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

Pattern classification approaches for breast cancer identification via MRI: state‐of‐the‐art and vision for the future

Mining algorithms for Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCEMRI) of breast tissue are discussed. The algorithms are based on recent advances in multidimensional signal processing and aim to advance current state‐of‐the‐art computer‐aided detection and analysis of breast tumours when these are observed at various states of development. The topics discussed include image feature extraction, information fusion using radiomics, multi‐parametric computer‐aided classification and diagnosis using information fusion of tensorial datasets as well as Clifford algebra based classification approaches and convolutional neural network deep learning methodologies. The discussion also extends to semi‐supervised deep learning and self‐supervised strategies as well as generative adversarial networks and algorithms using generated confrontational learning approaches. In order to address the problem of weakly labelled tumour images, generative adversarial deep learning strategies are considered for the classification of different tumour types. The proposed data fusion approaches provide a novel Artificial Intelligence (AI) based framework for more robust image registration that can potentially advance the early identification of heterogeneous tumour types, even when the associated imaged organs are registered as separate entities embedded in more complex geometric spaces. Finally, the general structure of a high‐dimensional medical imaging analysis platform that is based on multi‐task detection and learning is proposed as a way forward. The proposed algorithm makes use of novel loss functions that form the building blocks for a generated confrontation learning methodology that can be used for tensorial DCE‐MRI. Since some of the approaches discussed are also based on time‐lapse imaging, conclusions on the rate of proliferation of the disease can be made possible. The proposed framework can potentially reduce the costs associated with the interpretation of medical images by providing automated, faster and more consistent diagnosis

Deep Learning for Semantic Segmentation versus Classification in Computational Pathology: Application to mitosis analysis in Breast Cancer grading

Existing computational pathology approaches did not allow, yet, the emergence of effective/efficient computer-aided tools used as a second opinion for pathologists in the daily practice. Focusing on the case of computer-based qualification for breast cancer diagnosis, the present article proposes two deep learning architectures to efficiently and effectively detect and classify mitosis in a histopathological tissue sample. The first method consisted of two parts, entailing a preprocessing of the digital histological image and a free-handcrafted-feature Convolutional Neural Network (CNN) used for binary classification. Results show that the methodology proposed can achieve 95% accuracy in testing with an F1-score of 94.35%, which is higher than the results from the literature using classical image processing techniques and also higher than the approaches using handcrafted features combined with CNNs. The second approach was an end-to-end methodology using semantic segmentation. Results showed that this algorithm can achieve an accuracy higher than 95% in testing and an average Dice index of 0.6 which is higher than the results from the literature using CNNs (0.9 F1-score). Additionally, due to the semantic properties of the deep learning approach, an end-to-end deep learning framework is viable to perform both tasks: detection and classification of mitosis. The results showed the potential of deep learning in the analysis of Whole Slide Images (WSI) and its integration to computer-aided systems. The extension of this work to whole slide images is also addressed in the last two chapters; as well as, some computational key points that are useful when constructing a computer-aided-system inspired by the described technology.Trabajo de investigació

An introduction to double stain normalization technique for brain tumour histopathological images

Stain normalization is an image pre-processing method extensively used to standardize multiple variances of staining intensity in histopathology image analysis. Staining variations may occur for several reasons, such as unstandardized protocols while preparing the specimens, using dyes from different manufacturers, and varying parameters set while capturing the digital images. In this study, a double stain normalization technique based on immunohistochemical staining is developed to improve the performance of the conventional Reinhard’s algorithm. The proposed approach began with preparing a target image by applying the contrast-limited adaptive histogram equalization (CLAHE) technique to the targeted cells. Later, the colour distribution of the input image will be matched to the colour distribution of the target image through the linear transformation process. In this study, the power-law transformation was applied to address the over-enhancement and contrast degradation issues in the conventional method. Five quality metrics comprised of entropy, tenengrad criterion (TEN), mean square error (MSE), structural similarity index (SSIM) and correlation coefficient were used to measure the performance of the proposed system. The experimental results demonstrate that the proposed method outperformed all conventional techniques. The proposed method achieved the highest average values of 5.59, 3854.11 and 94.65 for entropy, TEN, and MSE analyses

Towards Secure and Intelligent Diagnosis: Deep Learning and Blockchain Technology for Computer-Aided Diagnosis Systems

