Digital pathology and artificial intelligence as the next chapter in diagnostic hematopathology

Comparative Analysis of the Performance of Automated Digital Cell Morphology Analyzers for Leukocyte Differentiation in Hematologic Malignancies: Mindray MC-80 Versus West Medical Vision Hema

INTRODUCTION

The use of artificial intelligence in hematology laboratories has improved the diagnostic evaluation of peripheral blood cells. The aim of this study is to compare the performance of two automated digital cell morphology analyzers, the Mindray MC-80 and the West Medical Vision Hema Pro, with manual microscopy, the gold standard, for leukocyte differentiation in patients with hematologic malignancies and infections.

METHODS

Peripheral blood smears from 75 patients were analyzed, including cases of acute lymphoblastic leukemia (ALL, 4), chronic lymphocytic leukemia (CLL, 20), acute myeloid leukemia (AML, 20), chronic myeloid leukemia (CML, 5), other lymphoproliferative disorders (LPD, 20), and infections (6). The agreement between microscopy, Vision Hema, and MC-80 was assessed by Bland-Altman analysis for eight leukocyte populations (neutrophils, lymphocytes, monocytes, eosinophils, basophils, band cells, myelocytes, and metamyelocytes).

RESULTS

Vision Hema demonstrated better agreement with manual microscopy for eight normally expected leukocyte populations (neutrophils, lymphocytes, monocytes, eosinophils, basophils, band cells, myelocytes, and metamyelocytes), whereas MC-80 exhibited greater biases, particularly in lymphocytes, basophils, and immature granulocytes. For pathologic cells, VH significantly overestimated blasts, while MC-80 classified them more accurately, showing better agreement with manual microscopy in acute leukemias. Additionally, MC-80 showed potential clinical value in detecting abnormal lymphocytes and promyelocytes, which may be relevant for hematologic malignancies.

CONCLUSION

Vision Hema provides more reliable classification of normally expected leukocyte populations, while MC-80 shows advantages in detecting abnormal cells, particularly in hematologic malignancies.

Utilization of Machine Learning in the Prediction, Diagnosis, Prognosis, and Management of Chronic Myeloid Leukemia

Chronic myeloid leukemia is a clonal hematologic disease characterized by the presence of the Philadelphia chromosome and the BCR::ABL1 fusion protein. Integrating different molecular, genetic, clinical, and laboratory data would improve the diagnostic, prognostic, and predictive sensitivity of chronic myeloid leukemia. However, without artificial intelligence support, managing such a vast volume of data would be impossible. Considering the advancements and growth in machine learning throughout the years, several models and algorithms have been proposed for the management of chronic myeloid leukemia. Here, we provide an overview of recent research that used specific algorithms on patients with chronic myeloid leukemia, highlighting the potential benefits of adopting machine learning in therapeutic contexts as well as its drawbacks. Our analysis demonstrated the great potential for advancing precision treatment in CML through the combination of clinical and genetic data, laboratory testing, and machine learning. We can use these powerful research instruments to unravel the molecular and spatial puzzles of CML by overcoming the current obstacles. A new age of patient-centered hematology care will be ushered in by this, opening the door for improved diagnosis accuracy, sophisticated risk assessment, and customized treatment plans.

Artificial intelligence in cytopathological applications for cancer: a review of accuracy and analytic validity

BACKGROUND

Cytopathological examination serves as a tool for diagnosing solid tumors and hematologic malignancies. Artificial intelligence (AI)-assisted methods have been widely discussed in the literature for increasing sensitivity, specificity and accuracy in the diagnosis of cytopathological clinical samples. Many of these tools are also used in clinical practice. There is a growing body of literature describing the role of AI in clinical settings, particularly in improving diagnostic accuracy and providing predictive and prognostic insights.

METHODS

A comprehensive search for this systematic review was conducted using databases Google, PUBMED (n = 450) and Google Scholar (n = 1067) with the keywords "Artificial Intelligence" AND "cytopathological" and "fine needle aspiration" AND "Deep Learning" AND "Machine Learning" AND "Hematologic Disorders" AND "Lung Cancer" AND "Pap Smear" and "cervical cancer screening" AND "Thyroid Cancer" AND "Breast Cancer" and "Sensitivity" and "Specificity". The search focused on literature reviews and systematic reviews published in English language between 2020 and 2024. PRISMA guidelines were adhered to with studies included and excluded as depicted in a flowchart. 417 results were screened with 34 studies were chosen for this review.

