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

Histo-MRI map study protocol: a prospective cohort study mapping MRI to histology for biomarker validation and prediction of prostate cancer

Magnetic resonance imaging; Pathology; Prostate diseaseImatges per ressonància magnètica; Patologia; Malaltia de la pròstataImágenes por resonancia magnética; Patología; Enfermedad de la próstataIntroduction Multiparametric MRI (mpMRI) is now widely used to risk stratify men with a suspicion of prostate cancer and identify suspicious regions for biopsy. However, the technique has modest specificity and a high false-positive rate, especially in men with mpMRI scored as indeterminate (3/5) or likely (4/5) to have clinically significant cancer (csPCa) (Gleason ≥3+4). Advanced MRI techniques have emerged which seek to improve this characterisation and could predict biopsy results non-invasively. Before these techniques are translated clinically, robust histological and clinical validation is required. Methods and analysis This study aims to clinically validate two advanced MRI techniques in a prospectively recruited cohort of men suspected of prostate cancer. Histological analysis of men undergoing biopsy or prostatectomy will be used for biological validation of biomarkers derived from Vascular and Extracellular Restricted Diffusion for Cytometry in Tumours and Luminal Water imaging. In particular, prostatectomy specimens will be processed using three-dimension printed patient-specific moulds to allow for accurate MRI and histology mapping. The index tests will be compared with the histological reference standard to derive false positive rate and true positive rate for men with mpMRI scores which are indeterminate (3/5) or likely (4/5) to have clinically significant prostate cancer (csPCa). Histopathological validation from both biopsy and prostatectomy samples will provide the best ground truth in validating promising MRI techniques which could predict biopsy results and help avoid unnecessary biopsies in men suspected of prostate cancer. Ethics and dissemination Ethical approval was granted by the London—Queen Square Research Ethics Committee (19/LO/1803) on 23 January 2020. Results from the study will be presented at conferences and submitted to peer-reviewed journals for publication. Results will also be available on ClinicalTrials.gov.This work is supported by Engineering and Physical Sciences Research Council (EPSRC), grant reference (EP/R006032/1) and EP/M020533/1

Histo-MRI map study protocol: a prospective cohort study mapping MRI to histology for biomarker validation and prediction of prostate cancer

INTRODUCTION: Multiparametric MRI (mpMRI) is now widely used to risk stratify men with a suspicion of prostate cancer and identify suspicious regions for biopsy. However, the technique has modest specificity and a high false-positive rate, especially in men with mpMRI scored as indeterminate (3/5) or likely (4/5) to have clinically significant cancer (csPCa) (Gleason ≥3+4). Advanced MRI techniques have emerged which seek to improve this characterisation and could predict biopsy results non-invasively. Before these techniques are translated clinically, robust histological and clinical validation is required. METHODS AND ANALYSIS: This study aims to clinically validate two advanced MRI techniques in a prospectively recruited cohort of men suspected of prostate cancer. Histological analysis of men undergoing biopsy or prostatectomy will be used for biological validation of biomarkers derived from Vascular and Extracellular Restricted Diffusion for Cytometry in Tumours and Luminal Water imaging. In particular, prostatectomy specimens will be processed using three-dimension printed patient-specific moulds to allow for accurate MRI and histology mapping. The index tests will be compared with the histological reference standard to derive false positive rate and true positive rate for men with mpMRI scores which are indeterminate (3/5) or likely (4/5) to have clinically significant prostate cancer (csPCa). Histopathological validation from both biopsy and prostatectomy samples will provide the best ground truth in validating promising MRI techniques which could predict biopsy results and help avoid unnecessary biopsies in men suspected of prostate cancer. ETHICS AND DISSEMINATION: Ethical approval was granted by the London-Queen Square Research Ethics Committee (19/LO/1803) on 23 January 2020. Results from the study will be presented at conferences and submitted to peer-reviewed journals for publication. Results will also be available on ClinicalTrials.gov. TRIAL REGISTRATION NUMBER: NCT04792138

