"No negatives needed": weakly-supervised regression for interpretable tumor detection in whole-slide histopathology images

Accurate tumor detection in digital pathology whole-slide images (WSIs) is crucial for cancer diagnosis and treatment planning. Multiple Instance Learning (MIL) has emerged as a widely used approach for weakly-supervised tumor detection with large-scale data without the need for manual annotations. However, traditional MIL methods often depend on classification tasks that require tumor-free cases as negative examples, which are challenging to obtain in real-world clinical workflows, especially for surgical resection specimens. We address this limitation by reformulating tumor detection as a regression task, estimating tumor percentages from WSIs, a clinically available target across multiple cancer types. In this paper, we provide an analysis of the proposed weakly-supervised regression framework by applying it to multiple organs, specimen types and clinical scenarios. We characterize the robustness of our framework to tumor percentage as a noisy regression target, and introduce a novel concept of amplification technique to improve tumor detection sensitivity when learning from small tumor regions. Finally, we provide interpretable insights into the model's predictions by analyzing visual attention and logit maps. Our code is available at https://github.com/DIAGNijmegen/tumor-percentage-mil-regression.

The iToBoS dataset: skin region images extracted from 3D total body photographs for lesion detection

Artificial intelligence has significantly advanced skin cancer diagnosis by enabling rapid and accurate detection of malignant lesions. In this domain, most publicly available image datasets consist of single, isolated skin lesions positioned at the center of the image. While these lesion-centric datasets have been fundamental for developing diagnostic algorithms, they lack the context of the surrounding skin, which is critical for improving lesion detection. The iToBoS dataset was created to address this challenge. It includes 16,954 images of skin regions from 100 participants, captured using 3D total body photography. Each image roughly corresponds to a $7 \times 9$ cm section of skin with all suspicious lesions annotated using bounding boxes. Additionally, the dataset provides metadata such as anatomical location, age group, and sun damage score for each image. This dataset aims to facilitate training and benchmarking of algorithms, with the goal of enabling early detection of skin cancer and deployment of this technology in non-clinical environments.

Robust Polyp Detection and Diagnosis through Compositional Prompt-Guided Diffusion Models

Colorectal cancer (CRC) is a significant global health concern, and early detection through screening plays a critical role in reducing mortality. While deep learning models have shown promise in improving polyp detection, classification, and segmentation, their generalization across diverse clinical environments, particularly with out-of-distribution (OOD) data, remains a challenge. Multi-center datasets like PolypGen have been developed to address these issues, but their collection is costly and time-consuming. Traditional data augmentation techniques provide limited variability, failing to capture the complexity of medical images. Diffusion models have emerged as a promising solution for generating synthetic polyp images, but the image generation process in current models mainly relies on segmentation masks as the condition, limiting their ability to capture the full clinical context. To overcome these limitations, we propose a Progressive Spectrum Diffusion Model (PSDM) that integrates diverse clinical annotations-such as segmentation masks, bounding boxes, and colonoscopy reports-by transforming them into compositional prompts. These prompts are organized into coarse and fine components, allowing the model to capture both broad spatial structures and fine details, generating clinically accurate synthetic images. By augmenting training data with PSDM-generated samples, our model significantly improves polyp detection, classification, and segmentation. For instance, on the PolypGen dataset, PSDM increases the F1 score by 2.12% and the mean average precision by 3.09%, demonstrating superior performance in OOD scenarios and enhanced generalization.

RadHop-Net: A Lightweight Radiomics-to-Error Regression for False Positive Reduction In MRI Prostate Cancer Detection

Clinically significant prostate cancer (csPCa) is a leading cause of cancer death in men, yet it has a high survival rate if diagnosed early. Bi-parametric MRI (bpMRI) reading has become a prominent screening test for csPCa. However, this process has a high false positive (FP) rate, incurring higher diagnostic costs and patient discomfort. This paper introduces RadHop-Net, a novel and lightweight CNN for FP reduction. The pipeline consists of two stages: Stage 1 employs data driven radiomics to extract candidate ROIs. In contrast, Stage 2 expands the receptive field about each ROI using RadHop-Net to compensate for the predicted error from Stage 1. Moreover, a novel loss function for regression problems is introduced to balance the influence between FPs and true positives (TPs). RadHop-Net is trained in a radiomics-to-error manner, thus decoupling from the common voxel-to-label approach. The proposed Stage 2 improves the average precision (AP) in lesion detection from 0.407 to 0.468 in the publicly available pi-cai dataset, also maintaining a significantly smaller model size than the state-of-the-art.