RESULTS

In the screening of patients with cervical cancer, bone marrow and peripheral blood smears and benign and malignant lesions in the lung, AI-assisted methods, particularly machine learning and deep learning (a subset of machine learning) methods, were applied to cytopathological data. These methods yielded greater diagnostic accuracy, specificity and sensitivity and decreased interobserver variability. Data sets were collected for both training and validation. Human machine combined performance was also found to be comparable to standalone performance in comparison with medical performance as well.

CONCLUSIONS

The use of AI in the analysis of cytopathological samples in research and clinical settings is increasing, and the involvement of pathologists in AI workflows is becoming increasingly important.

Optimization of diagnosis and treatment of hematological diseases via artificial intelligence

Background

Optimizing the diagnosis and treatment of hematological diseases is a challenging yet crucial research area. Effective treatment plans typically require the comprehensive integration of cell morphology, immunology, cytogenetics, and molecular biology. These plans also consider patient-specific factors such as disease stage, age, and genetic mutation status. With the advancement of artificial intelligence (AI), more "AI + medical" application models are emerging. In clinical practice, many AI-assisted systems have been successfully applied to the diagnosis and treatment of hematological diseases, enhancing precision and efficiency and offering valuable solutions for clinical practice.

Objective

This study summarizes the research progress of various AI-assisted systems applied in the clinical diagnosis and treatment of hematological diseases, with a focus on their application in morphology, immunology, cytogenetics, and molecular biology diagnosis, as well as prognosis prediction and treatment.

Methods

Using PubMed, Web of Science, and other network search engines, we conducted a literature search on studies from the past 5 years using the main keywords "artificial intelligence" and "hematological diseases." We classified the clinical applications of AI systems according to the diagnosis and treatment. We outline and summarize the current advancements in AI for optimizing the diagnosis and treatment of hematological diseases, as well as the difficulties and challenges in promoting the standardization of clinical diagnosis and treatment in this field.

Results

AI can significantly shorten turnaround times, reduce diagnostic costs, and accurately predict disease outcomes through applications in image-recognition technology, genomic data analysis, data mining, pattern recognition, and personalized medicine. However, several challenges remain, including the lack of AI product standards, standardized data, medical-industrial collaboration, and the complexity and non-interpretability of AI systems. In addition, regulatory gaps can lead to data privacy issues. Therefore, more research and improvements are needed to fully leverage the potential of AI to promote standardization of the clinical diagnosis and treatment of hematological diseases.

Conclusion

Our results serve as a reference point for the clinical diagnosis and treatment of hematological diseases and the development of AI-assisted clinical diagnosis and treatment systems. We offer suggestions for further development of AI in hematology and standardization of clinical diagnosis and treatment.

Deep Learning in Hematology: From Molecules to Patients

Deep learning (DL), a subfield of machine learning, has made remarkable strides across various aspects of medicine. This review examines DL's applications in hematology, spanning from molecular insights to patient care. The review begins by providing a straightforward introduction to the basics of DL tailored for those without prior knowledge, touching on essential concepts, principal architectures, and prevalent training methods. It then discusses the applications of DL in hematology, concentrating on elucidating the models' architecture, their applications, performance metrics, and inherent limitations. For example, at the molecular level, DL has improved the analysis of multi-omics data and protein structure prediction. For cells and tissues, DL enables the automation of cytomorphology analysis, interpretation of flow cytometry data, and diagnosis from whole slide images. At the patient level, DL's utility extends to analyzing curated clinical data, electronic health records, and clinical notes through large language models. While DL has shown promising results in various hematology applications, challenges remain in model generalizability and explainability. Moreover, the integration of novel DL architectures into hematology has been relatively slow in comparison to that in other medical fields.

Translating the regulatory landscape of medical devices to create fit-for-purpose artificial intelligence (AI) cytometry solutions

The implementation of medical software and artificial intelligence (AI) algorithms into routine clinical cytometry diagnostic practice requires a thorough understanding of regulatory requirements and challenges throughout the cytometry software product lifecycle. To provide cytometry software developers, computational scientists, researchers, industry professionals, and diagnostic physicians/pathologists with an introduction to European Union (EU) and United States (US) regulatory frameworks. Informed by community feedback and needs assessment established during two international cytometry workshops, this article provides an overview of regulatory landscapes as they pertain to the application of AI, AI-enabled medical devices, and Software as a Medical Device in diagnostic flow cytometry. Evolving regulatory frameworks are discussed, and specific examples regarding cytometry instruments, analysis software and clinical flow cytometry in-vitro diagnostic assays are provided. An important consideration for cytometry software development is the modular approach. As such, modules can be segregated and treated as independent components based on the medical purpose and risk and become subjected to a range of context-dependent compliance and regulatory requirements throughout their life cycle. Knowledge of regulatory and compliance requirements enhances the communication and collaboration between developers, researchers, end-users and regulators. This connection is essential to translate scientific innovation into diagnostic practice and to continue to shape the development and revision of new policies, standards, and approaches.

