John Abel

Chaitanya Dwivedi, Shima Nofallah, Maryam Pouryahya et al.

In pathology, tissue samples are assessed using multiple staining techniques to enhance contrast in unique histologic features. In this paper, we introduce a multimodal CNN-GNN based graph fusion approach that leverages complementary information from multiple non-registered histopathology images to predict pathologic scores. We demonstrate this approach in nonalcoholic steatohepatitis (NASH) by predicting CRN fibrosis stage and NAFLD Activity Score (NAS). Primary assessment of NASH typically requires liver biopsy evaluation on two histological stains: Trichrome (TC) and hematoxylin and eosin (H&E). Our multimodal approach learns to extract complementary information from TC and H&E graphs corresponding to each stain while simultaneously learning an optimal policy to combine this information. We report up to 20% improvement in predicting fibrosis stage and NAS component grades over single-stain modeling approaches, measured by computing linearly weighted Cohen's kappa between machine-derived vs. pathologist consensus scores. Broadly, this paper demonstrates the value of leveraging diverse pathology images for improved ML-powered histologic assessment.

Nhat Minh Le, Ciyue Shen, Neel Patel et al.

Pathology plays an important role in disease diagnosis, treatment decision-making and drug development. Previous works on interpretability for machine learning models on pathology images have revolved around methods such as attention value visualization and deriving human-interpretable features from model heatmaps. Mechanistic interpretability is an emerging area of model interpretability that focuses on reverse-engineering neural networks. Sparse Autoencoders (SAEs) have emerged as a promising direction in terms of extracting monosemantic features from polysemantic model activations. In this work, we trained a Sparse Autoencoder on the embeddings of a pathology pretrained foundation model. We found that Sparse Autoencoder features represent interpretable and monosemantic biological concepts. In particular, individual SAE dimensions showed strong correlations with cell type counts such as plasma cells and lymphocytes. These biological representations were unique to the pathology pretrained model and were not found in a self-supervised model pretrained on natural images. We demonstrated that such biologically-grounded monosemantic representations evolved across the model's depth, and the pathology foundation model eventually gained robustness to non-biological factors such as scanner type. The emergence of biologically relevant SAE features was generalizable to an out-of-domain dataset. Our work paves the way for further exploration around interpretable feature dimensions and their utility for medical and clinical applications.

Dinkar Juyal, Siddhant Shingi, Syed Ashar Javed et al.

Multiple Instance learning (MIL) models have been extensively used in pathology to predict biomarkers and risk-stratify patients from gigapixel-sized images. Machine learning problems in medical imaging often deal with rare diseases, making it important for these models to work in a label-imbalanced setting. In pathology images, there is another level of imbalance, where given a positively labeled Whole Slide Image (WSI), only a fraction of pixels within it contribute to the positive label. This compounds the severity of imbalance and makes imbalanced classification in pathology challenging. Furthermore, these imbalances can occur in out-of-distribution (OOD) datasets when the models are deployed in the real-world. We leverage the idea that decoupling feature and classifier learning can lead to improved decision boundaries for label imbalanced datasets. To this end, we investigate the integration of supervised contrastive learning with multiple instance learning (SC-MIL). Specifically, we propose a joint-training MIL framework in the presence of label imbalance that progressively transitions from learning bag-level representations to optimal classifier learning. We perform experiments with different imbalance settings for two well-studied problems in cancer pathology: subtyping of non-small cell lung cancer and subtyping of renal cell carcinoma. SC-MIL provides large and consistent improvements over other techniques on both in-distribution (ID) and OOD held-out sets across multiple imbalanced settings.

Tan H. Nguyen, Dinkar Juyal, Jin Li et al.