Tumor Detection, Segmentation and Classification Challenge on Automated 3D Breast Ultrasound: The TDSC-ABUS Challenge

Breast cancer is one of the most common causes of death among women worldwide. Early detection helps in reducing the number of deaths. Automated 3D Breast Ultrasound (ABUS) is a newer approach for breast screening, which has many advantages over handheld mammography such as safety, speed, and higher detection rate of breast cancer. Tumor detection, segmentation, and classification are key components in the analysis of medical images, especially challenging in the context of 3D ABUS due to the significant variability in tumor size and shape, unclear tumor boundaries, and a low signal-to-noise ratio. The lack of publicly accessible, well-labeled ABUS datasets further hinders the advancement of systems for breast tumor analysis. Addressing this gap, we have organized the inaugural Tumor Detection, Segmentation, and Classification Challenge on Automated 3D Breast Ultrasound 2023 (TDSC-ABUS2023). This initiative aims to spearhead research in this field and create a definitive benchmark for tasks associated with 3D ABUS image analysis. In this paper, we summarize the top-performing algorithms from the challenge and provide critical analysis for ABUS image examination. We offer the TDSC-ABUS challenge as an open-access platform at https://tdsc-abus2023.grand-challenge.org/ to benchmark and inspire future developments in algorithmic research.

From Slices to Sequences: Autoregressive Tracking Transformer for Cohesive and Consistent 3D Lymph Node Detection in CT Scans

Lymph node (LN) assessment is an essential task in the routine radiology workflow, providing valuable insights for cancer staging, treatment planning and beyond. Identifying scatteredly-distributed and low-contrast LNs in 3D CT scans is highly challenging, even for experienced clinicians. Previous lesion and LN detection methods demonstrate effectiveness of 2.5D approaches (i.e, using 2D network with multi-slice inputs), leveraging pretrained 2D model weights and showing improved accuracy as compared to separate 2D or 3D detectors. However, slice-based 2.5D detectors do not explicitly model inter-slice consistency for LN as a 3D object, requiring heuristic post-merging steps to generate final 3D LN instances, which can involve tuning a set of parameters for each dataset. In this work, we formulate 3D LN detection as a tracking task and propose LN-Tracker, a novel LN tracking transformer, for joint end-to-end detection and 3D instance association. Built upon DETR-based detector, LN-Tracker decouples transformer decoder's query into the track and detection groups, where the track query autoregressively follows previously tracked LN instances along the z-axis of a CT scan. We design a new transformer decoder with masked attention module to align track query's content to the context of current slice, meanwhile preserving detection query's high accuracy in current slice. An inter-slice similarity loss is introduced to encourage cohesive LN association between slices. Extensive evaluation on four lymph node datasets shows LN-Tracker's superior performance, with at least 2.7% gain in average sensitivity when compared to other top 3D/2.5D detectors. Further validation on public lung nodule and prostate tumor detection tasks confirms the generalizability of LN-Tracker as it achieves top performance on both tasks. Datasets will be released upon acceptance.

Single Shot AI-assisted quantification of KI-67 proliferation index in breast cancer

Reliable quantification of Ki-67, a key proliferation marker in breast cancer, is essential for molecular subtyping and informed treatment planning. Conventional approaches, including visual estimation and manual counting, suffer from interobserver variability and limited reproducibility. This study introduces an AI-assisted method using the YOLOv8 object detection framework for automated Ki-67 scoring. High-resolution digital images (40x magnification) of immunohistochemically stained tumor sections were captured from Ki-67 hotspot regions and manually annotated by a domain expert to distinguish Ki-67-positive and negative tumor cells. The dataset was augmented and divided into training (80%), validation (10%), and testing (10%) subsets. Among the YOLOv8 variants tested, the Medium model achieved the highest performance, with a mean Average Precision at 50% Intersection over Union (mAP50) exceeding 85% for Ki-67-positive cells. The proposed approach offers an efficient, scalable, and objective alternative to conventional scoring methods, supporting greater consistency in Ki-67 evaluation. Future directions include developing user-friendly clinical interfaces and expanding to multi-institutional datasets to enhance generalizability and facilitate broader adoption in diagnostic practice.

