Current status of machine learning in thyroid cytopathology

Surveying the Digital Cytology Workflow in Italy: An Initial Report on AI Integration Across Key Professional Roles

BACKGROUND

The integration of artificial intelligence (AI) in healthcare, particularly in digital cytology, has the potential to enhance diagnostic accuracy and workflow efficiency. However, AI adoption remains limited due to technological and human-related barriers. Understanding the perceptions and experiences of healthcare professionals is essential for overcoming these challenges and facilitating effective AI implementation.

OBJECTIVES

This study aimed to assess AI integration in digital cytology workflows by evaluating professionals' perspectives on its benefits, challenges, and requirements for successful adoption.

METHODS

A survey was conducted among 150 professionals working in public and private healthcare settings in Italy, including laboratory technicians (35%), medical doctors (25%), biologists (20%), and specialists in diagnostic technical sciences (20%). Data were collected through a structured Computer-Assisted Web Interview (CAWI) and a Virtual Focus Group (VFG) to capture quantitative and qualitative insights on AI familiarity, perceived advantages, and barriers to adoption.

RESULTS

The findings indicated varying levels of AI familiarity among professionals. While many recognized AI's potential to improve diagnostic accuracy and streamline workflows, concerns were raised regarding resistance to change, implementation costs, and doubts about AI reliability. Participants emphasized the need for structured training and continuous support to facilitate AI adoption in digital cytology.

CONCLUSIONS

Addressing barriers such as resistance, cost, and trust is essential for the successful integration of AI in digital cytology workflows. Tailored training programs and ongoing professional support can enhance AI adoption, ultimately optimizing diagnostic processes and improving clinical outcomes.

Can Artificial Intelligence Software be Utilised for Thyroid Multi-Disciplinary Team Outcomes?

OBJECTIVES

ChatGPT is one of the most publicly available artificial intelligence (AI) softwares. Ear, nose and throat (ENT) services are often stretched due to the increasing incidence of thyroid malignancies. This study aims to investigate whether there is a role for AI software in providing accurate thyroid multidisciplinary team (MDT) outcomes.

METHODS

A retrospective study looking at unique thyroid MDT outcomes between October 2023 and May 2024. ChatGPT-4TM was used to generate outcomes based on the British Thyroid Association (BTA) Guidelines for Management of Thyroid Cancer. Concordance levels were collected and analysed.

RESULTS

Thirty thyroid cases with a mean age of 58 (n = 24 female, n = 6 male) were discussed. The MDT's outcome had a 100% concordance with BTA Guidelines. When comparing ChatGPT-4TM and our MDT the highest level of concordance Y1 was seen in 67% of case while 13% of cases were completely discordant.

CONCLUSIONS/SIGNIFICANCE

AI is cheap, easy to use can optimise complex thyroid MDT decision making. This could free some clinicians allowing them to meet other demands of the ENT service. Some key issues are the inability to completely rely on the AI software for outcomes without being counterchecked by a clinician.

Advancements in Digital Cytopathology Since COVID-19: Insights from a Narrative Review of Review Articles

Background/Objectives: The integration of digitalization in cytopathology is an emerging field with transformative potential, aiming to enhance diagnostic precision and operational efficiency. This narrative review of reviews (NRR) seeks to identify prevailing themes, opportunities, challenges, and recommendations related to the process of digitalization in cytopathology. Methods: Utilizing a standardized checklist and quality control procedures, this review examines recent advancements and future implications in this domain. Twenty-one review studies were selected through a systematic process. Results: The results highlight key emerging trends, themes, opportunities, challenges, and recommendations in digital cytopathology. First, the study identifies pivotal themes that reflect the ongoing technological transformation, guiding future focus areas in the field. A major trend is the integration of artificial intelligence (AI), which is increasingly critical in improving diagnostic accuracy, streamlining workflows, and assisting decision making. Notably, emerging AI technologies like large language models (LLMs) and chatbots are expected to provide real-time support and automate tasks, though concerns around ethics and privacy must be addressed. The reviews also emphasize the need for standardized protocols, comprehensive training, and rigorous validation to ensure AI tools are reliable and effective across clinical settings. Lastly, digital cytopathology holds significant potential to improve healthcare accessibility, especially in remote areas, by enabling faster, more efficient diagnoses and fostering global collaboration through telepathology. Conclusions: Overall, this study highlights the transformative impact of digitalization in cytopathology, improving diagnostic accuracy, efficiency, and global accessibility through tools like whole-slide imaging and telepathology. While artificial intelligence plays a significant role, the broader focus is on integrating digital solutions to enhance workflows and collaboration. Addressing challenges such as standardization, training, and ethical considerations is crucial to fully realize the potential of these advancements.

