MERA: Multimodal and Multiscale Self-Explanatory Model with Considerably Reduced Annotation for Lung Nodule Diagnosis

Lung cancer, a leading cause of cancer-related deaths globally, emphasises the importance of early detection for better patient outcomes. Pulmonary nodules, often early indicators of lung cancer, necessitate accurate, timely diagnosis. Despite Explainable Artificial Intelligence (XAI) advances, many existing systems struggle providing clear, comprehensive explanations, especially with limited labelled data. This study introduces MERA, a Multimodal and Multiscale self-Explanatory model designed for lung nodule diagnosis with considerably Reduced Annotation requirements. MERA integrates unsupervised and weakly supervised learning strategies (self-supervised learning techniques and Vision Transformer architecture for unsupervised feature extraction) and a hierarchical prediction mechanism leveraging sparse annotations via semi-supervised active learning in the learned latent space. MERA explains its decisions on multiple levels: model-level global explanations via semantic latent space clustering, instance-level case-based explanations showing similar instances, local visual explanations via attention maps, and concept explanations using critical nodule attributes. Evaluations on the public LIDC dataset show MERA's superior diagnostic accuracy and self-explainability. With only 1% annotated samples, MERA achieves diagnostic accuracy comparable to or exceeding state-of-the-art methods requiring full annotation. The model's inherent design delivers comprehensive, robust, multilevel explanations aligned closely with clinical practice, enhancing trustworthiness and transparency. Demonstrated viability of unsupervised and weakly supervised learning lowers the barrier to deploying diagnostic AI in broader medical domains. Our complete code is open-source available: https://github.com/diku-dk/credanno.

Subspecialty-Specific Foundation Model for Intelligent Gastrointestinal Pathology

Gastrointestinal (GI) diseases represent a clinically significant burden, necessitating precise diagnostic approaches to optimize patient outcomes. Conventional histopathological diagnosis, heavily reliant on the subjective interpretation of pathologists, suffers from limited reproducibility and diagnostic variability. To overcome these limitations and address the lack of pathology-specific foundation models for GI diseases, we develop Digepath, a specialized foundation model for GI pathology. Our framework introduces a dual-phase iterative optimization strategy combining pretraining with fine-screening, specifically designed to address the detection of sparsely distributed lesion areas in whole-slide images. Digepath is pretrained on more than 353 million image patches from over 200,000 hematoxylin and eosin-stained slides of GI diseases. It attains state-of-the-art performance on 33 out of 34 tasks related to GI pathology, including pathological diagnosis, molecular prediction, gene mutation prediction, and prognosis evaluation, particularly in diagnostically ambiguous cases and resolution-agnostic tissue classification.We further translate the intelligent screening module for early GI cancer and achieve near-perfect 99.6% sensitivity across 9 independent medical institutions nationwide. The outstanding performance of Digepath highlights its potential to bridge critical gaps in histopathological practice. This work not only advances AI-driven precision pathology for GI diseases but also establishes a transferable paradigm for other pathology subspecialties.

A Novel Channel Boosted Residual CNN-Transformer with Regional-Boundary Learning for Breast Cancer Detection

Recent advancements in detecting tumors using deep learning on breast ultrasound images (BUSI) have demonstrated significant success. Deep CNNs and vision-transformers (ViTs) have demonstrated individually promising initial performance. However, challenges related to model complexity and contrast, texture, and tumor morphology variations introduce uncertainties that hinder the effectiveness of current methods. This study introduces a novel hybrid framework, CB-Res-RBCMT, combining customized residual CNNs and new ViT components for detailed BUSI cancer analysis. The proposed RBCMT uses stem convolution blocks with CNN Meet Transformer (CMT) blocks, followed by new Regional and boundary (RB) feature extraction operations for capturing contrast and morphological variations. Moreover, the CMT block incorporates global contextual interactions through multi-head attention, enhancing computational efficiency with a lightweight design. Additionally, the customized inverse residual and stem CNNs within the CMT effectively extract local texture information and handle vanishing gradients. Finally, the new channel-boosted (CB) strategy enriches the feature diversity of the limited dataset by combining the original RBCMT channels with transfer learning-based residual CNN-generated maps. These diverse channels are processed through a spatial attention block for optimal pixel selection, reducing redundancy and improving the discrimination of minor contrast and texture variations. The proposed CB-Res-RBCMT achieves an F1-score of 95.57%, accuracy of 95.63%, sensitivity of 96.42%, and precision of 94.79% on the standard harmonized stringent BUSI dataset, outperforming existing ViT and CNN methods. These results demonstrate the versatility of our integrated CNN-Transformer framework in capturing diverse features and delivering superior performance in BUSI cancer diagnosis.

