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Huo X, Ong KH, Lau KW, Gole L, Young DM, Tan CL, Zhu X, Zhang C, Zhang Y, Li L, Han H, Lu H, Zhang J, Hou J, Zhao H, Gan H, Yin L, Wang X, Chen X, Lv H, Cao H, Yu X, Shi Y, Huang Z, Marini G, Xu J, Liu B, Chen B, Wang Q, Gui K, Shi W, Sun Y, Chen W, Cao D, Sanders SJ, Lee HK, Hue SSS, Yu W, Tan SY. A comprehensive AI model development framework for consistent Gleason grading. Commun Med (Lond) 2024; 4:84. [PMID: 38724730 PMCID: PMC11082180 DOI: 10.1038/s43856-024-00502-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 04/17/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Artificial Intelligence(AI)-based solutions for Gleason grading hold promise for pathologists, while image quality inconsistency, continuous data integration needs, and limited generalizability hinder their adoption and scalability. METHODS We present a comprehensive digital pathology workflow for AI-assisted Gleason grading. It incorporates A!MagQC (image quality control), A!HistoClouds (cloud-based annotation), Pathologist-AI Interaction (PAI) for continuous model improvement, Trained on Akoya-scanned images only, the model utilizes color augmentation and image appearance migration to address scanner variations. We evaluate it on Whole Slide Images (WSI) from another five scanners and conduct validations with pathologists to assess AI efficacy and PAI. RESULTS Our model achieves an average F1 score of 0.80 on annotations and 0.71 Quadratic Weighted Kappa on WSIs for Akoya-scanned images. Applying our generalization solution increases the average F1 score for Gleason pattern detection from 0.73 to 0.88 on images from other scanners. The model accelerates Gleason scoring time by 43% while maintaining accuracy. Additionally, PAI improve annotation efficiency by 2.5 times and led to further improvements in model performance. CONCLUSIONS This pipeline represents a notable advancement in AI-assisted Gleason grading for improved consistency, accuracy, and efficiency. Unlike previous methods limited by scanner specificity, our model achieves outstanding performance across diverse scanners. This improvement paves the way for its seamless integration into clinical workflows.
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Affiliation(s)
- Xinmi Huo
- Computational Digital Pathology Lab, Bioinformatics Institute, A*STAR, Singapore, Singapore
| | - Kok Haur Ong
- Computational Digital Pathology Lab, Bioinformatics Institute, A*STAR, Singapore, Singapore
| | - Kah Weng Lau
- Computational & Molecular Pathology Lab, Institute of Molecule and Cell Biology, A*STAR, Singapore, Singapore
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Laurent Gole
- Computational & Molecular Pathology Lab, Institute of Molecule and Cell Biology, A*STAR, Singapore, Singapore
| | - David M Young
- Computational & Molecular Pathology Lab, Institute of Molecule and Cell Biology, A*STAR, Singapore, Singapore
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Char Loo Tan
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - Xiaohui Zhu
- Department of Pathology, Nanfang Hospital and Basic Medical College, Southern Medical University, Guangzhou, Guangdong Province, China
- Guangdong Province Key Laboratory of Molecular Tumor Pathology, Guangzhou, Guangdong Province, China
| | - Chongchong Zhang
- Department of Pathology, The 910 Hospital of PLA, QuanZhou, Fujian Province, China
| | - Yonghui Zhang
- Department of Pathology, The 910 Hospital of PLA, QuanZhou, Fujian Province, China
| | - Longjie Li
- Computational Digital Pathology Lab, Bioinformatics Institute, A*STAR, Singapore, Singapore
| | - Hao Han
- Computational & Molecular Pathology Lab, Institute of Molecule and Cell Biology, A*STAR, Singapore, Singapore
| | - Haoda Lu
- Computational Digital Pathology Lab, Bioinformatics Institute, A*STAR, Singapore, Singapore
- Institute for AI in Medicine, School of Artificial Intelligence, Nanjing University of Information Science and Technology (NUIST), Nanjing, Jiangsu Province, China
| | - Jing Zhang
- Department of Pathology, Shanghai Changzheng Hospital, Shanghai, China
| | - Jun Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huanfen Zhao
- Department of Pathology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Hualei Gan
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Lijuan Yin
- Department of Pathology, Changhai Hospital of Shanghai, Shanghai, China
| | - Xingxing Wang
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyue Chen
- Department of Pathology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Hong Lv
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Haotian Cao
- Department of Pathology, Shanghai Changzheng Hospital, Shanghai, China
| | - Xiaozhen Yu
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yabin Shi
- Department of Pathology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Ziling Huang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Gabriel Marini
- Computational Digital Pathology Lab, Bioinformatics Institute, A*STAR, Singapore, Singapore
| | - Jun Xu
- Institute for AI in Medicine, School of Artificial Intelligence, Nanjing University of Information Science and Technology (NUIST), Nanjing, Jiangsu Province, China
| | - Bingxian Liu
- Ningbo KonFoong Bioinformation Tech Co. Ltd, Ningbo, Zhejiang Province, China
| | - Bingxian Chen
- Ningbo KonFoong Bioinformation Tech Co. Ltd, Ningbo, Zhejiang Province, China
| | - Qiang Wang
- Ningbo KonFoong Bioinformation Tech Co. Ltd, Ningbo, Zhejiang Province, China
| | - Kun Gui
- Ningbo KonFoong Bioinformation Tech Co. Ltd, Ningbo, Zhejiang Province, China
| | - Wenzhao Shi
- Vishuo Biomedical Pte Ltd, Singapore, Singapore
| | - Yingying Sun
- Cancer Center, Department of Pathology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang Province, China
| | - Wanyuan Chen
- Cancer Center, Department of Pathology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang Province, China
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou, Zhejiang Province, China
- Clinical Research Center for Cancer of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Dalong Cao
- Department of Urology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Stephan J Sanders
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA
- Institute of Developmental and Regenerative Medicine, University of Oxford, Oxford, UK
| | - Hwee Kuan Lee
- Computational Digital Pathology Lab, Bioinformatics Institute, A*STAR, Singapore, Singapore
| | - Susan Swee-Shan Hue
- Computational & Molecular Pathology Lab, Institute of Molecule and Cell Biology, A*STAR, Singapore, Singapore.
- Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore.
| | - Weimiao Yu
- Computational Digital Pathology Lab, Bioinformatics Institute, A*STAR, Singapore, Singapore.
- Computational & Molecular Pathology Lab, Institute of Molecule and Cell Biology, A*STAR, Singapore, Singapore.
- Institute for AI in Medicine, School of Artificial Intelligence, Nanjing University of Information Science and Technology (NUIST), Nanjing, Jiangsu Province, China.
| | - Soo Yong Tan
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Evans H, Snead D. Why do errors arise in artificial intelligence diagnostic tools in histopathology and how can we minimize them? Histopathology 2024; 84:279-287. [PMID: 37921030 DOI: 10.1111/his.15071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023]
Abstract
Artificial intelligence (AI)-based diagnostic tools can offer numerous benefits to the field of histopathology, including improved diagnostic accuracy, efficiency and productivity. As a result, such tools are likely to have an increasing role in routine practice. However, all AI tools are prone to errors, and these AI-associated errors have been identified as a major risk in the introduction of AI into healthcare. The errors made by AI tools are different, in terms of both cause and nature, to the errors made by human pathologists. As highlighted by the National Institute for Health and Care Excellence, it is imperative that practising pathologists understand the potential limitations of AI tools, including the errors made. Pathologists are in a unique position to be gatekeepers of AI tool use, maximizing patient benefit while minimizing harm. Furthermore, their pathological knowledge is essential to understanding when, and why, errors have occurred and so to developing safer future algorithms. This paper summarises the literature on errors made by AI diagnostic tools in histopathology. These include erroneous errors, data concerns (data bias, hidden stratification, data imbalances, distributional shift, and lack of generalisability), reinforcement of outdated practices, unsafe failure mode, automation bias, and insensitivity to impact. Methods to reduce errors in both tool design and clinical use are discussed, and the practical roles for pathologists in error minimisation are highlighted. This aims to inform and empower pathologists to move safely through this seismic change in practice and help ensure that novel AI tools are adopted safely.
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Affiliation(s)
- Harriet Evans
- Histopathology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - David Snead
- Histopathology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
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Devos G, Devlies W, De Meerleer G, Baldewijns M, Gevaert T, Moris L, Milonas D, Van Poppel H, Berghen C, Everaerts W, Claessens F, Joniau S. Neoadjuvant hormonal therapy before radical prostatectomy in high-risk prostate cancer. Nat Rev Urol 2021; 18:739-62. [PMID: 34526701 DOI: 10.1038/s41585-021-00514-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 02/08/2023]
Abstract
Patients with high-risk prostate cancer treated with curative intent are at an increased risk of biochemical recurrence, metastatic progression and cancer-related death compared with patients treated for low-risk or intermediate-risk disease. Thus, these patients often need multimodal therapy to achieve complete disease control. Over the past two decades, multiple studies on the use of neoadjuvant treatment have been performed using conventional androgen deprivation therapy, which comprises luteinizing hormone-releasing hormone agonists or antagonists and/or first-line anti-androgens. However, despite results from these studies demonstrating a reduction in positive surgical margins and tumour volume, no benefit has been observed in hard oncological end points, such as cancer-related death. The introduction of potent androgen receptor signalling inhibitors (ARSIs), such as abiraterone, apalutamide, enzalutamide and darolutamide, has led to a renewed interest in using neoadjuvant hormonal treatment in high-risk prostate cancer. The addition of ARSIs to androgen deprivation therapy has demonstrated substantial survival benefits in the metastatic castration-resistant, non-metastatic castration-resistant and metastatic hormone-sensitive settings. Intuitively, a similar survival effect can be expected when applying ARSIs as a neoadjuvant strategy in high-risk prostate cancer. Most studies on neoadjuvant ARSIs use a pathological end point as a surrogate for long-term oncological outcome. However, no consensus yet exists regarding the ideal definition of pathological response following neoadjuvant hormonal therapy and pathologists might encounter difficulties in determining pathological response in hormonally treated prostate specimens. The neoadjuvant setting also provides opportunities to gain insight into resistance mechanisms against neoadjuvant hormonal therapy and, consequently, to guide personalized therapy.
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