similarity between each WSI patch and textual descriptions of predefined pathology concepts. GECKO then employs a dual-branch MIL network: one branch aggregates patch embeddings into a WSI-level deep embedding, while the other aggregates the concept prior into a corresponding WSI-level concept embedding. Both aggregated embeddings are aligned using a contrastive objective, thereby pretraining the entire dual-branch MIL model. Moreover, when auxiliary modalities such as transcriptomics data are available, GECKO seamlessly integrates them. Across five diverse tasks, GECKO consistently outperforms prior unimodal and multimodal pretraining approaches while also delivering clinically meaningful interpretability that bridges the gap between computational models and pathology expertise. Code is made available at https://github.com/bmi-imaginelab/GECKO

Srikar Yellapragada, Alexandros Graikos, Kostas Triaridis et al.

The growing volume of high-resolution Whole Slide Images in digital histopathology poses significant storage, transmission, and computational efficiency challenges. Standard compression methods, such as JPEG, reduce file sizes but often fail to preserve fine-grained phenotypic details critical for downstream tasks. In this work, we repurpose autoencoders (AEs) designed for Latent Diffusion Models as an efficient learned compression framework for pathology images. We systematically benchmark three AE models with varying compression levels and evaluate their reconstruction ability using pathology foundation models. We introduce a fine-tuning strategy to further enhance reconstruction fidelity that optimizes a pathology-specific learned perceptual metric. We validate our approach on downstream tasks, including segmentation, patch classification, and multiple instance learning, showing that replacing images with AE-compressed reconstructions leads to minimal performance degradation. Additionally, we propose a K-means clustering-based quantization method for AE latents, improving storage efficiency while maintaining reconstruction quality. We provide the weights of the fine-tuned autoencoders at https://huggingface.co/collections/StonyBrook-CVLab/pathology-fine-tuned-aes-67d45f223a659ff2e3402dd0.

Han Le, Rajarsi Gupta, Le Hou et al.

Quantitative assessment of Tumor-TIL spatial relationships is increasingly important in both basic science and clinical aspects of breast cancer research. We have developed and evaluated convolutional neural network (CNN) analysis pipelines to generate combined maps of cancer regions and tumor infiltrating lymphocytes (TILs) in routine diagnostic breast cancer whole slide tissue images (WSIs). We produce interactive whole slide maps that provide 1) insight about the structural patterns and spatial distribution of lymphocytic infiltrates and 2) facilitate improved quantification of TILs. We evaluated both tumor and TIL analyses using three CNN networks - Resnet-34, VGG16 and Inception v4, and demonstrated that the results compared favorably to those obtained by what believe are the best published methods. We have produced open-source tools and generated a public dataset consisting of tumor/TIL maps for 1,015 TCGA breast cancer images. We also present a customized web-based interface that enables easy visualization and interactive exploration of high-resolution combined Tumor-TIL maps for 1,015TCGA invasive breast cancer cases that can be downloaded for further downstream analyses.

Alexandros Graikos, Srikar Yellapragada, Minh-Quan Le et al.

To synthesize high-fidelity samples, diffusion models typically require auxiliary data to guide the generation process. However, it is impractical to procure the painstaking patch-level annotation effort required in specialized domains like histopathology and satellite imagery; it is often performed by domain experts and involves hundreds of millions of patches. Modern-day self-supervised learning (SSL) representations encode rich semantic and visual information. In this paper, we posit that such representations are expressive enough to act as proxies to fine-grained human labels. We introduce a novel approach that trains diffusion models conditioned on embeddings from SSL. Our diffusion models successfully project these features back to high-quality histopathology and remote sensing images. In addition, we construct larger images by assembling spatially consistent patches inferred from SSL embeddings, preserving long-range dependencies. Augmenting real data by generating variations of real images improves downstream classifier accuracy for patch-level and larger, image-scale classification tasks. Our models are effective even on datasets not encountered during training, demonstrating their robustness and generalizability. Generating images from learned embeddings is agnostic to the source of the embeddings. The SSL embeddings used to generate a large image can either be extracted from a reference image, or sampled from an auxiliary model conditioned on any related modality (e.g. class labels, text, genomic data). As proof of concept, we introduce the text-to-large image synthesis paradigm where we successfully synthesize large pathology and satellite images out of text descriptions.

