SI-MIL: Taming Deep MIL for Self-Interpretability in Gigapixel Histopathology

Introducing interpretability and reasoning into Multiple Instance Learning (MIL) methods for Whole Slide Image (WSI) analysis is challenging, given the complexity of gigapixel slides. Traditionally, MIL interpretability is limited to identifying salient regions deemed pertinent for downstream tasks, offering little insight to the end-user (pathologist) regarding the rationale behind these selections. To address this, we propose Self-Interpretable MIL (SI-MIL), a method intrinsically designed for interpretability from the very outset. SI-MIL employs a deep MIL framework to guide an interpretable branch grounded on handcrafted pathological features, facilitating linear predictions. Beyond identifying salient regions, SI-MIL uniquely provides feature-level interpretations rooted in pathological insights for WSIs. Notably, SI-MIL, with its linear prediction constraints, challenges the prevalent myth of an inevitable trade-off between model interpretability and performance, demonstrating competitive results compared to state-of-the-art methods on WSI-level prediction tasks across three cancer types. In addition, we thoroughly benchmark the local- and global-interpretability of SI-MIL in terms of statistical analysis, a domain expert study, and desiderata of interpretability, namely, user-friendliness and faithfulness.

Learned representation-guided diffusion models for large-image generation

To synthesize high-fidelity samples, diffusion models typically require auxiliary data to guide the generation process. However, it is impractical to procure the painstaking patch-level annotation effort required in specialized domains like histopathology and satellite imagery; it is often performed by domain experts and involves hundreds of millions of patches. Modern-day self-supervised learning (SSL) representations encode rich semantic and visual information. In this paper, we posit that such representations are expressive enough to act as proxies to fine-grained human labels. We introduce a novel approach that trains diffusion models conditioned on embeddings from SSL. Our diffusion models successfully project these features back to high-quality histopathology and remote sensing images. In addition, we construct larger images by assembling spatially consistent patches inferred from SSL embeddings, preserving long-range dependencies. Augmenting real data by generating variations of real images improves downstream classifier accuracy for patch-level and larger, image-scale classification tasks. Our models are effective even on datasets not encountered during training, demonstrating their robustness and generalizability. Generating images from learned embeddings is agnostic to the source of the embeddings. The SSL embeddings used to generate a large image can either be extracted from a reference image, or sampled from an auxiliary model conditioned on any related modality (e.g. class labels, text, genomic data). As proof of concept, we introduce the text-to-large image synthesis paradigm where we successfully synthesize large pathology and satellite images out of text descriptions.

Automated Assessment of Critical View of Safety in Laparoscopic Cholecystectomy

Cholecystectomy (gallbladder removal) is one of the most common procedures in the US, with more than 1.2M procedures annually. Compared with classical open cholecystectomy, laparoscopic cholecystectomy (LC) is associated with significantly shorter recovery period, and hence is the preferred method. However, LC is also associated with an increase in bile duct injuries (BDIs), resulting in significant morbidity and mortality. The primary cause of BDIs from LCs is misidentification of the cystic duct with the bile duct. Critical view of safety (CVS) is the most effective of safety protocols, which is said to be achieved during the surgery if certain criteria are met. However, due to suboptimal understanding and implementation of CVS, the BDI rates have remained stable over the last three decades. In this paper, we develop deep-learning techniques to automate the assessment of CVS in LCs. An innovative aspect of our research is on developing specialized learning techniques by incorporating domain knowledge to compensate for the limited training data available in practice. In particular, our CVS assessment process involves a fusion of two segmentation maps followed by an estimation of a certain region of interest based on anatomical structures close to the gallbladder, and then finally determination of each of the three CVS criteria via rule-based assessment of structural information. We achieved a gain of over 11.8% in mIoU on relevant classes with our two-stream semantic segmentation approach when compared to a single-model baseline, and 1.84% in mIoU with our proposed Sobel loss function when compared to a Transformer-based baseline model. For CVS criteria, we achieved up to 16% improvement and, for the overall CVS assessment, we achieved 5% improvement in balanced accuracy compared to DeepCVS under the same experiment settings.

