A review of artificial intelligence in prostate cancer detection on imaging

A multitude of studies have explored the role of artificial intelligence (AI) in providing diagnostic support to radiologists, pathologists, and urologists in prostate cancer detection, risk-stratification, and management. This review provides a comprehensive overview of relevant literature regarding the use of AI models in (1) detecting prostate cancer on radiology images (magnetic resonance and ultrasound imaging), (2) detecting prostate cancer on histopathology images of prostate biopsy tissue, and (3) assisting in supporting tasks for prostate cancer detection (prostate gland segmentation, MRI-histopathology registration, MRI-ultrasound registration). We discuss both the potential of these AI models to assist in the clinical workflow of prostate cancer diagnosis, as well as the current limitations including variability in training data sets, algorithms, and evaluation criteria. We also discuss ongoing challenges and what is needed to bridge the gap between academic research on AI for prostate cancer and commercial solutions that improve routine clinical care

Artificial intelligence in cancer imaging: Clinical challenges and applications

Judgement, as one of the core tenets of medicine, relies upon the integration of multilayered data with nuanced decision making. Cancer offers a unique context for medical decisions given not only its variegated forms with evolution of disease but also the need to take into account the individual condition of patients, their ability to receive treatment, and their responses to treatment. Challenges remain in the accurate detection, characterization, and monitoring of cancers despite improved technologies. Radiographic assessment of disease most commonly relies upon visual evaluations, the interpretations of which may be augmented by advanced computational analyses. In particular, artificial intelligence (AI) promises to make great strides in the qualitative interpretation of cancer imaging by expert clinicians, including volumetric delineation of tumors over time, extrapolation of the tumor genotype and biological course from its radiographic phenotype, prediction of clinical outcome, and assessment of the impact of disease and treatment on adjacent organs. AI may automate processes in the initial interpretation of images and shift the clinical workflow of radiographic detection, management decisions on whether or not to administer an intervention, and subsequent observation to a yet to be envisioned paradigm. Here, the authors review the current state of AI as applied to medical imaging of cancer and describe advances in 4 tumor types (lung, brain, breast, and prostate) to illustrate how common clinical problems are being addressed. Although most studies evaluating AI applications in oncology to date have not been vigorously validated for reproducibility and generalizability, the results do highlight increasingly concerted efforts in pushing AI technology to clinical use and to impact future directions in cancer care

Deep learning for an improved diagnostic pathway of prostate cancer in a small multi-parametric magnetic resonance data regime

Prostate Cancer (PCa) is the second most commonly diagnosed cancer among men, with an estimated incidence of 1.3 million new cases worldwide in 2018. The current diagnostic pathway of PCa relies on prostate-specific antigen (PSA) levels in serum. Nevertheless, PSA testing comes at the cost of under-detection of malignant lesions and a substantial over-diagnosis of indolent ones, leading to unnecessary invasive testing such biopsies and treatment in indolent PCa lesions. Magnetic Resonance Imaging (MRI) is a non-invasive technique that has emerged as a valuable tool for PCa detection, staging, early screening, treatment planning and intervention. However, analysis of MRI relies on expertise, can be time-consuming, requires specialized training and in its absence suffers from inter and intra-reader variability and sub-optimal interpretations. Deep Learning (DL) techniques have the ability to recognize complex patterns in imaging data and are able to automatize certain assessments or tasks while offering a lesser degree of subjectiveness, providing a tool that can help clinicians in their daily tasks. In spite of it, DL success has traditionally relied on the availability of large amounts of labelled data, which are rarely available in the medical field and are costly and hard to obtain due to privacy regulations of patients’ data and required specialized training, among others. This work investigates DL algorithms specially tailored to work in a limited data regime with the final objective of improving the current prostate cancer diagnostic pathway by improving the performance of DL algorithms for PCa MRI applications in a limited data regime scenario. In particular, this thesis starts by exploring Generative Adversarial Networks (GAN) to generate synthetic samples and their effect on tasks such as prostate capsule segmentation and PCa lesion significance classification (triage). Following, we explore the use of Auto-encoders (AEs) to exploit the data imbalance that is usually present in medical imaging datasets. Specifically, we propose a framework based on AEs to detect the presence of prostate lesions (tumours) by uniquely learning from control (healthy) data in an outlier detection-like fashion. This thesis also explores more recent DL paradigms that have shown promising results in natural images: generative and contrastive self-supervised learning (SSL). In both cases, we propose specific prostate MRI image manipulations for a PCa lesion classification downstream task and show the improvements offered by the techniques when compared with other initialization methods such as ImageNet pre-training. Finally, we explore data fusion techniques in order to leverage different data sources in the form of MRI sequences (orthogonal views) acquired by default during patient examinations and that are commonly ignored in DL systems. We show improvements in a PCa lesion significance classification when compared to a single input system (axial view)