Pathomics Signature for Prognosis and Chemotherapy Benefits in Stage III Colon Cancer

Importance

The current TNM staging system may not provide adequate information for prognostic purposes and to assess the potential benefits of chemotherapy for patients with stage III colon cancer.

Objective

To develop and validate a pathomics signature to estimate prognosis and benefit from chemotherapy using hematoxylin-eosin (H-E)-stained slides.

Design, Setting, and Participants

This retrospective prognostic study used data from consecutive patients with histologically confirmed stage III colon cancer at 2 medical centers between January 2012 and December 2015. A total of 114 pathomics features were extracted from digital H-E-stained images from Nanfang Hospital of Southern Medical University, Guangzhou, China, and a pathomics signature was constructed using a least absolute shrinkage and selection operator Cox regression model in the training cohort. The associations of the pathomics signature with disease-free survival (DFS) and overall survival (OS) were evaluated. Patients at the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, formed the validation cohort. Data analysis was conducted from September 2022 to March 2023.

Main Outcomes and Measures

The prognostic accuracy of the pathomics signature as well as its association with chemotherapy response were evaluated.

Results

This study included 785 patients (mean [SD] age, 62.7 [11.1] years; 437 [55.7%] male). A pathomics signature was constructed based on 4 features. Multivariable analysis revealed that the pathomics signature was an independent factor associated with DFS (hazard ratio [HR], 2.46 [95% CI, 2.89-4.13]; P < .001) and OS (HR, 2.78 [95% CI, 2.34-3.31]; P < .001) in the training cohort. Incorporating the pathomics signature into pathomics nomograms resulted in better performance for the estimation of prognosis than the traditional model in a concordance index comparison in the training cohort (DFS: HR, 0.88 [95% CI, 0.86-0.89] vs HR, 0.73 [95% CI, 0.71-0.75]; P < .001; OS: HR, 0.85 [95% CI, 0.84-0.86] vs HR, 0.74 [95% CI, 0.72-0.76]; P < .001) and validation cohort (DFS: HR, 0.83 [95% CI, 0.82-0.85] vs HR, 0.70 [95% CI, 0.67-0.72]; P < .001; OS: HR, 0.80 [95% CI, 0.78-0.82] vs HR, 0.69 [0.67-0.72]; P < .001). Further analysis revealed that patients with a low pathomics signature were more likely to benefit from chemotherapy (eg, combined cohort: DFS: HR, 0.44 [95% CI, 0.28-0.69]; P = .001; OS: HR, 0.43 [95% CI, 0.29-0.64]; P < .001).

Conclusions and Relevance

These findings suggest that a pathomics signature could help identify patients most likely to benefit from chemotherapy in stage III colon cancer.

From microscope to micropixels: A rapid review of artificial intelligence for the peripheral blood film

Artificial intelligence (AI) and its application in classification of blood cells in the peripheral blood film is an evolving field in haematology. We performed a rapid review of the literature on AI and peripheral blood films, evaluating the condition studied, image datasets, machine learning models, training set size, testing set size and accuracy. A total of 283 studies were identified, encompassing 6 broad domains: malaria (n = 95), leukemia (n = 81), leukocytes (n = 72), mixed (n = 25), erythrocytes (n = 15) or Myelodysplastic syndrome (MDS) (n = 1). These publications have demonstrated high self-reported mean accuracy rates across various studies (95.5% for malaria, 96.0% for leukemia, 94.4% for leukocytes, 95.2% for mixed studies and 91.2% for erythrocytes), with an overall mean accuracy of 95.1%. Despite the high accuracy, the challenges toward real world translational usage of these AI trained models include the need for well-validated multicentre data, data standardisation, and studies on less common cell types and non-malarial blood-borne parasites.