Study on the Transformation Process of Thyroid Fine-Needle Aspiration Liquid-Based Cytology to Whole-Slide Image

OBJECTIVE

Analyse and summarise the reasons for failure in the digital acquisition of thyroid liquid-based cytology (LBC) slides and the technical challenges, and explore methods to obtain reliable and reproducible whole digital slide images for clinical thyroid cytology.

METHOD

Use the glass slide scanning imaging system to acquire whole-slide image (WSI) of thyroid LBC in sdpc format through different. Statistical analysis was conducted on the different acquisition methods, the quality of the glass slides, clinical and pathological characteristics of the case, TBSRTC grading and the quality of WSI.

RESULTS

The WSI obtained by different scanning methods showed a high level of consistency in quality (W = 0.325, p < 0.001), especially between fully automatic scanning with different focus densities (W = 0.9, p < 0.001). A total of 2114 images were obtained through different methods of multi-layer fusion and multi-point focusing scanning, with scan success rates of 100.0%, 100.0%, 100.0% and 23.6%, respectively. The correlation between the quality of thyroid LBC glass slides and the image quality of thyroid LBC WSI was statistically significant (p < 0.001). The correlation between TBSRTC grading and the quality of thyroid LBC digital WSI was statistically significant (p < 0.001).

CONCLUSIONS

Although the quality of glass slides has a significant impact, the success rate and image quality of malignant tumour scanning are both high. Overall, the risk of missed diagnosis of malignant tumours is low. In the future, we also need to improve the performance and algorithm of the scanner in cases of sparse cells.

Harnessing artificial intelligence for enhanced veterinary diagnostics: A look to quality assurance, Part I Model development

Artificial intelligence (AI) has transformative potential in veterinary pathology in tasks ranging from cell enumeration and cancer detection to prognosis forecasting, virtual staining techniques, and individually tailored treatment plans. Preclinical testing and validation of AI systems (AIS) are critical to ensure diagnostic safety, efficacy, and dependability. In this two-part series, challenges such as the AI chasm (ie, the discrepancy between the AIS model performance in research settings and real-world applications) and ethical considerations (data privacy, algorithmic bias) are reviewed and underscore the importance of tailored quality assurance measures that address the nuances of AI in veterinary pathology. This review advocates for a multidisciplinary approach to AI development and implementation, focusing on image-based tasks, highlighting the necessity for collaboration across veterinarians, computer scientists, and ethicists to successfully navigate the complex landscape of using AI in veterinary medicine. It calls for a concerted effort to bridge the AI chasm by addressing technical, ethical, and regulatory challenges, facilitating AI integration into veterinary pathology. The future of veterinary pathology must balance harnessing AI's potential while intentionally mitigating its risks, ensuring the welfare of animals and the integrity of the veterinary profession are safeguarded. Part I of this review focuses on considerations for model development, and Part II focuses on external validation of AI.

Machine Learning Streamlines the Morphometric Characterization and Multiclass Segmentation of Nuclei in Different Follicular Thyroid Lesions: Everything in a NUTSHELL

The diagnostic assessment of thyroid nodules is hampered by the persistence of uncertainty in borderline cases and further complicated by the inclusion of noninvasive follicular tumor with papillary-like nuclear features (NIFTP) as a less aggressive alternative to papillary thyroid carcinoma (PTC). In this setting, computational methods might facilitate the diagnostic process by unmasking key nuclear characteristics of NIFTP. The main aims of this work were to (1) identify morphometric features of NIFTP and PTC that are interpretable for the human eye and (2) develop a deep learning model for multiclass segmentation as a support tool to reduce diagnostic variability. Our findings confirmed that nuclei in NIFTP and PTC share multiple characteristics, setting them apart from hyperplastic nodules (HP). The morphometric analysis identified 15 features that can be translated into nuclear alterations readily understandable by pathologists, such as a remarkable internuclear homogeneity for HP in contrast to a major complexity in the chromatin texture of NIFTP and to the peculiar pattern of nuclear texture variability of PTC. A few NIFTP cases with available next-generation sequencing data were also analyzed to initially explore the impact of RAS-related mutations on nuclear morphometry. Finally, a pixel-based deep learning model was trained and tested on whole-slide images of NIFTP, PTC, and HP cases. The model, named NUTSHELL (NUclei from Thyroid tumors Segmentation to Highlight Encapsulated Low-malignant Lesions), successfully detected and classified the majority of nuclei in all whole-slide image tiles, showing comparable results with already well-established pathology nuclear scores. NUTSHELL provides an immediate overview of NIFTP areas and can be used to detect microfoci of PTC within extensive glandular samples or identify lymph node metastases. NUTSHELL can be run inside WSInfer with an easy rendering in QuPath, thus facilitating the democratization of digital pathology.

