Yesung Cho

Yesung Cho, Dongmyung Shin, Sujeong Hong et al.

Prostate cancer is one of the most frequently diagnosed malignancies in men worldwide. However, precise prediction of biochemical recurrence (BCR) after radical prostatectomy remains challenging due to the multifocality of tumors distributed throughout the prostate gland. In this paper, we propose a novel AI framework that simultaneously processes a series of multi-section pathology slides to capture the comprehensive tumor landscape across the entire prostate gland. To develop this predictive AI model, we curated a large-scale dataset of 23,451 slides from 789 patients. The proposed framework demonstrated strong predictive performance for 1- and 2-year BCR prediction, substantially outperforming established clinical benchmarks. The AI-derived risk score was validated as the most potent independent prognostic factor in a multivariable Cox proportional hazards analysis, surpassing conventional clinical markers such as pre-operative PSA and Gleason score. Furthermore, we demonstrated that integrating patch and slide sub-sampling strategies significantly reduces computational cost during both training and inference without compromising predictive performance, and generalizability of AI was confirmed through external validation. Collectively, these results highlight the clinical feasibility and prognostic value of the proposed AI-based multi-section slide analysis as a scalable tool for post-operative management in prostate cancer.

Yesung Cho, Sungmin Lee, Geongyu Lee et al.

Recent studies in pathology foundation models have shown that scaling training data, diversifying cancer types, and increasing model size consistently improve their performance. However, giga-scale foundation models, which are trained on hundreds of thousands of slides covering tens of cancer types and contain billions of parameters, pose significant challenges for practical use due to their tremendous computational costs in both development and deployment. In this work, we present a novel strategy, named the G2L framework, to increase the performance of large-scale foundation models, which consist of only $15\%$ of the parameters of giga-scale models, to a comparable performance level of giga-scale models in cancer-specific tasks. Our approach applies knowledge distillation, transferring the capabilities of a giga-scale model to a large-scale model, using just 1K pathology slides of a target cancer (e.g., breast, prostate, etc.). The resulting distilled model not only outperformed state-of-the-art models of the same size (i.e., large-scale) across several benchmarks but also, interestingly, surpassed the giga-scale teacher and huge-scale models in some benchmarks. In addition, the distilled model exhibited a higher robustness index, indicating improved resilience to image variations originating from multiple institutions. These findings suggest that the proposed distillation approach for a large-scale model is a data- and parameter-efficient way to achieve giga-scale-level performance for cancer-specific applications without prohibitive computational burden.