Liliana Ribeiro

Pedro C. Neto, Diana Montezuma, Sara P. Oliveira et al.

Considering the profound transformation affecting pathology practice, we aimed to develop a scalable artificial intelligence (AI) system to diagnose colorectal cancer from whole-slide images (WSI). For this, we propose a deep learning (DL) system that learns from weak labels, a sampling strategy that reduces the number of training samples by a factor of six without compromising performance, an approach to leverage a small subset of fully annotated samples, and a prototype with explainable predictions, active learning features and parallelisation. Noting some problems in the literature, this study is conducted with one of the largest WSI colorectal samples dataset with approximately 10,500 WSIs. Of these samples, 900 are testing samples. Furthermore, the robustness of the proposed method is assessed with two additional external datasets (TCGA and PAIP) and a dataset of samples collected directly from the proposed prototype. Our proposed method predicts, for the patch-based tiles, a class based on the severity of the dysplasia and uses that information to classify the whole slide. It is trained with an interpretable mixed-supervision scheme to leverage the domain knowledge introduced by pathologists through spatial annotations. The mixed-supervision scheme allowed for an intelligent sampling strategy effectively evaluated in several different scenarios without compromising the performance. On the internal dataset, the method shows an accuracy of 93.44% and a sensitivity between positive (low-grade and high-grade dysplasia) and non-neoplastic samples of 0.996. On the external test samples varied with TCGA being the most challenging dataset with an overall accuracy of 84.91% and a sensitivity of 0.996.

Ana Beatriz Vieira, Maria Valente, Diana Montezuma et al.

Quality control of medical images is a critical component of digital pathology, ensuring that diagnostic images meet required standards. A pre-analytical task within this process is the verification of the number of specimen fragments, a process that ensures that the number of fragments on a slide matches the number documented in the macroscopic report. This step is important to ensure that the slides contain the appropriate diagnostic material from the grossing process, thereby guaranteeing the accuracy of subsequent microscopic examination and diagnosis. Traditionally, this assessment is performed manually, requiring significant time and effort while being subject to significant variability due to its subjective nature. To address these challenges, this study explores an automated approach to fragment counting using the YOLOv9 and Vision Transformer models. Our results demonstrate that the automated system achieves a level of performance comparable to expert assessments, offering a reliable and efficient alternative to manual counting. Additionally, we present findings on interobserver variability, showing that the automated approach achieves an accuracy of 86%, which falls within the range of variation observed among experts (82-88%), further supporting its potential for integration into routine pathology workflows.