AI in Cytopathology: A Narrative Umbrella Review on Innovations, Challenges, and Future Directions

The integration of artificial intelligence (AI) in cytopathology is an emerging field with transformative potential, aiming to enhance diagnostic precision and operational efficiency. This umbrella review seeks to identify prevailing themes, opportunities, challenges, and recommendations related to AI in cytopathology. Utilizing a standardized checklist and quality control procedures, this review examines recent advancements and future implications of AI technologies in this domain. Twenty-one review studies were selected through a systematic process. AI has demonstrated promise in automating and refining diagnostic processes, potentially reducing errors and improving patient outcomes. However, several critical challenges need to be addressed to realize the benefits of AI fully. This review underscores the necessity for rigorous validation, ongoing empirical data on diagnostic accuracy, standardized protocols, and effective integration with existing clinical workflows. Ethical issues, including data privacy and algorithmic bias, must be managed to ensure responsible AI applications. Additionally, high costs and substantial training requirements present barriers to widespread AI adoption. Future directions highlight the importance of applying successful integration strategies from histopathology and radiology to cytopathology. Continuous research is needed to improve model interpretability, validation, and standardization. Developing effective strategies for incorporating AI into clinical practice and establishing comprehensive ethical and regulatory frameworks will be crucial for overcoming these challenges. In conclusion, while AI holds significant promise for advancing cytopathology, its full potential can only be achieved by addressing challenges related to validation, cost, and ethics. This review provides an overview of current advancements, identifies ongoing challenges, and offers a roadmap for the successful integration of AI into diagnostic cytopathology, informed by insights from related fields.

Minimally invasive biopsy-based diagnostics in support of precision cancer medicine

Precision cancer medicine (PCM) to support the treatment of solid tumors requires minimally invasive diagnostics. Here, we describe the development of fine-needle aspiration biopsy-based (FNA) molecular cytology which will be increasingly important in diagnostics and adaptive treatment. We provide support for FNA-based molecular cytology having a significant potential to replace core needle biopsy (CNB) as a patient-friendly potent technique for tumor sampling for various tumor types. This is not only because CNB is a more traumatic procedure and may be associated with more complications compared to FNA-based sampling, but also due to the recently developed molecular methods used with FNA. Recent studies show that image-guided FNA in combination with ultrasensitive molecular methods also offers opportunities for characterization of the tumor microenvironment which can aid therapeutic decisions. Here we provide arguments for an increased implementation of molecular FNA-based sampling as a patient-friendly diagnostic method, which may, due to its repeatability, facilitate regular sampling that is needed during different treatment lines, to provide tumor information, supporting treatment decisions, shortening lead times in healthcare, and benefit healthcare economics.

Holomics and Artificial Intelligence-Driven Precision Oncology for Medullary Thyroid Carcinoma: Addressing Challenges of a Rare and Aggressive Disease