Machine Learning-Based Pathomics Model to Predict the Prognosis in Clear Cell Renal Cell Carcinoma

Clear cell renal cell carcinoma (ccRCC) is a highly lethal urinary malignancy with poor overall survival (OS) rates. Integrating computer vision and machine learning in pathomics analysis offers potential for enhancing classification, prognosis, and treatment strategies for ccRCC. This study aims to create a pathomics model to predict OS in ccRCC patients. In this study, data from ccRCC patients in the TCGA database were used as a training set, with clinical data serving as a validation set. Pathological features were extracted from H&E-stained slides using PyRadiomics, and a pathomics model was constructed using the non-negative matrix factorization (NMF) algorithm. The model's predictive performance was assessed through Kaplan-Meier (KM) survival curves and Cox regression analysis. Additionally, differential gene expression, gene ontology (GO) enrichment analysis, immune infiltration, and mutational analysis were conducted to investigate the underlying biological mechanisms. A total of 368 pathomics features were extracted from H&E-stained slides of ccRCC patients, and a pathomics model comprising two subtypes (Cluster 1 and Cluster 2) was successfully constructed using the NMF algorithm. KM survival curves and Cox regression analysis revealed that Cluster 2 was associated with worse OS. A total of 76 differential genes were identified between the two subtypes, primarily involving extracellular matrix organization and structure. Immune-related genes, including CTLA4, CD80, and TIGIT, were highly expressed in Cluster 2, while the VHL and PBRM1 genes, along with mutations in the PI3K-Akt, HIF-1, and MAPK signaling pathways, exhibited mutation rates exceeding 40% in both subtypes. The machine learning-based pathomics model effectively predicts the OS of ccRCC patients and differentiates between subtypes. The critical roles of the immune-related gene CTLA4 and the PI3K-Akt, HIF-1, and MAPK signaling pathways offer new insights for further research on the molecular mechanisms, diagnosis, and treatment strategies for ccRCC.

ChatGPT as an aid for pathological diagnosis of cancer

Diagnostic workup of cancer patients is highly reliant on the science of pathology using cytopathology, histopathology, and other ancillary techniques like immunohistochemistry and molecular cytogenetics. Data processing and learning by means of artificial intelligence (AI) has become a spearhead for the advancement of medicine, with pathology and laboratory medicine being no exceptions. ChatGPT, an artificial intelligence (AI)-based chatbot, that was recently launched by OpenAI, is currently a talk of the town, and its role in cancer diagnosis is also being explored meticulously. Pathology workflow by integration of digital slides, implementation of advanced algorithms, and computer-aided diagnostic techniques extend the frontiers of the pathologist's view beyond a microscopic slide and enables effective integration, assimilation, and utilization of knowledge that is beyond human limits and boundaries. Despite of it's numerous advantages in the pathological diagnosis of cancer, it comes with several challenges like integration of digital slides with input language parameters, problems of bias, and legal issues which have to be addressed and worked up soon so that we as a pathologists diagnosing malignancies are on the same band wagon and don't miss the train.

Clinical Proteomics for Solid Organ Tissues

The evaluation of biopsied solid organ tissue has long relied on visual examination using a microscope. Immunohistochemistry is critical in this process, labeling and detecting cell lineage markers and therapeutic targets. However, while the practice of immunohistochemistry has reshaped diagnostic pathology and facilitated improvements in cancer treatment, it has also been subject to pervasive challenges with respect to standardization and reproducibility. Efforts are ongoing to improve immunohistochemistry, but for some applications, the benefit of such initiatives could be impeded by its reliance on monospecific antibody-protein reagents and limited multiplexing capacity. This perspective surveys the relevant challenges facing traditional immunohistochemistry and describes how mass spectrometry, particularly liquid chromatography-tandem mass spectrometry, could help alleviate problems. In particular, targeted mass spectrometry assays could facilitate measurements of individual proteins or analyte panels, using internal standards for more robust quantification and improved interlaboratory reproducibility. Meanwhile, untargeted mass spectrometry, showcased to date clinically in the form of amyloid typing, is inherently multiplexed, facilitating the detection and crude quantification of 100s to 1000s of proteins in a single analysis. Further, data-independent acquisition has yet to be applied in clinical practice, but offers particular strengths that could appeal to clinical users. Finally, we discuss the guidance that is needed to facilitate broader utilization in clinical environments and achieve standardization.