Saarthak Kapse, Pushpak Pati, Srijan Das et al.

Introducing interpretability and reasoning into Multiple Instance Learning (MIL) methods for Whole Slide Image (WSI) analysis is challenging, given the complexity of gigapixel slides. Traditionally, MIL interpretability is limited to identifying salient regions deemed pertinent for downstream tasks, offering little insight to the end-user (pathologist) regarding the rationale behind these selections. To address this, we propose Self-Interpretable MIL (SI-MIL), a method intrinsically designed for interpretability from the very outset. SI-MIL employs a deep MIL framework to guide an interpretable branch grounded on handcrafted pathological features, facilitating linear predictions. Beyond identifying salient regions, SI-MIL uniquely provides feature-level interpretations rooted in pathological insights for WSIs. Notably, SI-MIL, with its linear prediction constraints, challenges the prevalent myth of an inevitable trade-off between model interpretability and performance, demonstrating competitive results compared to state-of-the-art methods on WSI-level prediction tasks across three cancer types. In addition, we thoroughly benchmark the local and global-interpretability of SI-MIL in terms of statistical analysis, a domain expert study, and desiderata of interpretability, namely, user-friendliness and faithfulness.

Srikar Yellapragada, Alexandros Graikos, Kostas Triaridis et al.

Diffusion models have revolutionized image generation, yet several challenges restrict their application to large-image domains, such as digital pathology and satellite imagery. Given that it is infeasible to directly train a model on 'whole' images from domains with potential gigapixel sizes, diffusion-based generative methods have focused on synthesizing small, fixed-size patches extracted from these images. However, generating small patches has limited applicability since patch-based models fail to capture the global structures and wider context of large images, which can be crucial for synthesizing (semantically) accurate samples. To overcome this limitation, we present ZoomLDM, a diffusion model tailored for generating images across multiple scales. Central to our approach is a novel magnification-aware conditioning mechanism that utilizes self-supervised learning (SSL) embeddings and allows the diffusion model to synthesize images at different 'zoom' levels, i.e., fixed-size patches extracted from large images at varying scales. ZoomLDM synthesizes coherent histopathology images that remain contextually accurate and detailed at different zoom levels, achieving state-of-the-art image generation quality across all scales and excelling in the data-scarce setting of generating thumbnails of entire large images. The multi-scale nature of ZoomLDM unlocks additional capabilities in large image generation, enabling computationally tractable and globally coherent image synthesis up to $4096 \times 4096$ pixels and $4\times$ super-resolution. Additionally, multi-scale features extracted from ZoomLDM are highly effective in multiple instance learning experiments.

Varun Belagali, Srikar Yellapragada, Alexandros Graikos et al.

Self-supervised learning (SSL) methods have emerged as strong visual representation learners by training an image encoder to maximize similarity between features of different views of the same image. To perform this view-invariance task, current SSL algorithms rely on hand-crafted augmentations such as random cropping and color jittering to create multiple views of an image. Recently, generative diffusion models have been shown to improve SSL by providing a wider range of data augmentations. However, these diffusion models require pre-training on large-scale image-text datasets, which might not be available for many specialized domains like histopathology. In this work, we introduce Gen-SIS, a diffusion-based augmentation technique trained exclusively on unlabeled image data, eliminating any reliance on external sources of supervision such as text captions. We first train an initial SSL encoder on a dataset using only hand-crafted augmentations. We then train a diffusion model conditioned on embeddings from that SSL encoder. Following training, given an embedding of the source image, this diffusion model can synthesize its diverse views. We show that these `self-augmentations', i.e. generative augmentations based on the vanilla SSL encoder embeddings, facilitate the training of a stronger SSL encoder. Furthermore, based on the ability to interpolate between images in the encoder latent space, we introduce the novel pretext task of disentangling the two source images of an interpolated synthetic image. We validate Gen-SIS's effectiveness by demonstrating performance improvements across various downstream tasks in both natural images, which are generally object-centric, as well as digital histopathology images, which are typically context-based.