Differences in staining and imaging procedures can cause significant color variations in histopathology images, leading to poor generalization when deploying deep-learning models trained from a different data source. Various color augmentation methods have been proposed to generate synthetic images during training to make models more robust, eliminating the need for stain normalization during test time. Many color augmentation methods leverage domain labels to generate synthetic images. This approach causes three significant challenges to scaling such a model. Firstly, incorporating data from a new domain into deep-learning models trained on existing domain labels is not straightforward. Secondly, dependency on domain labels prevents the use of pathology images without domain labels to improve model performance. Finally, implementation of these methods becomes complicated when multiple domain labels (e.g., patient identification, medical center, etc) are associated with a single image. We introduce ContriMix, a novel domain label free stain color augmentation method based on DRIT++, a style-transfer method. Contrimix leverages sample stain color variation within a training minibatch and random mixing to extract content and attribute information from pathology images. This information can be used by a trained ContriMix model to create synthetic images to improve the performance of existing classifiers. ContriMix outperforms competing methods on the Camelyon17-WILDS dataset. Its performance is consistent across different slides in the test set while being robust to the color variation from rare substances in pathology images. We make our code and trained ContriMix models available for research use. The code for ContriMix can be found at https://gitlab.com/huutan86/contrimix

Ylaine Gerardin, John Shamshoian, Judy Shen et al.

Nested pairwise frames is a method for relative benchmarking of cell or tissue digital pathology models against manual pathologist annotations on a set of sampled patches. At a high level, the method compares agreement between a candidate model and pathologist annotations with agreement among pathologists' annotations. This evaluation framework addresses fundamental issues of data size and annotator variability in using manual pathologist annotations as a source of ground truth for model validation. We implemented nested pairwise frames evaluation for tissue classification, cell classification, and cell count prediction tasks and show results for cell and tissue models deployed on an H&E-stained melanoma dataset.

Dinkar Juyal, Harshith Padigela, Chintan Shah et al.

Pathology is the study of microscopic inspection of tissue, and a pathology diagnosis is often the medical gold standard to diagnose disease. Pathology images provide a unique challenge for computer-vision-based analysis: a single pathology Whole Slide Image (WSI) is gigapixel-sized and often contains hundreds of thousands to millions of objects of interest across multiple resolutions. In this work, we propose PathoLogy Universal TransfOrmer (PLUTO): a light-weight pathology FM that is pre-trained on a diverse dataset of 195 million image tiles collected from multiple sites and extracts meaningful representations across multiple WSI scales that enable a large variety of downstream pathology tasks. In particular, we design task-specific adaptation heads that utilize PLUTO's output embeddings for tasks which span pathology scales ranging from subcellular to slide-scale, including instance segmentation, tile classification, and slide-level prediction. We compare PLUTO's performance to other state-of-the-art methods on a diverse set of external and internal benchmarks covering multiple biologically relevant tasks, tissue types, resolutions, stains, and scanners. We find that PLUTO matches or outperforms existing task-specific baselines and pathology-specific foundation models, some of which use orders-of-magnitude larger datasets and model sizes when compared to PLUTO. Our findings present a path towards a universal embedding to power pathology image analysis, and motivate further exploration around pathology foundation models in terms of data diversity, architectural improvements, sample efficiency, and practical deployability in real-world applications.

Sai Chowdary Gullapally, Yibo Zhang, Nitin Kumar Mittal et al.

Machine learning algorithms have the potential to improve patient outcomes in digital pathology. However, generalization of these tools is currently limited by sensitivity to variations in tissue preparation, staining procedures and scanning equipment that lead to domain shift in digitized slides. To overcome this limitation and improve model generalization, we studied the effectiveness of two Synthetic DOmain-Targeted Augmentation (S-DOTA) methods, namely CycleGAN-enabled Scanner Transform (ST) and targeted Stain Vector Augmentation (SVA), and compared them against the International Color Consortium (ICC) profile-based color calibration (ICC Cal) method and a baseline method using traditional brightness, color and noise augmentations. We evaluated the ability of these techniques to improve model generalization to various tasks and settings: four models, two model types (tissue segmentation and cell classification), two loss functions, six labs, six scanners, and three indications (hepatocellular carcinoma (HCC), nonalcoholic steatohepatitis (NASH), prostate adenocarcinoma). We compared these methods based on the macro-averaged F1 scores on in-distribution (ID) and out-of-distribution (OOD) test sets across multiple domains, and found that S-DOTA methods (i.e., ST and SVA) led to significant improvements over ICC Cal and baseline on OOD data while maintaining comparable performance on ID data. Thus, we demonstrate that S-DOTA may help address generalization due to domain shift in real world applications.