Deep learning applications in the prostate cancer diagnostic pathway

Prostate cancer (PCa) is the second most frequently diagnosed cancer in men worldwide and the fifth leading cause of cancer death in men, with an estimated 1.4 million new cases in 2020 and 375,000 deaths. The risk factors most strongly associated to PCa are advancing age, family history, race, and mutations of the BRCA genes. Since the aforementioned risk factors are not preventable, early and accurate diagnoses are a key objective of the PCa diagnostic pathway. In the UK, clinical guidelines recommend multiparametric magnetic resonance imaging (mpMRI) of the prostate for use by radiologists to detect, score, and stage lesions that may correspond to clinically significant PCa (CSPCa), prior to confirmatory biopsy and histopathological grading. Computer-aided diagnosis (CAD) of PCa using artificial intelligence algorithms holds a currently unrealized potential to improve upon the diagnostic accuracy achievable by radiologist assessment of mpMRI, improve the reporting consistency between radiologists, and reduce reporting time. In this thesis, we build and evaluate deep learning-based CAD systems for the PCa diagnostic pathway, which address gaps identified in the literature. First, we introduce a novel patient-level classification framework, PCF, which uses a stacked ensemble of convolutional neural networks (CNNs) and support vector machines (SVMs) to assign a probability of having CSPCa to patients, using mpMRI and clinical features. Second, we introduce AutoProstate, a deep-learning powered framework for automated PCa assessment and reporting; AutoProstate utilizes biparametric MRI and clinical data to populate an automatic diagnostic report containing segmentations of the whole prostate, prostatic zones, and candidate CSPCa lesions, as well as several derived characteristics that are clinically valuable. Finally, as automatic segmentation algorithms have not yet reached the desired robustness for clinical use, we introduce interactive click-based segmentation applications for the whole prostate and prostatic lesions, with potential uses in diagnosis, active surveillance progression monitoring, and treatment planning

Domain Adaptation for Novel Imaging Modalities with Application to Prostate MRI

The need for training data can impede the adoption of novel imaging modalities for deep learning-based medical image analysis. Domain adaptation can mitigate this problem by exploiting training samples from an existing, densely-annotated source domain within a novel, sparsely-annotated target domain, by bridging the differences between the two domains. In this thesis we present methods for adapting between diffusion-weighed (DW)-MRI data from multiparametric (mp)-MRI acquisitions and VERDICT (Vascular, Extracellular and Restricted Diffusion for Cytometry in Tumors) MRI, a richer DW-MRI technique involving an optimized acquisition protocol for cancer characterization. We also show that the proposed methods are general and their applicability extends beyond medical imaging. First, we propose a semi-supervised domain adaptation method for prostate lesion segmentation on VERDICT MRI. Our approach relies on stochastic generative modelling to translate across two heterogeneous domains at pixel-space and exploits the inherent uncertainty in the cross-domain mapping to generate multiple outputs conditioned on a single input. We further extend this approach to the unsupervised scenario where there is no labeled data for the target domain. We rely on stochastic generative modelling to translate across the two domains at pixel space and introduce two loss functions that promote semantic consistency. Finally we demonstrate that the proposed approaches extend beyond medical image analysis and focus on unsupervised domain adaptation for semantic segmentation of urban scenes. We show that relying on stochastic generative modelling allows us to train more accurate target networks and achieve state-of-the-art performance on two challenging semantic segmentation benchmarks