Attention De-sparsification Matters: Inducing Diversity in Digital Pathology Representation Learning

We propose DiRL, a Diversity-inducing Representation Learning technique for histopathology imaging. Self-supervised learning techniques, such as contrastive and non-contrastive approaches, have been shown to learn rich and effective representations of digitized tissue samples with limited pathologist supervision. Our analysis of vanilla SSL-pretrained models' attention distribution reveals an insightful observation: sparsity in attention, i.e, models tends to localize most of their attention to some prominent patterns in the image. Although attention sparsity can be beneficial in natural images due to these prominent patterns being the object of interest itself, this can be sub-optimal in digital pathology; this is because, unlike natural images, digital pathology scans are not object-centric, but rather a complex phenotype of various spatially intermixed biological components. Inadequate diversification of attention in these complex images could result in crucial information loss. To address this, we leverage cell segmentation to densely extract multiple histopathology-specific representations, and then propose a prior-guided dense pretext task for SSL, designed to match the multiple corresponding representations between the views. Through this, the model learns to attend to various components more closely and evenly, thus inducing adequate diversification in attention for capturing context rich representations. Through quantitative and qualitative analysis on multiple tasks across cancer types, we demonstrate the efficacy of our method and observe that the attention is more globally distributed.

PathLDM: Text conditioned Latent Diffusion Model for Histopathology

To achieve high-quality results, diffusion models must be trained on large datasets. This can be notably prohibitive for models in specialized domains, such as computational pathology. Conditioning on labeled data is known to help in data-efficient model training. Therefore, histopathology reports, which are rich in valuable clinical information, are an ideal choice as guidance for a histopathology generative model. In this paper, we introduce PathLDM, the first text-conditioned Latent Diffusion Model tailored for generating high-quality histopathology images. Leveraging the rich contextual information provided by pathology text reports, our approach fuses image and textual data to enhance the generation process. By utilizing GPT's capabilities to distill and summarize complex text reports, we establish an effective conditioning mechanism. Through strategic conditioning and necessary architectural enhancements, we achieved a SoTA FID score of 7.64 for text-to-image generation on the TCGA-BRCA dataset, significantly outperforming the closest text-conditioned competitor with FID 30.1.

Learning to Segment from Noisy Annotations: A Spatial Correction Approach

Noisy labels can significantly affect the performance of deep neural networks (DNNs). In medical image segmentation tasks, annotations are error-prone due to the high demand in annotation time and in the annotators' expertise. Existing methods mostly assume noisy labels in different pixels are \textit{i.i.d}. However, segmentation label noise usually has strong spatial correlation and has prominent bias in distribution. In this paper, we propose a novel Markov model for segmentation noisy annotations that encodes both spatial correlation and bias. Further, to mitigate such label noise, we propose a label correction method to recover true label progressively. We provide theoretical guarantees of the correctness of the proposed method. Experiments show that our approach outperforms current state-of-the-art methods on both synthetic and real-world noisy annotations.

SAM-Path: A Segment Anything Model for Semantic Segmentation in Digital Pathology

Semantic segmentations of pathological entities have crucial clinical value in computational pathology workflows. Foundation models, such as the Segment Anything Model (SAM), have been recently proposed for universal use in segmentation tasks. SAM shows remarkable promise in instance segmentation on natural images. However, the applicability of SAM to computational pathology tasks is limited due to the following factors: (1) lack of comprehensive pathology datasets used in SAM training and (2) the design of SAM is not inherently optimized for semantic segmentation tasks. In this work, we adapt SAM for semantic segmentation by introducing trainable class prompts, followed by further enhancements through the incorporation of a pathology encoder, specifically a pathology foundation model. Our framework, SAM-Path enhances SAM's ability to conduct semantic segmentation in digital pathology without human input prompts. Through experiments on two public pathology datasets, the BCSS and the CRAG datasets, we demonstrate that the fine-tuning with trainable class prompts outperforms vanilla SAM with manual prompts and post-processing by 27.52% in Dice score and 71.63% in IOU. On these two datasets, the proposed additional pathology foundation model further achieves a relative improvement of 5.07% to 5.12% in Dice score and 4.50% to 8.48% in IOU.

