Microscope Based HER2 Scoring System

The overexpression of human epidermal growth factor receptor 2 (HER2) has been established as a therapeutic target in multiple types of cancers, such as breast and gastric cancers. Immunohistochemistry (IHC) is employed as a basic HER2 test to identify the HER2-positive, borderline, and HER2-negative patients. However, the reliability and accuracy of HER2 scoring are affected by many factors, such as pathologists' experience. Recently, artificial intelligence (AI) has been used in various disease diagnosis to improve diagnostic accuracy and reliability, but the interpretation of diagnosis results is still an open problem. In this paper, we propose a real-time HER2 scoring system, which follows the HER2 scoring guidelines to complete the diagnosis, and thus each step is explainable. Unlike the previous scoring systems based on whole-slide imaging, our HER2 scoring system is integrated into an augmented reality (AR) microscope that can feedback AI results to the pathologists while reading the slide. The pathologists can help select informative fields of view (FOVs), avoiding the confounding regions, such as DCIS. Importantly, we illustrate the intermediate results with membrane staining condition and cell classification results, making it possible to evaluate the reliability of the diagnostic results. Also, we support the interactive modification of selecting regions-of-interest, making our system more flexible in clinical practice. The collaboration of AI and pathologists can significantly improve the robustness of our system. We evaluate our system with 285 breast IHC HER2 slides, and the classification accuracy of 95\% shows the effectiveness of our HER2 scoring system.