Background/Objective: Medullary thyroid carcinoma (MTC) is a rare yet aggressive form of thyroid cancer comprising a disproportionate share of thyroid cancer-related mortalities, despite its low prevalence. MTC differs from other differentiated thyroid malignancies due to its heterogeneous nature, presenting complexities in both hereditary and sporadic cases. Traditional management guidelines, which are designed primarily for papillary thyroid carcinoma (PTC), fall short in providing the individualized care required for patients with MTC. In recent years, the sheer volume of data generated from clinical evaluations, radiological imaging, pathological assessments, genetic mutations, and immunological profiles has made it humanly impossible for clinicians to simultaneously analyze and integrate these diverse data streams effectively. This data deluge necessitates the adoption of advanced technologies to assist in decision-making processes. Holomics, which is an integrated approach that combines various omics technologies, along with artificial intelligence (AI), emerges as a powerful solution to address these challenges. Methods: This article reviews how AI-driven precision oncology can enhance the diagnostic workup, staging, risk stratification, management, and follow-up care of patients with MTC by processing vast amounts of complex data quickly and accurately. Articles published in English language and indexed in Pubmed were searched. Results: AI algorithms can identify patterns and correlations that may not be apparent to human clinicians, thereby improving the precision of personalized treatment plans. Moreover, the implementation of AI in the management of MTC enables the collation and synthesis of clinical experiences from across the globe, facilitating a more comprehensive understanding of the disease and its treatment outcomes. Conclusions: The integration of holomics and AI in the management of patients with MTC represents a significant advancement in precision oncology. This innovative approach not only addresses the complexities of a rare and aggressive disease but also paves the way for global collaboration and equitable healthcare solutions, ultimately transforming the landscape of treatment and care of patients with MTC. By leveraging AI and holomics, we can strive toward making personalized healthcare accessible to every individual, regardless of their economic status, thereby improving overall survival rates and quality of life for MTC patients worldwide. This global approach aligns with the United Nations Sustainable Development Goal 3, which aims to ensure healthy lives and promote well-being at all ages.

Thyroid Fine-Needle Aspiration: The Current and Future Landscape of Cytopathology

Thyroid cytology is a rapidly evolving field that has seen significant advances in recent years. Its main goal is to accurately diagnose thyroid nodules, differentiate between benign and malignant lesions, and risk stratify nodules when a definitive diagnosis is not possible. The current landscape of thyroid cytology includes the use of fine-needle aspiration for the diagnosis of thyroid nodules with the use of uniform, tiered reporting systems such as the Bethesda System for Reporting Thyroid Cytopathology. In recent years, molecular testing has emerged as a reliable preoperative diagnostic tool that stratifies patients into different risk categories (low, intermediate, or high) with varying probabilities of malignancy and helps guide patient treatment.

The current state of digital cytology and artificial intelligence (AI): global survey results from the American Society of Cytopathology Digital Cytology Task Force

INTRODUCTION

The integration of whole slide imaging (WSI) and artificial intelligence (AI) with digital cytology has been growing gradually. Therefore, there is a need to evaluate the current state of digital cytology. This study aimed to determine the current landscape of digital cytology via a survey conducted as part of the American Society of Cytopathology (ASC) Digital Cytology White Paper Task Force.

MATERIALS AND METHODS

A survey with 43 questions pertaining to the current practices and experiences of WSI and AI in both surgical pathology and cytology was created. The survey was sent to members of the ASC, the International Academy of Cytology (IAC), and the Papanicolaou Society of Cytopathology (PSC). Responses were recorded and analyzed.

RESULTS

In total, 327 individuals participated in the survey, spanning a diverse array of practice settings, roles, and experiences around the globe. The majority of responses indicated there was routine scanning of surgical pathology slides (n = 134; 61%) with fewer respondents scanning cytology slides (n = 150; 46%). The primary challenge for surgical WSI is the need for faster scanning and cost minimization, whereas image quality is the top issue for cytology WSI. AI tools are not widely utilized, with only 16% of participants using AI for surgical pathology samples and 13% for cytology practice.

CONCLUSIONS

Utilization of digital pathology is limited in cytology laboratories as compared to surgical pathology. However, as more laboratories are willing to implement digital cytology in the near future, the establishment of practical clinical guidelines is needed.

Machine Learning Model as a Useful Tool for Prediction of Thyroid Nodules Histology, Aggressiveness and Treatment-Related Complications