Cancer is the second leading cause of death across the world after cardiovascular disease. The survival rate of patients with cancerous tissue can significantly decrease due to late-stage diagnosis. Nowadays, advancements of whole slide imaging scanners have resulted in a dramatic increase of patient data in the domain of digital pathology. Large-scale histopathology images need to be analyzed promptly for early cancer detection which is critical for improving patient's survival rate and treatment planning. Advances of medical image processing and deep learning methods have facilitated the extraction and analysis of high-level features from histopathological data that could assist in life-critical diagnosis and reduce the considerable healthcare cost associated with cancer. In clinical trials, due to the complexity and large variance of collected image data, developing computer-aided diagnosis systems to support quantitative medical image analysis is an area of active research. The first goal of this research is to automate the classification and segmentation process of cancerous regions in histopathology images of different cancer tissues by developing models using deep learning-based architectures. In this research, a framework with different modules is proposed, including (1) data pre-processing, (2) data augmentation, (3) feature extraction, and (4) deep learning architectures. Four validation studies were designed to conduct this research. (1) differentiating benign and malignant lesions in breast cancer (2) differentiating between immature leukemic blasts and normal cells in leukemia cancer (3) differentiating benign and malignant regions in lung cancer, and (4) differentiating benign and malignant regions in colorectal cancer. Training machine learning models, disease diagnosis, and treatment often requires collecting patients' medical data. Privacy and trusted authenticity concerns make data owners reluctant to share their personal and medical data. Motivated by the advantages of Blockchain technology in healthcare data sharing frameworks, the focus of the second part of this research is to integrate Blockchain technology in computer-aided diagnosis systems to address the problems of managing access control, authentication, provenance, and confidentiality of sensitive medical data. To do so, a hierarchical identity and attribute-based access control mechanism using smart contract and Ethereum Blockchain is proposed to securely process healthcare data without revealing sensitive information to an unauthorized party leveraging the trustworthiness of transactions in a collaborative healthcare environment. The proposed access control mechanism provides a solution to the challenges associated with centralized access control systems and ensures data transparency and traceability for secure data sharing, and data ownership

Development and validation of artificial intelligence-based prescreening of large-bowel biopsies taken in the UK and Portugal: a retrospective cohort study

Background Histopathological examination is a crucial step in the diagnosis and treatment of many major diseases. Aiming to facilitate diagnostic decision making and improve the workload of pathologists, we developed an artificial intelligence (AI)-based prescreening tool that analyses whole-slide images (WSIs) of large-bowel biopsies to identify typical, non-neoplastic, and neoplastic biopsies. Methods This retrospective cohort study was conducted with an internal development cohort of slides acquired from a hospital in the UK and three external validation cohorts of WSIs acquired from two hospitals in the UK and one clinical laboratory in Portugal. To learn the differential histological patterns from digitised WSIs of large-bowel biopsy slides, our proposed weakly supervised deep-learning model (Colorectal AI Model for Abnormality Detection [CAIMAN]) used slide-level diagnostic labels and no detailed cell or region-level annotations. The method was developed with an internal development cohort of 5054 biopsy slides from 2080 patients that were labelled with corresponding diagnostic categories assigned by pathologists. The three external validation cohorts, with a total of 1536 slides, were used for independent validation of CAIMAN. Each WSI was classified into one of three classes (ie, typical, atypical non-neoplastic, and atypical neoplastic). Prediction scores of image tiles were aggregated into three prediction scores for the whole slide, one for its likelihood of being typical, one for its likelihood of being non-neoplastic, and one for its likelihood of being neoplastic. The assessment of the external validation cohorts was conducted by the trained and frozen CAIMAN model. To evaluate model performance, we calculated area under the convex hull of the receiver operating characteristic curve (AUROC), area under the precision-recall curve, and specificity compared with our previously published iterative draw and rank sampling (IDaRS) algorithm. We also generated heat maps and saliency maps to analyse and visualise the relationship between the WSI diagnostic labels and spatial features of the tissue microenvironment. The main outcome of this study was the ability of CAIMAN to accurately identify typical and atypical WSIs of colon biopsies, which could potentially facilitate automatic removing of typical biopsies from the diagnostic workload in clinics. Findings A randomly selected subset of all large bowel biopsies was obtained between Jan 1, 2012, and Dec 31, 2017. The AI training, validation, and assessments were done between Jan 1, 2021, and Sept 30, 2022. WSIs with diagnostic labels were collected between Jan 1 and Sept 30, 2022. Our analysis showed no statistically significant differences across prediction scores from CAIMAN for typical and atypical classes based on anatomical sites of the biopsy. At 0·99 sensitivity, CAIMAN (specificity 0·5592) was more accurate than an IDaRS-based weakly supervised WSI-classification pipeline (0·4629) in identifying typical and atypical biopsies on cross-validation in the internal development cohort (p<0·0001). At 0·99 sensitivity, CAIMAN was also more accurate than IDaRS for two external validation cohorts (p<0·0001), but not for a third external validation cohort (p=0·10). CAIMAN provided higher specificity than IDaRS at some high-sensitivity thresholds (0·7763 vs 0·6222 for 0·95 sensitivity, 0·7126 vs 0·5407 for 0·97 sensitivity, and 0·5615 vs 0·3970 for 0·99 sensitivity on one of the external validation cohorts) and showed high classification performance in distinguishing between neoplastic biopsies (AUROC 0·9928, 95% CI 0·9927–0·9929), inflammatory biopsies (0·9658, 0·9655–0·9661), and atypical biopsies (0·9789, 0·9786–0·9792). On the three external validation cohorts, CAIMAN had AUROC values of 0·9431 (95% CI 0·9165–0·9697), 0·9576 (0·9568–0·9584), and 0·9636 (0·9615–0·9657) for the detection of atypical biopsies. Saliency maps supported the representation of disease heterogeneity in model predictions and its association with relevant histological features. Interpretation CAIMAN, with its high sensitivity in detecting atypical large-bowel biopsies, might be a promising improvement in clinical workflow efficiency and diagnostic decision making in prescreening of typical colorectal biopsies. Funding The Pathology Image Data Lake for Analytics, Knowledge and Education Centre of Excellence; the UK Government's Industrial Strategy Challenge Fund; and Innovate UK on behalf of UK Research and Innovation