DuoFormer: Leveraging Hierarchical Visual Representations by Local and Global Attention

We here propose a novel hierarchical transformer model that adeptly integrates the feature extraction capabilities of Convolutional Neural Networks (CNNs) with the advanced representational potential of Vision Transformers (ViTs). Addressing the lack of inductive biases and dependence on extensive training datasets in ViTs, our model employs a CNN backbone to generate hierarchical visual representations. These representations are then adapted for transformer input through an innovative patch tokenization. We also introduce a 'scale attention' mechanism that captures cross-scale dependencies, complementing patch attention to enhance spatial understanding and preserve global perception. Our approach significantly outperforms baseline models on small and medium-sized medical datasets, demonstrating its efficiency and generalizability. The components are designed as plug-and-play for different CNN architectures and can be adapted for multiple applications. The code is available at https://github.com/xiaoyatang/DuoFormer.git.

F2FLDM: Latent Diffusion Models with Histopathology Pre-Trained Embeddings for Unpaired Frozen Section to FFPE Translation

The Frozen Section (FS) technique is a rapid and efficient method, taking only 15-30 minutes to prepare slides for pathologists' evaluation during surgery, enabling immediate decisions on further surgical interventions. However, FS process often introduces artifacts and distortions like folds and ice-crystal effects. In contrast, these artifacts and distortions are absent in the higher-quality formalin-fixed paraffin-embedded (FFPE) slides, which require 2-3 days to prepare. While Generative Adversarial Network (GAN)-based methods have been used to translate FS to FFPE images (F2F), they may leave morphological inaccuracies with remaining FS artifacts or introduce new artifacts, reducing the quality of these translations for clinical assessments. In this study, we benchmark recent generative models, focusing on GANs and Latent Diffusion Models (LDMs), to overcome these limitations. We introduce a novel approach that combines LDMs with Histopathology Pre-Trained Embeddings to enhance restoration of FS images. Our framework leverages LDMs conditioned by both text and pre-trained embeddings to learn meaningful features of FS and FFPE histopathology images. Through diffusion and denoising techniques, our approach not only preserves essential diagnostic attributes like color staining and tissue morphology but also proposes an embedding translation mechanism to better predict the targeted FFPE representation of input FS images. As a result, this work achieves a significant improvement in classification performance, with the Area Under the Curve rising from 81.99% to 94.64%, accompanied by an advantageous CaseFD. This work establishes a new benchmark for FS to FFPE image translation quality, promising enhanced reliability and accuracy in histopathology FS image analysis. Our work is available at https://minhmanho.github.io/f2f_ldm/.

DISC: Latent Diffusion Models with Self-Distillation from Separated Conditions for Prostate Cancer Grading

Latent Diffusion Models (LDMs) can generate high-fidelity images from noise, offering a promising approach for augmenting histopathology images for training cancer grading models. While previous works successfully generated high-fidelity histopathology images using LDMs, the generation of image tiles to improve prostate cancer grading has not yet been explored. Additionally, LDMs face challenges in accurately generating admixtures of multiple cancer grades in a tile when conditioned by a tile mask. In this study, we train specific LDMs to generate synthetic tiles that contain multiple Gleason Grades (GGs) by leveraging pixel-wise annotations in input tiles. We introduce a novel framework named Self-Distillation from Separated Conditions (DISC) that generates GG patterns guided by GG masks. Finally, we deploy a training framework for pixel-level and slide-level prostate cancer grading, where synthetic tiles are effectively utilized to improve the cancer grading performance of existing models. As a result, this work surpasses previous works in two domains: 1) our LDMs enhanced with DISC produce more accurate tiles in terms of GG patterns, and 2) our training scheme, incorporating synthetic data, significantly improves the generalization of the baseline model for prostate cancer grading, particularly in challenging cases of rare GG5, demonstrating the potential of generative models to enhance cancer grading when data is limited.

CLASS-M: Adaptive stain separation-based contrastive learning with pseudo-labeling for histopathological image classification

Histopathological image classification is an important task in medical image analysis. Recent approaches generally rely on weakly supervised learning due to the ease of acquiring case-level labels from pathology reports. However, patch-level classification is preferable in applications where only a limited number of cases are available or when local prediction accuracy is critical. On the other hand, acquiring extensive datasets with localized labels for training is not feasible. In this paper, we propose a semi-supervised patch-level histopathological image classification model, named CLASS-M, that does not require extensively labeled datasets. CLASS-M is formed by two main parts: a contrastive learning module that uses separated Hematoxylin and Eosin images generated through an adaptive stain separation process, and a module with pseudo-labels using MixUp. We compare our model with other state-of-the-art models on two clear cell renal cell carcinoma datasets. We demonstrate that our CLASS-M model has the best performance on both datasets. Our code is available at github.com/BzhangURU/Paper_CLASS-M/tree/main

Analyzing the Domain Shift Immunity of Deep Homography Estimation

Homography estimation is a basic image-alignment method in many applications. Recently, with the development of convolutional neural networks (CNNs), some learning based approaches have shown great success in this task. However, the performance across different domains has never been researched. Unlike other common tasks (\eg, classification, detection, segmentation), CNN based homography estimation models show a domain shift immunity, which means a model can be trained on one dataset and tested on another without any transfer learning. To explain this unusual performance, we need to determine how CNNs estimate homography. In this study, we first show the domain shift immunity of different deep homography estimation models. We then use a shallow network with a specially designed dataset to analyze the features used for estimation. The results show that networks use low-level texture information to estimate homography. We also design some experiments to compare the performance between different texture densities and image features distorted on some common datasets to demonstrate our findings. Based on these findings, we provide an explanation of the domain shift immunity of deep homography estimation.

