An AI based, open access screening tool for early diagnosis of Burkitt lymphoma

Burkitt Lymphoma (BL) is a highly treatable cancer. However, delayed diagnosis of BL contributes to high mortality in BL endemic regions of Africa. Lack of enough pathologists in the region is a major reason for delayed diagnosis. The work described in this paper is a proof-of-concept study to develop a targeted, open access AI tool for screening of histopathology slides in suspected BL cases. Slides were obtained from a total of 90 BL patients. 70 Tonsillectomy samples were used as controls. We fine-tuned 6 pre-trained models and evaluated the performance of all 6 models across different configurations. An ensemble-based consensus approach ensured a balanced and robust classification. The tool applies novel features to BL diagnosis including use of multiple image magnifications, thus enabling use of different magnifications of images based on the microscope/scanner available in remote clinics, composite scoring of multiple models and utilizing MIL with weak labeling and image augmentation, enabling use of relatively low sample size to achieve good performance on the inference set. The open access model allows free access to the AI tool from anywhere with an internet connection. The ultimate aim of this work is making pathology services accessible, efficient and timely in remote clinics in regions where BL is endemic. New generation of low-cost slide scanners/microscopes is expected to make slide images available immediately for the AI tool for screening and thus accelerate diagnosis by pathologists available locally or online

Pitfalls in machine learning‐based assessment of tumor‐infiltrating lymphocytes in breast cancer: a report of the international immuno‐oncology biomarker working group

The clinical significance of the tumor-immune interaction in breast cancer (BC) has been well established, and tumor-infiltrating lymphocytes (TILs) have emerged as a predictive and prognostic biomarker for patients with triple-negative (estrogen receptor, progesterone receptor, and HER2 negative) breast cancer (TNBC) and HER2-positive breast cancer. How computational assessment of TILs can complement manual TIL-assessment in trial- and daily practices is currently debated and still unclear. Recent efforts to use machine learning (ML) for the automated evaluation of TILs show promising results. We review state-of-the-art approaches and identify pitfalls and challenges by studying the root cause of ML discordances in comparison to manual TILs quantification. We categorize our findings into four main topics; (i) technical slide issues, (ii) ML and image analysis aspects, (iii) data challenges, and (iv) validation issues. The main reason for discordant assessments is the inclusion of false-positive areas or cells identified by performance on certain tissue patterns, or design choices in the computational implementation. To aid the adoption of ML in TILs assessment, we provide an in-depth discussion of ML and image analysis including validation issues that need to be considered before reliable computational reporting of TILs can be incorporated into the trial- and routine clinical management of patients with TNBC

Image-based multiplex immune profiling of cancer tissues : translational implications. A report of the International Immuno-oncology Biomarker Working Group on Breast Cancer

Recent advances in the field of immuno-oncology have brought transformative changes in the management of cancer patients. The immune profile of tumours has been found to have key value in predicting disease prognosis and treatment response in various cancers. Multiplex immunohistochemistry and immunofluorescence have emerged as potent tools for the simultaneous detection of multiple protein biomarkers in a single tissue section, thereby expanding opportunities for molecular and immune profiling while preserving tissue samples. By establishing the phenotype of individual tumour cells when distributed within a mixed cell population, the identification of clinically relevant biomarkers with high-throughput multiplex immunophenotyping of tumour samples has great potential to guide appropriate treatment choices. Moreover, the emergence of novel multi-marker imaging approaches can now provide unprecedented insights into the tumour microenvironment, including the potential interplay between various cell types. However, there are significant challenges to widespread integration of these technologies in daily research and clinical practice. This review addresses the challenges and potential solutions within a structured framework of action from a regulatory and clinical trial perspective. New developments within the field of immunophenotyping using multiplexed tissue imaging platforms and associated digital pathology are also described, with a specific focus on translational implications across different subtypes of cancer.Gilead Breast Cancer Research Grant; Breast Cancer Research Foundation; Susan G Komen Leadership; Interne Fondsen KU Leuven/Internal Funds KU Leuven; Swedish Society for Medical Research; Swedish Breast Cancer Association; Cancer Research Program; US Department of Defense; Mayo Clinic Breast Cancer; Marie Sklodowska Curie; NHMRC; National Institutes of Health; Cancer Research UK; Japan Society for the Promotion of Science; Horizon 2020 European Union Research and Innovation Programme National Cancer Institute; National Heart, Lung and Blood Institute; National Institute of Biomedical Imaging and Bioengineering; VA Merit Review Award; US Department of Veterans Affairs Biomedical Laboratory Research Breast Cancer Research Program; Prostate Cancer Research Program; Lung Cancer Research Program; Kidney Precision Medicine Project (KPMP) Glue Grant; EPSRC; Melbourne Research Scholarship; Peter MacCallum Cancer Centre; KWF Kankerbestrijding; Dutch Ministry of Health, Welfare and Sport the Breast Cancer Research Foundation; Agence Nationale de la Recherche; Q-Life; National Breast Cancer Foundation of Australia; National Health and Medical Council of Australia; All-Island Cancer Research Institute; Irish Cancer Society; Science Foundation Ireland Investigator Programme; Science Foundation Ireland Strategic Partnership Programme. Open access funding provided by IReL.https://pathsocjournals.onlinelibrary.wiley.com/journal/10969896hj2024ImmunologySDG-03:Good heatlh and well-bein