Souradeep Chakraborty, Dana Perez, Paul Friedman et al.

We present a method for classifying the expertise of a pathologist based on how they allocated their attention during a cancer reading. We engage this decoding task by developing a novel method for predicting the attention of pathologists as they read whole-slide Images (WSIs) of prostate and make cancer grade classifications. Our ground truth measure of a pathologists' attention is the x, y and z (magnification) movement of their viewport as they navigated through WSIs during readings, and to date we have the attention behavior of 43 pathologists reading 123 WSIs. These data revealed that specialists have higher agreement in both their attention and cancer grades compared to general pathologists and residents, suggesting that sufficient information may exist in their attention behavior to classify their expertise level. To attempt this, we trained a transformer-based model to predict the visual attention heatmaps of resident, general, and specialist (GU) pathologists during Gleason grading. Based solely on a pathologist's attention during a reading, our model was able to predict their level of expertise with 75.3%, 56.1%, and 77.2% accuracy, respectively, better than chance and baseline models. Our model therefore enables a pathologist's expertise level to be easily and objectively evaluated, important for pathology training and competency assessment. Tools developed from our model could also be used to help pathology trainees learn how to read WSIs like an expert.

Wentao Huang, Meilong Xu, Xiaoling Hu et al.

Spatial transcriptomics (ST) provides essential spatial context by mapping gene expression within tissue, enabling detailed study of cellular heterogeneity and tissue organization. However, aligning ST data with histology images poses challenges due to inherent spatial distortions and modality-specific variations. Existing methods largely rely on direct alignment, which often fails to capture complex cross-modal relationships. To address these limitations, we propose a novel framework that aligns gene and image features using a ranking-based alignment loss, preserving relative similarity across modalities and enabling robust multi-scale alignment. To further enhance the alignment's stability, we employ self-supervised knowledge distillation with a teacher-student network architecture, effectively mitigating disruptions from high dimensionality, sparsity, and noise in gene expression data. Extensive experiments on seven public datasets that encompass gene expression prediction, slide-level classification, and survival analysis demonstrate the efficacy of our method, showing improved alignment and predictive performance over existing methods.

Jakub R. Kaczmarzyk, Rishul Sharma, Peter K. Koo et al.

Foundation models for computational pathology have shown great promise for specimen-level tasks and are increasingly accessible to researchers. However, specimen-level models built on these foundation models remain largely unavailable, hindering their broader utility and impact. To address this gap, we developed SpinPath, a toolkit designed to democratize specimen-level deep learning by providing a zoo of pretrained specimen-level models, a Python-based inference engine, and a JavaScript-based inference platform. We demonstrate the utility of SpinPath in metastasis detection tasks across nine foundation models. SpinPath may foster reproducibility, simplify experimentation, and accelerate the adoption of specimen-level deep learning in computational pathology research.

Srikar Yellapragada, Alexandros Graikos, Prateek Prasanna et al.

To achieve high-quality results, diffusion models must be trained on large datasets. This can be notably prohibitive for models in specialized domains, such as computational pathology. Conditioning on labeled data is known to help in data-efficient model training. Therefore, histopathology reports, which are rich in valuable clinical information, are an ideal choice as guidance for a histopathology generative model. In this paper, we introduce PathLDM, the first text-conditioned Latent Diffusion Model tailored for generating high-quality histopathology images. Leveraging the rich contextual information provided by pathology text reports, our approach fuses image and textual data to enhance the generation process. By utilizing GPT's capabilities to distill and summarize complex text reports, we establish an effective conditioning mechanism. Through strategic conditioning and necessary architectural enhancements, we achieved a SoTA FID score of 7.64 for text-to-image generation on the TCGA-BRCA dataset, significantly outperforming the closest text-conditioned competitor with FID 30.1.

Ujjwal Baid, Sarthak Pati, Tahsin M. Kurc et al.

