Predict Patient Self-reported Race from Skin Histological Images

Artificial Intelligence (AI) has demonstrated success in computational pathology (CPath) for disease detection, biomarker classification, and prognosis prediction. However, its potential to learn unintended demographic biases, particularly those related to social determinants of health, remains understudied. This study investigates whether deep learning models can predict self-reported race from digitized dermatopathology slides and identifies potential morphological shortcuts. Using a multisite dataset with a racially diverse population, we apply an attention-based mechanism to uncover race-associated morphological features. After evaluating three dataset curation strategies to control for confounding factors, the final experiment showed that White and Black demographic groups retained high prediction performance (AUC: 0.799, 0.762), while overall performance dropped to 0.663. Attention analysis revealed the epidermis as a key predictive feature, with significant performance declines when these regions were removed. These findings highlight the need for careful data curation and bias mitigation to ensure equitable AI deployment in pathology. Code available at: https://github.com/sinai-computational-pathology/CPath_SAIF.

A Clinical Benchmark of Public Self-Supervised Pathology Foundation Models

The use of self-supervised learning (SSL) to train pathology foundation models has increased substantially in the past few years. Notably, several models trained on large quantities of clinical data have been made publicly available in recent months. This will significantly enhance scientific research in computational pathology and help bridge the gap between research and clinical deployment. With the increase in availability of public foundation models of different sizes, trained using different algorithms on different datasets, it becomes important to establish a benchmark to compare the performance of such models on a variety of clinically relevant tasks spanning multiple organs and diseases. In this work, we present a collection of pathology datasets comprising clinical slides associated with clinically relevant endpoints including cancer diagnoses and a variety of biomarkers generated during standard hospital operation from two medical centers. We leverage these datasets to systematically assess the performance of public pathology foundation models and provide insights into best practices for training new foundation models and selecting appropriate pretrained models.

Computational Pathology at Health System Scale -- Self-Supervised Foundation Models from Three Billion Images

Recent breakthroughs in self-supervised learning have enabled the use of large unlabeled datasets to train visual foundation models that can generalize to a variety of downstream tasks. While this training paradigm is well suited for the medical domain where annotations are scarce, large-scale pre-training in the medical domain, and in particular pathology, has not been extensively studied. Previous work in self-supervised learning in pathology has leveraged smaller datasets for both pre-training and evaluating downstream performance. The aim of this project is to train the largest academic foundation model and benchmark the most prominent self-supervised learning algorithms by pre-training and evaluating downstream performance on large clinical pathology datasets. We collected the largest pathology dataset to date, consisting of over 3 billion images from over 423 thousand microscopy slides. We compared pre-training of visual transformer models using the masked autoencoder (MAE) and DINO algorithms. We evaluated performance on six clinically relevant tasks from three anatomic sites and two institutions: breast cancer detection, inflammatory bowel disease detection, breast cancer estrogen receptor prediction, lung adenocarcinoma EGFR mutation prediction, and lung cancer immunotherapy response prediction. Our results demonstrate that pre-training on pathology data is beneficial for downstream performance compared to pre-training on natural images. Additionally, the DINO algorithm achieved better generalization performance across all tasks tested. The presented results signify a phase change in computational pathology research, paving the way into a new era of more performant models based on large-scale, parallel pre-training at the billion-image scale.