Learning Deep Neural Networks for Enhanced Prostate Histological Image Analysis

In recent years, deep convolutional neural networks (CNNs) have shown promise for improving prostate cancer diagnosis by enabling quantitative histopathology through digital pathology. However, there are a number of factors that limit the widespread adoption and clinical utility of deep learning for digital pathology. One of these limitations is the requirement for large labelled training datasets which are expensive to construct due to limited availability of the requisite expertise. Additionally, digital pathology applications typically require the digitisation of histological slides at high magnifications. This process can be challenging especially when digitising large histological slides such as prostatectomies. This work studies and addresses these issues in two important applications of digital pathology: prostate nuclei detection and cell type classification. We study the performance of CNNs at different magnifications and demonstrate that it is possible to perform nuclei detection in low magnification prostate histopathology using CNNs with minimal loss in accuracy. We then study the training of prostate nuclei detectors in the small data setting and demonstrate that although it is possible to train nuclei detectors with minimal data, the models will be sensitive to hyperparameter choice and therefore may not generalise well. Instead, we show that pre-training the CNNs with colon histology data makes them more robust to hyperparameter choice. We then study the CNN performance for prostate cell type classification using supervised, transfer and semi-supervised learning in the small data setting. Our results show that transfer learning can be detrimental to performance but semi-supervised learning is able to provide significant improvements to the learning curve, allowing the training of neural networks with modest amounts of labelled data. We then propose a novel semi-supervised learning method called Deeply-supervised Exemplar CNNs and demonstrate their ability to improve the cell type classifier learning curves at a much better rate than previous semi-supervised neural network methods

Automated classification of cancer tissues using multispectral imagery

Automated classification of medical images for colorectal and prostate cancer diagnosis is a crucial tool for improving routine diagnosis decisions. Therefore, in the last few decades, there has been an increasing interest in refining and adapting machine learning algorithms to classify microscopic images of tumour biopsies. Recently, multispectral imagery has received a significant interest from the research community due to the fast-growing development of high-performance computers. This thesis investigates novel algorithms for automatic classification of colorectal and prostate cancer using multispectral imagery in order to propose a system outperforming the state-of-the-art techniques in the field. To achieve this objective, several feature extraction methods based on image texture have been investigated, analysed and evaluated. A novel texture feature for multispectral images is also constructed as an adaptation of the local binary pattern texture feature to multispectral images by expanding the pixels neighbourhood to the spectral dimension. It has the advantage of capturing the multispectral information with a limited feature vector size. This feature has demonstrated improved classification results when compared against traditional texture features. In order to further enhance the systems performance, advanced classification schemes such as bag-of-features - to better capture local information - and stacked generalisation - to select the most discriminative texture features - are explored and evaluated. Finally, the recent years have seen an accelerated and exponential rise of deep learning, boosted by the advances in hardware, and more specifically graphics processing units. Such models have demonstrated excellent results for supervised learning in multiple applications. This observation has motivated the employment in this thesis of deep neural network architectures, namely convolutional neural networks. Experiments were also carried out to evaluate and compare the performance obtained with the features extracted using convolutional neural networks with random initialisation against features extracted with pre-trained models on ImageNet dataset. The analysis of the classication accuracy achieved with deep learning models reveals that the latter outperforms the previously proposed texture extraction methods. In this thesis, the algorithms are assessed using two separate multiclass datasets: the first one consists of prostate tumour multispectral images, and the second contains multispectral images of colorectal tumours. The colorectal dataset was acquired on a wide domain of the light spectrum ranging from the visible to the infrared wavelengths. This dataset was used to demonstrate the improved results produced using infrared light as well as visible light