We evaluate the performance of federated learning (FL) in developing deep learning models for analysis of digitized tissue sections. A classification application was considered as the example use case, on quantifiying the distribution of tumor infiltrating lymphocytes within whole slide images (WSIs). A deep learning classification model was trained using 50*50 square micron patches extracted from the WSIs. We simulated a FL environment in which a dataset, generated from WSIs of cancer from numerous anatomical sites available by The Cancer Genome Atlas repository, is partitioned in 8 different nodes. Our results show that the model trained with the federated training approach achieves similar performance, both quantitatively and qualitatively, to that of a model trained with all the training data pooled at a centralized location. Our study shows that FL has tremendous potential for enabling development of more robust and accurate models for histopathology image analysis without having to collect large and diverse training data at a single location.

Souradeep Chakraborty, Ke Ma, Rajarsi Gupta et al.

We study the attention of pathologists as they examine whole-slide images (WSIs) of prostate cancer tissue using a digital microscope. To the best of our knowledge, our study is the first to report in detail how pathologists navigate WSIs of prostate cancer as they accumulate information for their diagnoses. We collected slide navigation data (i.e., viewport location, magnification level, and time) from 13 pathologists in 2 groups (5 genitourinary (GU) specialists and 8 general pathologists) and generated visual attention heatmaps and scanpaths. Each pathologist examined five WSIs from the TCGA PRAD dataset, which were selected by a GU pathology specialist. We examined and analyzed the distributions of visual attention for each group of pathologists after each WSI was examined. To quantify the relationship between a pathologist's attention and evidence for cancer in the WSI, we obtained tumor annotations from a genitourinary specialist. We used these annotations to compute the overlap between the distribution of visual attention and annotated tumor region to identify strong correlations. Motivated by this analysis, we trained a deep learning model to predict visual attention on unseen WSIs. We find that the attention heatmaps predicted by our model correlate quite well with the ground truth attention heatmap and tumor annotations on a test set of 17 WSIs by using various spatial and temporal evaluation metrics.

Sijia Liu, Andrew Wen, Liwei Wang et al.

While we pay attention to the latest advances in clinical natural language processing (NLP), we can notice some resistance in the clinical and translational research community to adopt NLP models due to limited transparency, interpretability, and usability. In this study, we proposed an open natural language processing development framework. We evaluated it through the implementation of NLP algorithms for the National COVID Cohort Collaborative (N3C). Based on the interests in information extraction from COVID-19 related clinical notes, our work includes 1) an open data annotation process using COVID-19 signs and symptoms as the use case, 2) a community-driven ruleset composing platform, and 3) a synthetic text data generation workflow to generate texts for information extraction tasks without involving human subjects. The corpora were derived from texts from three different institutions (Mayo Clinic, University of Kentucky, University of Minnesota). The gold standard annotations were tested with a single institution's (Mayo) ruleset. This resulted in performances of 0.876, 0.706, and 0.694 in F-scores for Mayo, Minnesota, and Kentucky test datasets, respectively. The study as a consortium effort of the N3C NLP subgroup demonstrates the feasibility of creating a federated NLP algorithm development and benchmarking platform to enhance multi-institution clinical NLP study and adoption. Although we use COVID-19 as a use case in this effort, our framework is general enough to be applied to other domains of interest in clinical NLP.

Shahira Abousamra, David Belinsky, John Van Arnam et al.

In digital pathology, both detection and classification of cells are important for automatic diagnostic and prognostic tasks. Classifying cells into subtypes, such as tumor cells, lymphocytes or stromal cells is particularly challenging. Existing methods focus on morphological appearance of individual cells, whereas in practice pathologists often infer cell classes through their spatial context. In this paper, we propose a novel method for both detection and classification that explicitly incorporates spatial contextual information. We use the spatial statistical function to describe local density in both a multi-class and a multi-scale manner. Through representation learning and deep clustering techniques, we learn advanced cell representation with both appearance and spatial context. On various benchmarks, our method achieves better performance than state-of-the-arts, especially on the classification task. We also create a new dataset for multi-class cell detection and classification in breast cancer and we make both our code and data publicly available.

Xinyu Dong, Jianyuan Deng, Sina Rashidian et al.