Spatial analyses of immune cell infiltration in cancer : current methods and future directions. A report of the International Immuno-Oncology Biomarker Working Group on Breast Cancer

Modern histologic imaging platforms coupled with machine learning methods have provided new opportunities to map the spatial distribution of immune cells in the tumor microenvironment. However, there exists no standardized method for describing or analyzing spatial immune cell data, and most reported spatial analyses are rudimentary. In this review, we provide an overview of two approaches for reporting and analyzing spatial data (raster versus vector-based). We then provide a compendium of spatial immune cell metrics that have been reported in the literature, summarizing prognostic associations in the context of a variety of cancers. We conclude by discussing two well-described clinical biomarkers, the breast cancer stromal tumor infiltrating lymphocytes score and the colon cancer Immunoscore, and describe investigative opportunities to improve clinical utility of these spatial biomarkers. © 2023 The Pathological Society of Great Britain and Ireland.http://www.thejournalofpathology.com/hj2024ImmunologySDG-03:Good heatlh and well-bein

Image-based multiplex immune profiling of cancer tissues: translational implications. A report of the International Immuno-oncology Biomarker Working Group on Breast Cancer

Recent advances in the field of immuno-oncology have brought transformative changes in the management of cancer patients. The immune profile of tumours has been found to have key value in predicting disease prognosis and treatment response in various cancers. Multiplex immunohistochemistry and immunofluorescence have emerged as potent tools for the simultaneous detection of multiple protein biomarkers in a single tissue section, thereby expanding opportunities for molecular and immune profiling while preserving tissue samples. By establishing the phenotype of individual tumour cells when distributed within a mixed cell population, the identification of clinically relevant biomarkers with high-throughput multiplex immunophenotyping of tumour samples has great potential to guide appropriate treatment choices. Moreover, the emergence of novel multi-marker imaging approaches can now provide unprecedented insights into the tumour microenvironment, including the potential interplay between various cell types. However, there are significant challenges to widespread integration of these technologies in daily research and clinical practice. This review addresses the challenges and potential solutions within a structured framework of action from a regulatory and clinical trial perspective. New developments within the field of immunophenotyping using multiplexed tissue imaging platforms and associated digital pathology are also described, with a specific focus on translational implications across different subtypes of cancer

Pitfalls in machine learning-based assessment of tumor-infiltrating lymphocytes in breast cancer: A report of the International Immuno-Oncology Biomarker Working Group on Breast Cancer

The clinical significance of the tumor-immune interaction in breast cancer is now established, and tumor-infiltrating lymphocytes (TILs) have emerged as predictive and prognostic biomarkers for patients with triple-negative (estrogen receptor, progesterone receptor, and HER2-negative) breast cancer and HER2-positive breast cancer. How computational assessments of TILs might complement manual TIL assessment in trial and daily practices is currently debated. Recent efforts to use machine learning (ML) to automatically evaluate TILs have shown promising results. We review state-of-the-art approaches and identify pitfalls and challenges of automated TIL evaluation by studying the root cause of ML discordances in comparison to manual TIL quantification. We categorize our findings into four main topics: (1) technical slide issues, (2) ML and image analysis aspects, (3) data challenges, and (4) validation issues. The main reason for discordant assessments is the inclusion of false-positive areas or cells identified by performance on certain tissue patterns or design choices in the computational implementation. To aid the adoption of ML for TIL assessment, we provide an in-depth discussion of ML and image analysis, including validation issues that need to be considered before reliable computational reporting of TILs can be incorporated into the trial and routine clinical management of patients with triple-negative breast cancer