Anomaly-Driven Approach for Enhanced Prostate Cancer Segmentation

Magnetic Resonance Imaging (MRI) plays an important role in identifying clinically significant prostate cancer (csPCa), yet automated methods face challenges such as data imbalance, variable tumor sizes, and a lack of annotated data. This study introduces Anomaly-Driven U-Net (adU-Net), which incorporates anomaly maps derived from biparametric MRI sequences into a deep learning-based segmentation framework to improve csPCa identification. We conduct a comparative analysis of anomaly detection methods and evaluate the integration of anomaly maps into the segmentation pipeline. Anomaly maps, generated using Fixed-Point GAN reconstruction, highlight deviations from normal prostate tissue, guiding the segmentation model to potential cancerous regions. We compare the performance by using the average score, computed as the mean of the AUROC and Average Precision (AP). On the external test set, adU-Net achieves the best average score of 0.618, outperforming the baseline nnU-Net model (0.605). The results demonstrate that incorporating anomaly detection into segmentation improves generalization and performance, particularly with ADC-based anomaly maps, offering a promising direction for automated csPCa identification.

A Foundation Model Framework for Multi-View MRI Classification of Extramural Vascular Invasion and Mesorectal Fascia Invasion in Rectal Cancer

Background: Accurate MRI-based identification of extramural vascular invasion (EVI) and mesorectal fascia invasion (MFI) is pivotal for risk-stratified management of rectal cancer, yet visual assessment is subjective and vulnerable to inter-institutional variability. Purpose: To develop and externally evaluate a multicenter, foundation-model-driven framework that automatically classifies EVI and MFI on axial and sagittal T2-weighted MRI. Methods: This retrospective study used 331 pre-treatment rectal cancer MRI examinations from three European hospitals. After TotalSegmentator-guided rectal patch extraction, a self-supervised frequency-domain harmonization pipeline was trained to minimize scanner-related contrast shifts. Four classifiers were compared: ResNet50, SeResNet, the universal biomedical pretrained transformer (UMedPT) with a lightweight MLP head, and a logistic-regression variant using frozen UMedPT features (UMedPT_LR). Results: UMedPT_LR achieved the best EVI detection when axial and sagittal features were fused (AUC = 0.82; sensitivity = 0.75; F1 score = 0.73), surpassing the Chaimeleon Grand-Challenge winner (AUC = 0.74). The highest MFI performance was attained by UMedPT on axial harmonized images (AUC = 0.77), surpassing the Chaimeleon Grand-Challenge winner (AUC = 0.75). Frequency-domain harmonization improved MFI classification but variably affected EVI performance. Conventional CNNs (ResNet50, SeResNet) underperformed, especially in F1 score and balanced accuracy. Conclusion: These findings demonstrate that combining foundation model features, harmonization, and multi-view fusion significantly enhances diagnostic performance in rectal MRI.

Adaptive Deep Learning for Multiclass Breast Cancer Classification via Misprediction Risk Analysis

Breast cancer remains one of the leading causes of cancer-related deaths worldwide. Early detection is crucial for improving patient outcomes, yet the diagnostic process is often complex and prone to inconsistencies among pathologists. Computer-aided diagnostic approaches have significantly enhanced breast cancer detection, particularly in binary classification (benign vs. malignant). However, these methods face challenges in multiclass classification, leading to frequent mispredictions. In this work, we propose a novel adaptive learning approach for multiclass breast cancer classification using H&E-stained histopathology images. First, we introduce a misprediction risk analysis framework that quantifies and ranks the likelihood of an image being mislabeled by a classifier. This framework leverages an interpretable risk model that requires only a small number of labeled samples for training. Next, we present an adaptive learning strategy that fine-tunes classifiers based on the specific characteristics of a given dataset. This approach minimizes misprediction risk, allowing the classifier to adapt effectively to the target workload. We evaluate our proposed solutions on real benchmark datasets, demonstrating that our risk analysis framework more accurately identifies mispredictions compared to existing methods. Furthermore, our adaptive learning approach significantly improves the performance of state-of-the-art deep neural network classifiers.