The United States is experiencing an opioid epidemic, and there were more than 10 million opioid misusers aged 12 or older each year. Identifying patients at high risk of Opioid Use Disorder (OUD) can help to make early clinical interventions to reduce the risk of OUD. Our goal is to predict OUD patients among opioid prescription users through analyzing electronic health records with machine learning and deep learning methods. This will help us to better understand the diagnoses of OUD, providing new insights on opioid epidemic. Electronic health records of patients who have been prescribed with medications containing active opioid ingredients were extracted from Cerner Health Facts database between January 1, 2008 and December 31, 2017. Long Short-Term Memory (LSTM) models were applied to predict opioid use disorder risk in the future based on recent five encounters, and compared to Logistic Regression, Random Forest, Decision Tree and Dense Neural Network. Prediction performance was assessed using F-1 score, precision, recall, and AUROC. Our temporal deep learning model provided promising prediction results which outperformed other methods, with a F1 score of 0.8023 and AUCROC of 0.9369. The model can identify OUD related medications and vital signs as important features for the prediction. LSTM based temporal deep learning model is effective on predicting opioid use disorder using a patient past history of electronic health records, with minimal domain knowledge. It has potential to improve clinical decision support for early intervention and prevention to combat the opioid epidemic.

Erich Bremer, Jonas Almeida, Joel Saltz

Regions of Interest (ROI) contain morphological features in pathology whole slide images (WSI) are delimited with polygons[1]. These polygons are often represented in either a textual notation (with the array of edges) or in a binary mask form. Textual notations have an advantage of human readability and portability, whereas, binary mask representations are more useful as the input and output of feature-extraction pipelines that employ deep learning methodologies. For any given whole slide image, more than a million cellular features can be segmented generating a corresponding number of polygons. The corpus of these segmentations for all processed whole slide images creates various challenges for filtering specific areas of data for use in interactive real-time and multi-scale displays and analysis. Simple range queries of image locations do not scale and, instead, spatial indexing schemes are required. In this paper we propose using Hilbert Curves simultaneously for spatial indexing and as a polygonal ROI representation. This is achieved by using a series of Hilbert Curves[2] creating an efficient and inherently spatially-indexed machine-usable form. The distinctive property of Hilbert curves that enables both mask and polygon delimitation of ROIs is that the elements of the vector extracted ro describe morphological features maintain their relative positions for different scales of the same image.

Le Hou, Rajarsi Gupta, John S. Van Arnam et al.

The distribution and appearance of nuclei are essential markers for the diagnosis and study of cancer. Despite the importance of nuclear morphology, there is a lack of large scale, accurate, publicly accessible nucleus segmentation data. To address this, we developed an analysis pipeline that segments nuclei in whole slide tissue images from multiple cancer types with a quality control process. We have generated nucleus segmentation results in 5,060 Whole Slide Tissue images from 10 cancer types in The Cancer Genome Atlas. One key component of our work is that we carried out a multi-level quality control process (WSI-level and image patch-level), to evaluate the quality of our segmentation results. The image patch-level quality control used manual segmentation ground truth data from 1,356 sampled image patches. The datasets we publish in this work consist of roughly 5 billion quality controlled nuclei from more than 5,060 TCGA WSIs from 10 different TCGA cancer types and 1,356 manually segmented TCGA image patches from the same 10 cancer types plus additional 4 cancer types. Data is available at https://doi.org/10.7937/tcia.2019.4a4dkp9u

Robert M. Patton, J. Travis Johnston, Steven R. Young et al.

Deep learning, through the use of neural networks, has demonstrated remarkable ability to automate many routine tasks when presented with sufficient data for training. The neural network architecture (e.g. number of layers, types of layers, connections between layers, etc.) plays a critical role in determining what, if anything, the neural network is able to learn from the training data. The trend for neural network architectures, especially those trained on ImageNet, has been to grow ever deeper and more complex. The result has been ever increasing accuracy on benchmark datasets with the cost of increased computational demands. In this paper we demonstrate that neural network architectures can be automatically generated, tailored for a specific application, with dual objectives: accuracy of prediction and speed of prediction. Using MENNDL--an HPC-enabled software stack for neural architecture search--we generate a neural network with comparable accuracy to state-of-the-art networks on a cancer pathology dataset that is also $16\times$ faster at inference. The speedup in inference is necessary because of the volume and velocity of cancer pathology data; specifically, the previous state-of-the-art networks are too slow for individual researchers without access to HPC systems to keep pace with the rate of data generation. Our new model enables researchers with modest computational resources to analyze newly generated data faster than it is collected.