Style transfer as data augmentation: evaluating unpaired image-to-image translation models in mammography

Several studies indicate that deep learning models can learn to detect breast cancer from mammograms (X-ray images of the breasts). However, challenges with overfitting and poor generalisability prevent their routine use in the clinic. Models trained on data from one patient population may not perform well on another due to differences in their data domains, emerging due to variations in scanning technology or patient characteristics. Data augmentation techniques can be used to improve generalisability by expanding the diversity of feature representations in the training data by altering existing examples. Image-to-image translation models are one approach capable of imposing the characteristic feature representations (i.e. style) of images from one dataset onto another. However, evaluating model performance is non-trivial, particularly in the absence of ground truths (a common reality in medical imaging). Here, we describe some key aspects that should be considered when evaluating style transfer algorithms, highlighting the advantages and disadvantages of popular metrics, and important factors to be mindful of when implementing them in practice. We consider two types of generative models: a cycle-consistent generative adversarial network (CycleGAN) and a diffusion-based SynDiff model. We learn unpaired image-to-image translation across three mammography datasets. We highlight that undesirable aspects of model performance may determine the suitability of some metrics, and also provide some analysis indicating the extent to which various metrics assess unique aspects of model performance. We emphasise the need to use several metrics for a comprehensive assessment of model performance.

Tumor monitoring and detection of lymph node metastasis using quantitative ultrasound and immune cytokine profiling in dogs undergoing radiation therapy: a pilot study

Quantitative ultrasound (QUS) characterizes the composition of cells to distinguish diseased from healthy tissue. QUS can reflect the complexity of the tumor and detect early lymph node (LN) metastasis ex vivo. The objective in this study was to gather preliminary QUS and cytokine data from dogs undergoing radiation therapy and correlate QUS data with both LN metastasis and tumor response. Spontaneous solid tumors were evaluated with QUS before and up to one year after receiving RT. Additionally, regional LNs were evaluated with QUS in vivo, then excised and examined with histopathology to detect metastasis. Paired t-tests were used to compare QUS data of metastatic and non-metastatic LNs within patients. Furthermore, paired t-tests compared pre- versus post-RT QUS data. Serum was collected at each time point for cytokine profiles. Most statistical tests were underpowered to produce significant p values, but interesting trends were observed. The lowest p values for LN tests were found with the envelope statistics K (p = 0.142) and mu (p = 0.181), which correspond to cell structure and number of scatterers. For tumor response, the lowest p values were found with K (p = 0.115) and mu (p = 0.127) when comparing baseline QUS data with QUS data 1 week after RT. Monocyte chemoattractant protein 1 (MCP-1) was significantly higher in dogs with cancer when compared to healthy controls (p = 1.12e-4). A weak correlation was found between effective scatterer diameter (ESD) and Transforming growth factor beta 1 (TGFB-1). While statistical tests on the preliminary QUS data alone were underpowered to detect significant differences among groups, our methods create a basis for future studies.

Analysis of Transferred Pre-Trained Deep Convolution Neural Networks in Breast Masses Recognition

Breast cancer detection based on pre-trained convolution neural network (CNN) has gained much interest among other conventional computer-based systems. In the past few years, CNN technology has been the most promising way to find cancer in mammogram scans. In this paper, the effect of layer freezing in a pre-trained CNN is investigated for breast cancer detection by classifying mammogram images as benign or malignant. Different VGG19 scenarios have been examined based on the number of convolution layer blocks that have been frozen. There are a total of six scenarios in this study. The primary benefits of this research are twofold: it improves the model's ability to detect breast cancer cases and it reduces the training time of VGG19 by freezing certain layers.To evaluate the performance of these scenarios, 1693 microbiological images of benign and malignant breast cancers were utilized. According to the reported results, the best recognition rate was obtained from a frozen first block of VGG19 with a sensitivity of 95.64 %, while the training of the entire VGG19 yielded 94.48%.