CPLOYO: A Pulmonary Nodule Detection Model with Multi-Scale Feature Fusion and Nonlinear Feature Learning

The integration of Internet of Things (IoT) technology in pulmonary nodule detection significantly enhances the intelligence and real-time capabilities of the detection system. Currently, lung nodule detection primarily focuses on the identification of solid nodules, but different types of lung nodules correspond to various forms of lung cancer. Multi-type detection contributes to improving the overall lung cancer detection rate and enhancing the cure rate. To achieve high sensitivity in nodule detection, targeted improvements were made to the YOLOv8 model. Firstly, the C2f\_RepViTCAMF module was introduced to augment the C2f module in the backbone, thereby enhancing detection accuracy for small lung nodules and achieving a lightweight model design. Secondly, the MSCAF module was incorporated to reconstruct the feature fusion section of the model, improving detection accuracy for lung nodules of varying scales. Furthermore, the KAN network was integrated into the model. By leveraging the KAN network's powerful nonlinear feature learning capability, detection accuracy for small lung nodules was further improved, and the model's generalization ability was enhanced. Tests conducted on the LUNA16 dataset demonstrate that the improved model outperforms the original model as well as other mainstream models such as YOLOv9 and RT-DETR across various evaluation metrics.

Improving the generalization of deep learning models in the segmentation of mammography images

Mammography stands as the main screening method for detecting breast cancer early, enhancing treatment success rates. The segmentation of landmark structures in mammography images can aid the medical assessment in the evaluation of cancer risk and the image acquisition adequacy. We introduce a series of data-centric strategies aimed at enriching the training data for deep learning-based segmentation of landmark structures. Our approach involves augmenting the training samples through annotation-guided image intensity manipulation and style transfer to achieve better generalization than standard training procedures. These augmentations are applied in a balanced manner to ensure the model learns to process a diverse range of images generated by different vendor equipments while retaining its efficacy on the original data. We present extensive numerical and visual results that demonstrate the superior generalization capabilities of our methods when compared to the standard training. For this evaluation, we consider a large dataset that includes mammography images generated by different vendor equipments. Further, we present complementary results that show both the strengths and limitations of our methods across various scenarios. The accuracy and robustness demonstrated in the experiments suggest that our method is well-suited for integration into clinical practice.

ColonScopeX: Leveraging Explainable Expert Systems with Multimodal Data for Improved Early Diagnosis of Colorectal Cancer

Colorectal cancer (CRC) ranks as the second leading cause of cancer-related deaths and the third most prevalent malignant tumour worldwide. Early detection of CRC remains problematic due to its non-specific and often embarrassing symptoms, which patients frequently overlook or hesitate to report to clinicians. Crucially, the stage at which CRC is diagnosed significantly impacts survivability, with a survival rate of 80-95\% for Stage I and a stark decline to 10\% for Stage IV. Unfortunately, in the UK, only 14.4\% of cases are diagnosed at the earliest stage (Stage I). In this study, we propose ColonScopeX, a machine learning framework utilizing explainable AI (XAI) methodologies to enhance the early detection of CRC and pre-cancerous lesions. Our approach employs a multimodal model that integrates signals from blood sample measurements, processed using the Savitzky-Golay algorithm for fingerprint smoothing, alongside comprehensive patient metadata, including medication history, comorbidities, age, weight, and BMI. By leveraging XAI techniques, we aim to render the model's decision-making process transparent and interpretable, thereby fostering greater trust and understanding in its predictions. The proposed framework could be utilised as a triage tool or a screening tool of the general population. This research highlights the potential of combining diverse patient data sources and explainable machine learning to tackle critical challenges in medical diagnostics.

Multimodal AI-driven Biomarker for Early Detection of Cancer Cachexia

Cancer cachexia is a multifactorial syndrome characterized by progressive muscle wasting, metabolic dysfunction, and systemic inflammation, leading to reduced quality of life and increased mortality. Despite extensive research, no single definitive biomarker exists, as cachexia-related indicators such as serum biomarkers, skeletal muscle measurements, and metabolic abnormalities often overlap with other conditions. Existing composite indices, including the Cancer Cachexia Index (CXI), Modified CXI (mCXI), and Cachexia Score (CASCO), integrate multiple biomarkers but lack standardized thresholds, limiting their clinical utility. This study proposes a multimodal AI-based biomarker for early cancer cachexia detection, leveraging open-source large language models (LLMs) and foundation models trained on medical data. The approach integrates heterogeneous patient data, including demographics, disease status, lab reports, radiological imaging (CT scans), and clinical notes, using a machine learning framework that can handle missing data. Unlike previous AI-based models trained on curated datasets, this method utilizes routinely collected clinical data, enhancing real-world applicability. Additionally, the model incorporates confidence estimation, allowing the identification of cases requiring expert review for precise clinical interpretation. Preliminary findings demonstrate that integrating multiple data modalities improves cachexia prediction accuracy at the time of cancer diagnosis. The AI-based biomarker dynamically adapts to patient-specific factors such as age, race, ethnicity, weight, cancer type, and stage, avoiding the limitations of fixed-threshold biomarkers. This multimodal AI biomarker provides a scalable and clinically viable solution for early cancer cachexia detection, facilitating personalized interventions and potentially improving treatment outcomes and patient survival.