Phenotyping the virulence of SARS-CoV-2 variants in hamsters by digital pathology and machine learning

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has continued to evolve throughout the coronavirus disease-19 (COVID-19) pandemic, giving rise to multiple variants of concern (VOCs) with different biological properties. As the pandemic progresses, it will be essential to test in near real time the potential of any new emerging variant to cause severe disease. BA.1 (Omicron) was shown to be attenuated compared to the previous VOCs like Delta, but it is possible that newly emerging variants may regain a virulent phenotype. Hamsters have been proven to be an exceedingly good model for SARS-CoV-2 pathogenesis. Here, we aimed to develop robust quantitative pipelines to assess the virulence of SARS-CoV-2 variants in hamsters. We used various approaches including RNAseq, RNA in situ hybridization, immunohistochemistry, and digital pathology, including software assisted whole section imaging and downstream automatic analyses enhanced by machine learning, to develop methods to assess and quantify virus-induced pulmonary lesions in an unbiased manner. Initially, we used Delta and Omicron to develop our experimental pipelines. We then assessed the virulence of recent Omicron sub-lineages including BA.5, XBB, BQ.1.18, BA.2, BA.2.75 and EG.5.1. We show that in experimentally infected hamsters, accurate quantification of alveolar epithelial hyperplasia and macrophage infiltrates represent robust markers for assessing the extent of virus-induced pulmonary pathology, and hence virus virulence. In addition, using these pipelines, we could reveal how some Omicron sub-lineages (e.g., BA.2.75 and EG.5.1) have regained virulence compared to the original BA.1. Finally, to maximise the utility of the digital pathology pipelines reported in our study, we developed an online repository containing representative whole organ histopathology sections that can be visualised at variable magnifications (https://covid-atlas.cvr.gla.ac.uk). Overall, this pipeline can provide unbiased and invaluable data for rapidly assessing newly emerging variants and their potential to cause severe disease.

Digital Pathology: Transforming Diagnosis in the Digital Age

In the context of rapid technological advancements, the narrative review titled "Digital Pathology: Transforming Diagnosis in the Digital Age" explores the significant impact of digital pathology in reshaping diagnostic approaches. This review delves into the various effects of the field, including remote consultations and artificial intelligence (AI)-assisted analysis, revealing the ongoing transformation taking place. The investigation explores the process of digitizing traditional glass slides, which aims to improve accessibility and facilitate sharing. Additionally, it addresses the complexities associated with data security and standardization challenges. Incorporating AI enhances pathologists' diagnostic capabilities and accelerates analytical procedures. Furthermore, the review highlights the growing importance of collaborative networks facilitating global knowledge sharing. It also emphasizes the significant impact of this technology on medical education and patient care. This narrative review aims to provide an overview of digital pathology's transformative and innovative potential, highlighting its disruptive nature in reshaping diagnostic practices.

Artificial Intelligence-Assisted Diagnostic Cytology and Genomic Testing for Hematologic Disorders

Artificial intelligence (AI) is a rapidly evolving field of computer science that involves the development of computational programs that can mimic human intelligence. In particular, machine learning and deep learning models have enabled the identification and grouping of patterns within data, leading to the development of AI systems that have been applied in various areas of hematology, including digital pathology, alpha thalassemia patient screening, cytogenetics, immunophenotyping, and sequencing. These AI-assisted methods have shown promise in improving diagnostic accuracy and efficiency, identifying novel biomarkers, and predicting treatment outcomes. However, limitations such as limited databases, lack of validation and standardization, systematic errors, and bias prevent AI from completely replacing manual diagnosis in hematology. In addition, the processing of large amounts of patient data and personal information by AI poses potential data privacy issues, necessitating the development of regulations to evaluate AI systems and address ethical concerns in clinical AI systems. Nonetheless, with continued research and development, AI has the potential to revolutionize the field of hematology and improve patient outcomes. To fully realize this potential, however, the challenges facing AI in hematology must be addressed and overcome.

Applied machine learning in hematopathology

An increasing number of machine learning applications are being developed and applied to digital pathology, including hematopathology. The goal of these modern computerized tools is often to support diagnostic workflows by extracting and summarizing information from multiple data sources, including digital images of human tissue. Hematopathology is inherently multimodal and can serve as an ideal case study for machine learning applications. However, hematopathology also poses unique challenges compared to other pathology subspecialities when applying machine learning approaches. By modeling the pathologist workflow and thinking process, machine learning algorithms may be designed to address practical and tangible problems in hematopathology. In this article, we discuss the current trends in machine learning in hematopathology. We review currently available machine learning enabled medical devices supporting hematopathology workflows. We then explore current machine learning research trends of the field with a focus on bone marrow cytology and histopathology, and how adoption of new machine learning tools may be enabled through the transition to digital pathology.