Shahira Abousamra, Le Hou, Rajarsi Gupta et al.

Deep learning classifiers for characterization of whole slide tissue morphology require large volumes of annotated data to learn variations across different tissue and cancer types. As is well known, manual generation of digital pathology training data is time consuming and expensive. In this paper, we propose a semi-automated method for annotating a group of similar instances at once, instead of collecting only per-instance manual annotations. This allows for a much larger training set, that reflects visual variability across multiple cancer types and thus training of a single network which can be automatically applied to each cancer type without human adjustment. We apply our method to the important task of classifying Tumor Infiltrating Lymphocytes (TILs) in H&E images. Prior approaches were trained for individual cancer types, with smaller training sets and human-in-the-loop threshold adjustment. We utilize these thresholded results as large scale "semi-automatic" annotations. Combined with existing manual annotations, our trained deep networks are able to automatically produce better TIL prediction results in 12 cancer types, compared to the human-in-the-loop approach.

Maozheng Zhao, Le Hou, Han Le et al.

For the task of semantic segmentation, high-resolution (pixel-level) ground truth is very expensive to collect, especially for high resolution images such as gigapixel pathology images. On the other hand, collecting low resolution labels (labels for a block of pixels) for these high resolution images is much more cost efficient. Conventional methods trained on these low-resolution labels are only capable of giving low-resolution predictions. The existing state-of-the-art label super resolution (LSR) method is capable of predicting high resolution labels, using only low-resolution supervision, given the joint distribution between low resolution and high resolution labels. However, it does not consider the inter-instance variance which is crucial in the ideal mathematical formulation. In this work, we propose a novel loss function modeling the inter-instance variance. We test our method on a real world application: infiltrating breast cancer region segmentation in histopathology slides. Experimental results show the effectiveness of our method.

Sina Rashidian, Janos Hajagos, Richard Moffitt et al.

Characterization of a patient clinical phenotype is central to biomedical informatics. ICD codes, assigned to inpatient encounters by coders, is important for population health and cohort discovery when clinical information is limited. While ICD codes are assigned to patients by professionals trained and certified in coding there is substantial variability in coding. We present a methodology that uses deep learning methods to model coder decision making and that predicts ICD codes. Our approach predicts codes based on demographics, lab results, and medications, as well as codes from previous encounters. We are able to predict existing codes with high accuracy for all three of the test cases we investigated: diabetes, acute renal failure, and chronic kidney disease. We employed a panel of clinicians, in a blinded manner, to assess ground truth and compared the predictions of coders, model and clinicians. When disparities between the model prediction and coder assigned codes were reviewed, our model outperformed coder assigned ICD codes.

Quoc Dang Vu, Simon Graham, Minh Nguyen Nhat To et al.

High-resolution microscopy images of tissue specimens provide detailed information about the morphology of normal and diseased tissue. Image analysis of tissue morphology can help cancer researchers develop a better understanding of cancer biology. Segmentation of nuclei and classification of tissue images are two common tasks in tissue image analysis. Development of accurate and efficient algorithms for these tasks is a challenging problem because of the complexity of tissue morphology and tumor heterogeneity. In this paper we present two computer algorithms; one designed for segmentation of nuclei and the other for classification of whole slide tissue images. The segmentation algorithm implements a multiscale deep residual aggregation network to accurately segment nuclear material and then separate clumped nuclei into individual nuclei. The classification algorithm initially carries out patch-level classification via a deep learning method, then patch-level statistical and morphological features are used as input to a random forest regression model for whole slide image classification. The segmentation and classification algorithms were evaluated in the MICCAI 2017 Digital Pathology challenge. The segmentation algorithm achieved an accuracy score of 0.78. The classification algorithm achieved an accuracy score of 0.81.