Computer-Aided Detection and diagnosis for prostate cancer based on mono and multi-parametric MRI: A review

International audienceProstate cancer is the second most diagnosed cancer of men all over the world. In the last decades, new imaging techniques based on Magnetic Resonance Imaging (MRI) have been developed improving diagnosis.In practise, diagnosis can be affected by multiple factors such as observer variability and visibility and complexity of the lesions. In this regard, computer-aided detection and computer-aided diagnosis systemshave been designed to help radiologists in their clinical practice. Research on computer-aided systems specifically focused for prostate cancer is a young technology and has been part of a dynamic field ofresearch for the last ten years. This survey aims to provide a comprehensive review of the state of the art in this lapse of time, focusing on the different stages composing the work-flow of a computer-aidedsystem. We also provide a comparison between studies and a discussion about the potential avenues for future research. In addition, this paper presents a new public online dataset which is made available to theresearch community with the aim of providing a common evaluation framework to overcome some of the current limitations identified in this survey

Medical Image Registration Using Deep Neural Networks

Registration is a fundamental problem in medical image analysis wherein images are transformed spatially to align corresponding anatomical structures in each image. Recently, the development of learning-based methods, which exploit deep neural networks and can outperform classical iterative methods, has received considerable interest from the research community. This interest is due in part to the substantially reduced computational requirements that learning-based methods have during inference, which makes them particularly well-suited to real-time registration applications. Despite these successes, learning-based methods can perform poorly when applied to images from different modalities where intensity characteristics can vary greatly, such as in magnetic resonance and ultrasound imaging. Moreover, registration performance is often demonstrated on well-curated datasets, closely matching the distribution of the training data. This makes it difficult to determine whether demonstrated performance accurately represents the generalization and robustness required for clinical use. This thesis presents learning-based methods which address the aforementioned difficulties by utilizing intuitive point-set-based representations, user interaction and meta-learning-based training strategies. Primarily, this is demonstrated with a focus on the non-rigid registration of 3D magnetic resonance imaging to sparse 2D transrectal ultrasound images to assist in the delivery of targeted prostate biopsies. While conventional systematic prostate biopsy methods can require many samples to be taken to confidently produce a diagnosis, tumor-targeted approaches have shown improved patient, diagnostic, and disease management outcomes with fewer samples. However, the available intraoperative transrectal ultrasound imaging alone is insufficient for accurate targeted guidance. As such, this exemplar application is used to illustrate the effectiveness of sparse, interactively-acquired ultrasound imaging for real-time, interventional registration. The presented methods are found to improve registration accuracy, relative to state-of-the-art, with substantially lower computation time and require a fraction of the data at inference. As a result, these methods are particularly attractive given their potential for real-time registration in interventional applications

Computer-Assisted Characterization of Prostate Cancer on Magnetic Resonance Imaging

Prostate cancer (PCa) is one of the most prevalent cancers among men. Early diagnosis can improve survival and reduce treatment costs. Current inter-radiologist variability for detection of PCa is high. The use of multi-parametric magnetic resonance imaging (mpMRI) with machine learning algorithms has been investigated both for improving PCa detection and for PCa diagnosis. Widespread clinical implementation of computer-assisted PCa lesion characterization remains elusive; critically needed is a model that is validated against a histologic reference standard that is densely sampled in an unbiased fashion. We address this using our technique for highly accurate fusion of mpMRI with whole-mount digitized histology of the surgical specimen. In this thesis, we present models for characterization of malignant, benign and confounding tissue and aggressiveness of PCa. Further validation on a larger dataset could enable improved characterization performance, improving survival rates and enabling a more personalized treatment plan