Thyroid nodules are very common, 5-15% of which are malignant. Despite the low mortality rate of well-differentiated thyroid cancer, some variants may behave aggressively, making nodule differentiation mandatory. Ultrasound and fine-needle aspiration biopsy are simple, safe, cost-effective and accurate diagnostic tools, but have some potential limits. Recently, machine learning (ML) approaches have been successfully applied to healthcare datasets to predict the outcomes of surgical procedures. The aim of this work is the application of ML to predict tumor histology (HIS), aggressiveness and post-surgical complications in thyroid patients. This retrospective study was conducted at the ENT Division of Eastern Piedmont University, Novara (Italy), and reported data about 1218 patients who underwent surgery between January 2006 and December 2018. For each patient, general information, HIS and outcomes are reported. For each prediction task, we trained ML models on pre-surgery features alone as well as on both pre- and post-surgery data. The ML pipeline included data cleaning, oversampling to deal with unbalanced datasets and exploration of hyper-parameter space for random forest models, testing their stability and ranking feature importance. The main results are (i) the construction of a rich, hand-curated, open dataset including pre- and post-surgery features (ii) the development of accurate yet explainable ML models. Results highlight pre-screening as the most important feature to predict HIS and aggressiveness, and that, in our population, having an out-of-range (Low) fT3 dosage at pre-operative examination is strongly associated with a higher aggressiveness of the disease. Our work shows how ML models can find patterns in thyroid patient data and could support clinicians to refine diagnostic tools and improve their accuracy.

A Framework for Detecting Thyroid Cancer from Ultrasound and Histopathological Images Using Deep Learning, Meta-Heuristics, and MCDM Algorithms

Computer-assisted diagnostic systems have been developed to aid doctors in diagnosing thyroid-related abnormalities. The aim of this research is to improve the diagnosis accuracy of thyroid abnormality detection models that can be utilized to alleviate undue pressure on healthcare professionals. In this research, we proposed deep learning, metaheuristics, and a MCDM algorithms-based framework to detect thyroid-related abnormalities from ultrasound and histopathological images. The proposed method uses three recently developed deep learning techniques (DeiT, Swin Transformer, and Mixer-MLP) to extract features from the thyroid image datasets. The feature extraction techniques are based on the Image Transformer and MLP models. There is a large number of redundant features that can overfit the classifiers and reduce the generalization capabilities of the classifiers. In order to avoid the overfitting problem, six feature transformation techniques (PCA, TSVD, FastICA, ISOMAP, LLE, and UMP) are analyzed to reduce the dimensionality of the data. There are five different classifiers (LR, NB, SVC, KNN, and RF) evaluated using the 5-fold stratified cross-validation technique on the transformed dataset. Both datasets exhibit large class imbalances and hence, the stratified cross-validation technique is used to evaluate the performance. The MEREC-TOPSIS MCDM technique is used for ranking the evaluated models at different analysis stages. In the first stage, the best feature extraction and classification techniques are chosen, whereas, in the second stage, the best dimensionality reduction method is evaluated in wrapper feature selection mode. Two best-ranked models are further selected for the weighted average ensemble learning and features selection using the recently proposed meta-heuristics FOX-optimization algorithm. The PCA+FOX optimization-based feature selection + random forest model achieved the highest TOPSIS score and performed exceptionally well with an accuracy of 99.13%, F2-score of 98.82%, and AUC-ROC score of 99.13% on the ultrasound dataset. Similarly, the model achieved an accuracy score of 90.65%, an F2-score of 92.01%, and an AUC-ROC score of 95.48% on the histopathological dataset. This study exploits the combination novelty of different algorithms in order to improve the thyroid cancer diagnosis capabilities. This proposed framework outperforms the current state-of-the-art diagnostic methods for thyroid-related abnormalities in ultrasound and histopathological datasets and can significantly aid medical professionals by reducing the excessive burden on the medical fraternity.

Trends in AI-powered Classification of Thyroid Neoplasms Based on Histopathology Images - a Systematic Review

Background

Assessment of thyroid nodules histopathology using AI is crucial for an accurate diagnosis. This systematic review analyzes recent works employing deep learning approaches for classifying thyroid nodules based on histopathology images, evaluating their performance, and identifying limitations.

Methods

Eligibility criteria focused on peer-reviewed English papers published in the last 5 years, applying deep learning to categorize thyroid histopathology images. The PubMed database was searched using relevant keyword combinations.

Results

Out of 103 articles, 11 studies met inclusion criteria. They used convolutional neural networks to classify thyroid neoplasm. Most studies aimed for basic tumor subtyping; however, 3 studies targeted the prediction of tumor-associated mutation. Accuracy ranged from 77% to 100%, with most over 90%.

Discussion

The findings from our analysis reveal the effectiveness of deep learning in identifying discriminative morphological patterns from histopathology images, thus enhancing the accuracy of thyroid nodule histopathological classification. Key limitations were small sample sizes, subjective annotation, and limited dataset diversity. Further research with larger diverse datasets, model optimization, and real-world validation is essential to translate these tools into clinical practice.