Le Hou, Ayush Agarwal, Dimitris Samaras et al.

Hematoxylin and Eosin stained histopathology image analysis is essential for the diagnosis and study of complicated diseases such as cancer. Existing state-of-the-art approaches demand extensive amount of supervised training data from trained pathologists. In this work we synthesize in an unsupervised manner, large histopathology image datasets, suitable for supervised training tasks. We propose a unified pipeline that: a) generates a set of initial synthetic histopathology images with paired information about the nuclei such as segmentation masks; b) refines the initial synthetic images through a Generative Adversarial Network (GAN) to reference styles; c) trains a task-specific CNN and boosts the performance of the task-specific CNN with on-the-fly generated adversarial examples. Our main contribution is that the synthetic images are not only realistic, but also representative (in reference styles) and relatively challenging for training task-specific CNNs. We test our method for nucleus segmentation using images from four cancer types. When no supervised data exists for a cancer type, our method without supervision cost significantly outperforms supervised methods which perform across-cancer generalization. Even when supervised data exists for all cancer types, our approach without supervision cost performs better than supervised methods.

Le Hou, Vu Nguyen, Dimitris Samaras et al.

Histopathology images are crucial to the study of complex diseases such as cancer. The histologic characteristics of nuclei play a key role in disease diagnosis, prognosis and analysis. In this work, we propose a sparse Convolutional Autoencoder (CAE) for fully unsupervised, simultaneous nucleus detection and feature extraction in histopathology tissue images. Our CAE detects and encodes nuclei in image patches in tissue images into sparse feature maps that encode both the location and appearance of nuclei. Our CAE is the first unsupervised detection network for computer vision applications. The pretrained nucleus detection and feature extraction modules in our CAE can be fine-tuned for supervised learning in an end-to-end fashion. We evaluate our method on four datasets and reduce the errors of state-of-the-art methods up to 42%. We are able to achieve comparable performance with only 5% of the fully-supervised annotation cost.

Veda Murthy, Le Hou, Dimitris Samaras et al.

Classifying the various shapes and attributes of a glioma cell nucleus is crucial for diagnosis and understanding the disease. We investigate automated classification of glioma nuclear shapes and visual attributes using Convolutional Neural Networks (CNNs) on pathology images of automatically segmented nuclei. We propose three methods that improve the performance of a previously-developed semi-supervised CNN. First, we propose a method that allows the CNN to focus on the most important part of an image- the image's center containing the nucleus. Second, we inject (concatenate) pre-extracted VGG features into an intermediate layer of our Semi-Supervised CNN so that during training, the CNN can learn a set of complementary features. Third, we separate the losses of the two groups of target classes (nuclear shapes and attributes) into a single-label loss and a multi-label loss so that the prior knowledge of inter-label exclusiveness can be incorporated. On a dataset of 2078 images, the proposed methods combined reduce the error rate of attribute and shape classification by 21.54% and 15.07% respectively compared to the existing state-of-the-art method on the same dataset.

Le Hou, Dimitris Samaras, Tahsin M. Kurc et al.

In Neural Networks (NN), Adaptive Activation Functions (AAF) have parameters that control the shapes of activation functions. These parameters are trained along with other parameters in the NN. AAFs have improved performance of Neural Networks (NN) in multiple classification tasks. In this paper, we propose and apply AAFs on feedforward NNs for regression tasks. We argue that applying AAFs in the regression (second-to-last) layer of a NN can significantly decrease the bias of the regression NN. However, using existing AAFs may lead to overfitting. To address this problem, we propose a Smooth Adaptive Activation Function (SAAF) with piecewise polynomial form which can approximate any continuous function to arbitrary degree of error. NNs with SAAFs can avoid overfitting by simply regularizing the parameters. In particular, an NN with SAAFs is Lipschitz continuous given a bounded magnitude of the NN parameters. We prove an upper-bound for model complexity in terms of fat-shattering dimension for any Lipschitz continuous regression model. Thus, regularizing the parameters in NNs with SAAFs avoids overfitting. We empirically evaluated NNs with SAAFs and achieved state-of-the-art results on multiple regression datasets.

