Chengwei Shao

Zhilin Zheng, Xu Fang, Jiawen Yao et al.

Lymph node (LN) metastasis status is one of the most critical prognostic and cancer staging factors for patients with resectable pancreatic ductal adenocarcinoma (PDAC), or in general, for any types of solid malignant tumors. Preoperative prediction of LN metastasis from non-invasive CT imaging is highly desired, as it might be straightforwardly used to guide the following neoadjuvant treatment decision and surgical planning. Most studies only capture the tumor characteristics in CT imaging to implicitly infer LN metastasis and very few work exploit direct LN's CT imaging information. To the best of our knowledge, this is the first work to propose a fully-automated LN segmentation and identification network to directly facilitate the LN metastasis status prediction task. Nevertheless LN segmentation/detection is very challenging since LN can be easily confused with other hard negative anatomic structures (e.g., vessels) from radiological images. We explore the anatomical spatial context priors of pancreatic LN locations by generating a guiding attention map from related organs and vessels to assist segmentation and infer LN status. As such, LN segmentation is impelled to focus on regions that are anatomically adjacent or plausible with respect to the specific organs and vessels. The metastasized LN identification network is trained to classify the segmented LN instances into positives or negatives by reusing the segmentation network as a pre-trained backbone and padding a new classification head. More importantly, we develop a LN metastasis status prediction network that combines the patient-wise aggregation results of LN segmentation/identification and deep imaging features extracted from the tumor region. Extensive quantitative nested five-fold cross-validation is conducted on a discovery dataset of 749 patients with PDAC.

Chengying She, Chengwei Chen, Xinran Zhang et al.

Multimodal evidence is critical in computational pathology: gigapixel whole slide images capture tumor morphology, while patient-level clinical descriptors preserve complementary context for prognosis. Integrating such heterogeneous signals remains challenging because feature spaces exhibit distinct statistics and scales. We introduce MMSF, a multitask and multimodal supervised framework built on a linear-complexity MIL backbone that explicitly decomposes and fuses cross-modal information. MMSF comprises a graph feature extraction module embedding tissue topology at the patch level, a clinical data embedding module standardizing patient attributes, a feature fusion module aligning modality-shared and modality-specific representations, and a Mamba-based MIL encoder with multitask prediction heads. Experiments on CAMELYON16 and TCGA-NSCLC demonstrate 2.1--6.6\% accuracy and 2.2--6.9\% AUC improvements over competitive baselines, while evaluations on five TCGA survival cohorts yield 7.1--9.8\% C-index improvements compared with unimodal methods and 5.6--7.1\% over multimodal alternatives.

Chengying She, Chengwei Chen, Dongjie Fan et al.

Whole slide images (WSIs) classification represents a fundamental challenge in computational pathology, where multiple instance learning (MIL) has emerged as the dominant paradigm. Current state-of-the-art (SOTA) MIL methods rely on attention mechanisms, achieving good performance but requiring substantial computational resources due to quadratic complexity when processing hundreds of thousands of patches. To address this computational bottleneck, we introduce EfficientMIL, a novel linear-complexity MIL approach for WSIs classification with the patches selection module Adaptive Patch Selector (APS) that we designed, replacing the quadratic-complexity self-attention mechanisms in Transformer-based MIL methods with efficient sequence models including RNN-based GRU, LSTM, and State Space Model (SSM) Mamba. EfficientMIL achieves significant computational efficiency improvements while outperforming other MIL methods across multiple histopathology datasets. On TCGA-Lung dataset, EfficientMIL-Mamba achieved AUC of 0.976 and accuracy of 0.933, while on CAMELYON16 dataset, EfficientMIL-GRU achieved AUC of 0.990 and accuracy of 0.975, surpassing previous state-of-the-art methods. Extensive experiments demonstrate that APS is also more effective for patches selection than conventional selection strategies.

Yujian Hu, Yilang Xiang, Yan-Jie Zhou et al.

The accurate and timely diagnosis of acute aortic syndromes (AAS) in patients presenting with acute chest pain remains a clinical challenge. Aortic CT angiography (CTA) is the imaging protocol of choice in patients with suspected AAS. However, due to economic and workflow constraints in China, the majority of suspected patients initially undergo non-contrast CT as the initial imaging testing, and CTA is reserved for those at higher risk. In this work, we present an artificial intelligence-based warning system, iAorta, using non-contrast CT for AAS identification in China, which demonstrates remarkably high accuracy and provides clinicians with interpretable warnings. iAorta was evaluated through a comprehensive step-wise study. In the multi-center retrospective study (n = 20,750), iAorta achieved a mean area under the receiver operating curve (AUC) of 0.958 (95% CI 0.950-0.967). In the large-scale real-world study (n = 137,525), iAorta demonstrated consistently high performance across various non-contrast CT protocols, achieving a sensitivity of 0.913-0.942 and a specificity of 0.991-0.993. In the prospective comparative study (n = 13,846), iAorta demonstrated the capability to significantly shorten the time to correct diagnostic pathway. For the prospective pilot deployment that we conducted, iAorta correctly identified 21 out of 22 patients with AAS among 15,584 consecutive patients presenting with acute chest pain and under non-contrast CT protocol in the emergency department (ED) and enabled the average diagnostic time of these 21 AAS positive patients to be 102.1 (75-133) mins. Last, the iAorta can help avoid delayed or missed diagnosis of AAS in settings where non-contrast CT remains the unavoidable the initial or only imaging test in resource-constrained regions and in patients who cannot or did not receive intravenous contrast.