Breast cancer diagnosis using Fourier transform infrared imaging and statistical learning

Cancer alters both the morphological and the biochemical properties of multiple cell types in a tissue. Generally, the morphology of epithelial cells is practically used for routine disease diagnoses. Current histopathological diagnosis involves manual interpretation of stained images for patient diagnosis. This is prone to inter- observer variability leading to low concordance rates amongst pathologists. Further, since structural features are mostly just defined for epithelial alterations during tumor progression, the use of associated stromal changes is limited. To overcome these challenges, digital analysis of these images is suggested that can result in the determination of precise and quantitative metrics both for epithelial and stromal disease signatures. In my dissertation work, I focused on building combinatorial approaches using chemical imaging, histopathology images, machine learning and deep learning. An emerging area of investigation is using spectrometry to perform tissue analysis that utilizes chemical imaging coupled to machine learning to identify spectral signatures indicative of disease state and its progression. Infrared spectroscopic imaging biochemically characterizes breast cancer, both for the epithelial cells and the tumor-associated microenvironment. I utilized multiple breast tissue assignments and a supervised learning approach to create different histologic and pathologic models using both high definition (HD) and standard definition (SD) data. The comparison of HD and SD modalities shows that new information richness associated with better spatial resolution facilitates the creation of complex, multiclass models of breast tissue without compromising on the sensitivity and the specificity of tissue segmentation. These models were then extended to discrete frequency measurements for rapid analysis cutting down tissue analysis time from days to minutes, making the technology feasible for research optimizations and clinical translation. Additionally, I optimized and tuned existing convolutional neural networks to identify different disease states in breast cancer and the corresponding microenvironment. Finally, I developed analytical tools for early detection and standardized analysis of stained image data. This can offer new opportunities for objective, accurate and comprehensive patient diagnosis and prognostics.LimitedAuthor requested closed access (OA after 2yrs) in Vireo ETD syste

Closed-loop atomic force microscopy-infrared spectroscopic imaging for nanoscale molecular characterization

Atomic force microscopy-infrared (AFM-IR) spectroscopic imaging techniques offer a non-perturbative, molecular contrast for characterization of nanomaterials; however, data are often complicated by the measurement apparatus, sample preparation conditions and low signal-to-noise ratio. Here, the authors demonstrate a closed-loop controlled AFM-IR instrument design to address measurement artifacts and reduce noise up to 5x compared to previous methods

Probe–Sample Interaction-Independent Atomic Force Microscopy–Infrared Spectroscopy: Toward Robust Nanoscale Compositional Mapping

Nanoscale topological imaging using atomic force microscopy (AFM) combined with infrared (IR) spectroscopy (AFM-IR) is a rapidly emerging modality to record correlated structural and chemical images. Although the expectation is that the spectral data faithfully represents the underlying chemical composition, the sample mechanical properties affect the recorded data (known as the probe–sample-interaction effect). Although experts in the field are aware of this effect, the contribution is not fully understood. Further, when the sample properties are not well-known or when AFM-IR experiments are conducted by nonexperts, there is a chance that these nonmolecular properties may affect analytical measurements in an uncertain manner. Techniques such as resonance-enhanced imaging and normalization of the IR signal using ratios might improve fidelity of recorded data, but they are not universally effective. Here, we provide a fully analytical model that relates cantilever response to the local sample expansion which opens several avenues. We demonstrate a new method for removing probe–sample-interaction effects in AFM-IR images by measuring the cantilever responsivity using a mechanically induced, out-of-plane sample vibration. This method is then applied to model polymers and mammary epithelial cells to show improvements in sensitivity, accuracy, and repeatability for measuring soft matter when compared to the current state of the art (resonance-enhanced operation). Understanding of the sample-dependent cantilever responsivity is an essential addition to AFM-IR imaging if the identification of chemical features at nanoscale resolutions is to be realized for arbitrary samples