Le Hou, Dimitris Samaras, Tahsin M. Kurc et al.

Convolutional Neural Networks (CNN) are state-of-the-art models for many image classification tasks. However, to recognize cancer subtypes automatically, training a CNN on gigapixel resolution Whole Slide Tissue Images (WSI) is currently computationally impossible. The differentiation of cancer subtypes is based on cellular-level visual features observed on image patch scale. Therefore, we argue that in this situation, training a patch-level classifier on image patches will perform better than or similar to an image-level classifier. The challenge becomes how to intelligently combine patch-level classification results and model the fact that not all patches will be discriminative. We propose to train a decision fusion model to aggregate patch-level predictions given by patch-level CNNs, which to the best of our knowledge has not been shown before. Furthermore, we formulate a novel Expectation-Maximization (EM) based method that automatically locates discriminative patches robustly by utilizing the spatial relationships of patches. We apply our method to the classification of glioma and non-small-cell lung carcinoma cases into subtypes. The classification accuracy of our method is similar to the inter-observer agreement between pathologists. Although it is impossible to train CNNs on WSIs, we experimentally demonstrate using a comparable non-cancer dataset of smaller images that a patch-based CNN can outperform an image-based CNN.

Thiago S. F. X. Teixeira, George Teodoro, Eduardo Valle et al.

Similarity search is critical for many database applications, including the increasingly popular online services for Content-Based Multimedia Retrieval (CBMR). These services, which include image search engines, must handle an overwhelming volume of data, while keeping low response times. Thus, scalability is imperative for similarity search in Web-scale applications, but most existing methods are sequential and target shared-memory machines. Here we address these issues with a distributed, efficient, and scalable index based on Locality-Sensitive Hashing (LSH). LSH is one of the most efficient and popular techniques for similarity search, but its poor referential locality properties has made its implementation a challenging problem. Our solution is based on a widely asynchronous dataflow parallelization with a number of optimizations that include a hierarchical parallelization to decouple indexing and data storage, locality-aware data partition strategies to reduce message passing, and multi-probing to limit memory usage. The proposed parallelization attained an efficiency of 90% in a distributed system with about 800 CPU cores. In particular, the original locality-aware data partition reduced the number of messages exchanged in 30%. Our parallel LSH was evaluated using the largest public dataset for similarity search (to the best of our knowledge) with $10^9$ 128-d SIFT descriptors extracted from Web images. This is two orders of magnitude larger than datasets that previous LSH parallelizations could handle.

George Teodoro, Eduardo Valle, Nathan Mariano et al.

Similarity search in high-dimentional spaces is a pivotal operation found a variety of database applications. Recently, there has been an increase interest in similarity search for online content-based multimedia services. Those services, however, introduce new challenges with respect to the very large volumes of data that have to be indexed/searched, and the need to minimize response times observed by the end-users. Additionally, those users dynamically interact with the systems creating fluctuating query request rates, requiring the search algorithm to adapt in order to better utilize the underline hardware to reduce response times. In order to address these challenges, we introduce hypercurves, a flexible framework for answering approximate k-nearest neighbor (kNN) queries for very large multimedia databases, aiming at online content-based multimedia services. Hypercurves executes on hybrid CPU--GPU environments, and is able to employ those devices cooperatively to support massive query request rates. In order to keep the response times optimal as the request rates vary, it employs a novel dynamic scheduler to partition the work between CPU and GPU. Hypercurves was throughly evaluated using a large database of multimedia descriptors. Its cooperative CPU--GPU execution achieved performance improvements of up to 30x when compared to the single CPU-core version. The dynamic work partition mechanism reduces the observed query response times in about 50% when compared to the best static CPU--GPU task partition configuration. In addition, Hypercurves achieves superlinear scalability in distributed (multi-node) executions, while keeping a high guarantee of equivalence with its sequential version --- thanks to the proof of probabilistic equivalence, which supported its aggressive parallelization design.