Histology-informed tiling of whole tissue sections improves the interpretability and predictability of cancer relapse and genetic alterations

Histopathologists establish cancer grade by assessing histological structures, such as glands in prostate cancer. Yet, digital pathology pipelines often rely on grid-based tiling that ignores tissue architecture. This introduces irrelevant information and limits interpretability. We introduce histology-informed tiling (HIT), which uses semantic segmentation to extract glands from whole slide images (WSIs) as biologically meaningful input patches for multiple-instance learning (MIL) and phenotyping. Trained on 137 samples from the ProMPT cohort, HIT achieved a gland-level Dice score of 0.83 +/- 0.17. By extracting 380,000 glands from 760 WSIs across ICGC-C and TCGA-PRAD cohorts, HIT improved MIL models AUCs by 10% for detecting copy number variation (CNVs) in genes related to epithelial-mesenchymal transitions (EMT) and MYC, and revealed 15 gland clusters, several of which were associated with cancer relapse, oncogenic mutations, and high Gleason. Therefore, HIT improved the accuracy and interpretability of MIL predictions, while streamlining computations by focussing on biologically meaningful structures during feature extraction.

Beyond attention: deriving biologically interpretable insights from weakly-supervised multiple-instance learning models

Recent advances in attention-based multiple instance learning (MIL) have improved our insights into the tissue regions that models rely on to make predictions in digital pathology. However, the interpretability of these approaches is still limited. In particular, they do not report whether high-attention regions are positively or negatively associated with the class labels or how well these regions correspond to previously established clinical and biological knowledge. We address this by introducing a post-training methodology to analyse MIL models. Firstly, we introduce prediction-attention-weighted (PAW) maps by combining tile-level attention and prediction scores produced by a refined encoder, allowing us to quantify the predictive contribution of high-attention regions. Secondly, we introduce a biological feature instantiation technique by integrating PAW maps with nuclei segmentation masks. This further improves interpretability by providing biologically meaningful features related to the cellular organisation of the tissue and facilitates comparisons with known clinical features. We illustrate the utility of our approach by comparing PAW maps obtained for prostate cancer diagnosis (i.e. samples containing malignant tissue, 381/516 tissue samples) and prognosis (i.e. samples from patients with biochemical recurrence following surgery, 98/663 tissue samples) in a cohort of patients from the international cancer genome consortium (ICGC UK Prostate Group). Our approach reveals that regions that are predictive of adverse prognosis do not tend to co-locate with the tumour regions, indicating that non-cancer cells should also be studied when evaluating prognosis.