Topology-Aware Uncertainty for Image Segmentation

Segmentation of curvilinear structures such as vasculature and road networks is challenging due to relatively weak signals and complex geometry/topology. To facilitate and accelerate large scale annotation, one has to adopt semi-automatic approaches such as proofreading by experts. In this work, we focus on uncertainty estimation for such tasks, so that highly uncertain, and thus error-prone structures can be identified for human annotators to verify. Unlike most existing works, which provide pixel-wise uncertainty maps, we stipulate it is crucial to estimate uncertainty in the units of topological structures, e.g., small pieces of connections and branches. To achieve this, we leverage tools from topological data analysis, specifically discrete Morse theory (DMT), to first capture the structures, and then reason about their uncertainties. To model the uncertainty, we (1) propose a joint prediction model that estimates the uncertainty of a structure while taking the neighboring structures into consideration (inter-structural uncertainty); (2) propose a novel Probabilistic DMT to model the inherent uncertainty within each structure (intra-structural uncertainty) by sampling its representations via a perturb-and-walk scheme. On various 2D and 3D datasets, our method produces better structure-wise uncertainty maps compared to existing works.

ViT-DAE: Transformer-driven Diffusion Autoencoder for Histopathology Image Analysis

Generative AI has received substantial attention in recent years due to its ability to synthesize data that closely resembles the original data source. While Generative Adversarial Networks (GANs) have provided innovative approaches for histopathological image analysis, they suffer from limitations such as mode collapse and overfitting in discriminator. Recently, Denoising Diffusion models have demonstrated promising results in computer vision. These models exhibit superior stability during training, better distribution coverage, and produce high-quality diverse images. Additionally, they display a high degree of resilience to noise and perturbations, making them well-suited for use in digital pathology, where images commonly contain artifacts and exhibit significant variations in staining. In this paper, we present a novel approach, namely ViT-DAE, which integrates vision transformers (ViT) and diffusion autoencoders for high-quality histopathology image synthesis. This marks the first time that ViT has been introduced to diffusion autoencoders in computational pathology, allowing the model to better capture the complex and intricate details of histopathology images. We demonstrate the effectiveness of ViT-DAE on three publicly available datasets. Our approach outperforms recent GAN-based and vanilla DAE methods in generating realistic images.

Prompt-MIL: Boosting Multi-Instance Learning Schemes via Task-specific Prompt Tuning

Whole slide image (WSI) classification is a critical task in computational pathology, requiring the processing of gigapixel-sized images, which is challenging for current deep-learning methods. Current state of the art methods are based on multi-instance learning schemes (MIL), which usually rely on pretrained features to represent the instances. Due to the lack of task-specific annotated data, these features are either obtained from well-established backbones on natural images, or, more recently from self-supervised models pretrained on histopathology. However, both approaches yield task-agnostic features, resulting in performance loss compared to the appropriate task-related supervision, if available. In this paper, we show that when task-specific annotations are limited, we can inject such supervision into downstream task training, to reduce the gap between fully task-tuned and task agnostic features. We propose Prompt-MIL, an MIL framework that integrates prompts into WSI classification. Prompt-MIL adopts a prompt tuning mechanism, where only a small fraction of parameters calibrates the pretrained features to encode task-specific information, rather than the conventional full fine-tuning approaches. Extensive experiments on three WSI datasets, TCGA-BRCA, TCGA-CRC, and BRIGHT, demonstrate the superiority of Prompt-MIL over conventional MIL methods, achieving a relative improvement of 1.49%-4.03% in accuracy and 0.25%-8.97% in AUROC while using fewer than 0.3% additional parameters. Compared to conventional full fine-tuning approaches, we fine-tune less than 1.3% of the parameters, yet achieve a relative improvement of 1.29%-13.61% in accuracy and 3.22%-27.18% in AUROC and reduce GPU memory consumption by 38%-45% while training 21%-27% faster.