Computational Pathology: A Survey Review and The Way Forward

Computational Pathology CPath is an interdisciplinary science that augments developments of computational approaches to analyze and model medical histopathology images. The main objective for CPath is to develop infrastructure and workflows of digital diagnostics as an assistive CAD system for clinical pathology, facilitating transformational changes in the diagnosis and treatment of cancer that are mainly address by CPath tools. With evergrowing developments in deep learning and computer vision algorithms, and the ease of the data flow from digital pathology, currently CPath is witnessing a paradigm shift. Despite the sheer volume of engineering and scientific works being introduced for cancer image analysis, there is still a considerable gap of adopting and integrating these algorithms in clinical practice. This raises a significant question regarding the direction and trends that are undertaken in CPath. In this article we provide a comprehensive review of more than 800 papers to address the challenges faced in problem design all-the-way to the application and implementation viewpoints. We have catalogued each paper into a model-card by examining the key works and challenges faced to layout the current landscape in CPath. We hope this helps the community to locate relevant works and facilitate understanding of the field's future directions. In a nutshell, we oversee the CPath developments in cycle of stages which are required to be cohesively linked together to address the challenges associated with such multidisciplinary science. We overview this cycle from different perspectives of data-centric, model-centric, and application-centric problems. We finally sketch remaining challenges and provide directions for future technical developments and clinical integration of CPath (https://github.com/AtlasAnalyticsLab/CPath_Survey).Comment: Accepted in Elsevier Journal of Pathology Informatics (JPI) 202

Computer-Aided Cancer Diagnosis and Grading via Sparse Directional Image Representations

Prostate cancer and breast cancer are the second cause of death among cancers in males and females, respectively. If not diagnosed, prostate and breast cancers can spread and metastasize to other organs and bones and make it impossible for treatment. Hence, early diagnosis of cancer is vital for patient survival. Histopathological evaluation of the tissue is used for cancer diagnosis. The tissue is taken during biopsies and stained using hematoxylin and eosin (H&E) stain. Then a pathologist looks for abnormal changes in the tissue to diagnose and grade the cancer. This process can be time-consuming and subjective. A reliable and repetitive automatic cancer diagnosis method can greatly reduce the time while producing more reliable results. The scope of this dissertation is developing computer vision and machine learning algorithms for automatic cancer diagnosis and grading methods with accuracy acceptable by the expert pathologists. Automatic image classification relies on feature representation methods. In this dissertation we developed methods utilizing sparse directional multiscale transforms - specifically shearlet transform - for medical image analysis. We particularly designed theses computer visions-based algorithms and methods to work with H&E images and MRI images. Traditional signal processing methods (e.g. Fourier transform, wavelet transform, etc.) are not suitable for detecting carcinoma cells due to their lack of directional sensitivity. However, shearlet transform has inherent directional sensitivity and multiscale framework that enables it to detect different edges in the tissue images. We developed techniques for extracting holistic and local texture features from the histological and MRI images using histogram and co-occurrence of shearlet coefficients, respectively. Then we combined these features with the color and morphological features using multiple kernel learning (MKL) algorithm and employed support vector machines (SVM) with MKL to classify the medical images. We further investigated the impact of deep neural networks in representing the medical images for cancer detection. The aforementioned engineered features have a few limitations. They lack generalizability due to being tailored to the specific texture and structure of the tissues. They are time-consuming and expensive and need prepossessing and sometimes it is difficult to extract discriminative features from the images. On the other hand, feature learning techniques use multiple processing layers and learn feature representations directly from the data. To address these issues, we have developed a deep neural network containing multiple layers of convolution, max-pooling, and fully connected layers, trained on the Red, Green, and Blue (RGB) images along with the magnitude and phase of shearlet coefficients. Then we developed a weighted decision fusion deep neural network that assigns weights on the output probabilities and update those weights via backpropagation. The final decision was a weighted sum of the decisions from the RGB, and the magnitude and the phase of shearlet networks. We used the trained networks for classification of benign and malignant H&E images and Gleason grading. Our experimental results show that our proposed methods based on feature engineering and feature learning outperform the state-of-the-art and are even near perfect (100%) for some databases in terms of classification accuracy, sensitivity, specificity, F1 score, and area under the curve (AUC) and hence are promising computer-based methods for cancer diagnosis and grading using images