Localization supervision of chest x-ray classifiers using label-specific eye-tracking annotation

Convolutional neural networks (CNNs) have been successfully applied to chest x-ray (CXR) images. Moreover, annotated bounding boxes have been shown to improve the interpretability of a CNN in terms of localizing abnormalities. However, only a few relatively small CXR datasets containing bounding boxes are available, and collecting them is very costly. Opportunely, eye-tracking (ET) data can be collected in a non-intrusive way during the clinical workflow of a radiologist. We use ET data recorded from radiologists while dictating CXR reports to train CNNs. We extract snippets from the ET data by associating them with the dictation of keywords and use them to supervise the localization of abnormalities. We show that this method improves a model's interpretability without impacting its image-level classification.

Stain based contrastive co-training for histopathological image analysis

We propose a novel semi-supervised learning approach for classification of histopathology images. We employ strong supervision with patch-level annotations combined with a novel co-training loss to create a semi-supervised learning framework. Co-training relies on multiple conditionally independent and sufficient views of the data. We separate the hematoxylin and eosin channels in pathology images using color deconvolution to create two views of each slide that can partially fulfill these requirements. Two separate CNNs are used to embed the two views into a joint feature space. We use a contrastive loss between the views in this feature space to implement co-training. We evaluate our approach in clear cell renal cell and prostate carcinomas, and demonstrate improvement over state-of-the-art semi-supervised learning methods.

Adversarially Robust Classification by Conditional Generative Model Inversion

Most adversarial attack defense methods rely on obfuscating gradients. These methods are successful in defending against gradient-based attacks; however, they are easily circumvented by attacks which either do not use the gradient or by attacks which approximate and use the corrected gradient. Defenses that do not obfuscate gradients such as adversarial training exist, but these approaches generally make assumptions about the attack such as its magnitude. We propose a classification model that does not obfuscate gradients and is robust by construction without assuming prior knowledge about the attack. Our method casts classification as an optimization problem where we "invert" a conditional generator trained on unperturbed, natural images to find the class that generates the closest sample to the query image. We hypothesize that a potential source of brittleness against adversarial attacks is the high-to-low-dimensional nature of feed-forward classifiers which allows an adversary to find small perturbations in the input space that lead to large changes in the output space. On the other hand, a generative model is typically a low-to-high-dimensional mapping. While the method is related to Defense-GAN, the use of a conditional generative model and inversion in our model instead of the feed-forward classifier is a critical difference. Unlike Defense-GAN, which was shown to generate obfuscated gradients that are easily circumvented, we show that our method does not obfuscate gradients. We demonstrate that our model is extremely robust against black-box attacks and has improved robustness against white-box attacks compared to naturally trained, feed-forward classifiers.

Comparing radiologists' gaze and saliency maps generated by interpretability methods for chest x-rays

The interpretability of medical image analysis models is considered a key research field. We use a dataset of eye-tracking data from five radiologists to compare the outputs of interpretability methods against the heatmaps representing where radiologists looked. We conduct a class-independent analysis of the saliency maps generated by two methods selected from the literature: Grad-CAM and attention maps from an attention-gated model. For the comparison, we use shuffled metrics, which avoid biases from fixation locations. We achieve scores comparable to an interobserver baseline in one shuffled metric, highlighting the potential of saliency maps from Grad-CAM to mimic a radiologist's attention over an image. We also divide the dataset into subsets to evaluate in which cases similarities are higher.

REFLACX, a dataset of reports and eye-tracking data for localization of abnormalities in chest x-rays

Deep learning has shown recent success in classifying anomalies in chest x-rays, but datasets are still small compared to natural image datasets. Supervision of abnormality localization has been shown to improve trained models, partially compensating for dataset sizes. However, explicitly labeling these anomalies requires an expert and is very time-consuming. We propose a method for collecting implicit localization data using an eye tracker to capture gaze locations and a microphone to capture a dictation of a report, imitating the setup of a reading room, and potentially scalable for large datasets. The resulting REFLACX (Reports and Eye-Tracking Data for Localization of Abnormalities in Chest X-rays) dataset was labeled by five radiologists and contains 3,032 synchronized sets of eye-tracking data and timestamped report transcriptions. We also provide bounding boxes around lungs and heart and validation labels consisting of ellipses localizing abnormalities and image-level labels. Furthermore, a small subset of the data contains readings from all radiologists, allowing for the calculation of inter-rater scores.