Improved joint modelling of breast cancer radiomics features and hazard by image registration aided longitudinal CT data

Patients with metastatic breast cancer (mBC) undergo continuous medical imaging during treatment, making accurate lesion detection and monitoring over time critical for clinical decisions. Predicting drug response from post-treatment data is essential for personalized care and pharmacological research. In collaboration with the U.S. Food and Drug Administration and Novartis Pharmaceuticals, we analyzed serial chest CT scans from two large-scale Phase III trials, MONALEESA 3 and MONALEESA 7. This paper has two objectives (a) Data Structuring developing a Registration Aided Automated Correspondence (RAMAC) algorithm for precise lesion tracking in longitudinal CT data, and (b) Survival Analysis creating imaging features and models from RAMAC structured data to predict patient outcomes. The RAMAC algorithm uses a two phase pipeline: three dimensional rigid registration aligns CT images, and a distance metric-based Hungarian algorithm tracks lesion correspondence. Using structured data, we developed interpretable models to assess progression-free survival (PFS) in mBC patients by combining baseline radiomics, post-treatment changes (Weeks 8, 16, 24), and demographic features. Radiomics effects were studied across time points separately and through a non-correlated additive framework. Radiomics features were reduced using (a) a regularized (L1-penalized) additive Cox proportional hazards model, and (b) variable selection via best subset selection. Performance, measured using the concordance index (C-index), improved with additional time points. Joint modeling, considering correlations among radiomics effects over time, provided insights into relationships between longitudinal radiomics and survival outcomes.

Augmented Intelligence for Multimodal Virtual Biopsy in Breast Cancer Using Generative Artificial Intelligence

Full-Field Digital Mammography (FFDM) is the primary imaging modality for routine breast cancer screening; however, its effectiveness is limited in patients with dense breast tissue or fibrocystic conditions. Contrast-Enhanced Spectral Mammography (CESM), a second-level imaging technique, offers enhanced accuracy in tumor detection. Nonetheless, its application is restricted due to higher radiation exposure, the use of contrast agents, and limited accessibility. As a result, CESM is typically reserved for select cases, leaving many patients to rely solely on FFDM despite the superior diagnostic performance of CESM. While biopsy remains the gold standard for definitive diagnosis, it is an invasive procedure that can cause discomfort for patients. We introduce a multimodal, multi-view deep learning approach for virtual biopsy, integrating FFDM and CESM modalities in craniocaudal and mediolateral oblique views to classify lesions as malignant or benign. To address the challenge of missing CESM data, we leverage generative artificial intelligence to impute CESM images from FFDM scans. Experimental results demonstrate that incorporating the CESM modality is crucial to enhance the performance of virtual biopsy. When real CESM data is missing, synthetic CESM images proved effective, outperforming the use of FFDM alone, particularly in multimodal configurations that combine FFDM and CESM modalities. The proposed approach has the potential to improve diagnostic workflows, providing clinicians with augmented intelligence tools to improve diagnostic accuracy and patient care. Additionally, as a contribution to the research community, we publicly release the dataset used in our experiments, facilitating further advancements in this field.

Influence of High-Performance Image-to-Image Translation Networks on Clinical Visual Assessment and Outcome Prediction: Utilizing Ultrasound to MRI Translation in Prostate Cancer

Purpose: This study examines the core traits of image-to-image translation (I2I) networks, focusing on their effectiveness and adaptability in everyday clinical settings. Methods: We have analyzed data from 794 patients diagnosed with prostate cancer (PCa), using ten prominent 2D/3D I2I networks to convert ultrasound (US) images into MRI scans. We also introduced a new analysis of Radiomic features (RF) via the Spearman correlation coefficient to explore whether networks with high performance (SSIM>85%) could detect subtle RFs. Our study further examined synthetic images by 7 invited physicians. As a final evaluation study, we have investigated the improvement that are achieved using the synthetic MRI data on two traditional machine learning and one deep learning method. Results: In quantitative assessment, 2D-Pix2Pix network substantially outperformed the other 7 networks, with an average SSIM~0.855. The RF analysis revealed that 76 out of 186 RFs were identified using the 2D-Pix2Pix algorithm alone, although half of the RFs were lost during the translation process. A detailed qualitative review by 7 medical doctors noted a deficiency in low-level feature recognition in I2I tasks. Furthermore, the study found that synthesized image-based classification outperformed US image-based classification with an average accuracy and AUC~0.93. Conclusion: This study showed that while 2D-Pix2Pix outperformed cutting-edge networks in low-level feature discovery and overall error and similarity metrics, it still requires improvement in low-level feature performance, as highlighted by Group 3. Further, the study found using synthetic image-based classification outperformed original US image-based methods.

MNet-SAt: A Multiscale Network with Spatial-enhanced Attention for Segmentation of Polyps in Colonoscopy

Objective: To develop a novel deep learning framework for the automated segmentation of colonic polyps in colonoscopy images, overcoming the limitations of current approaches in preserving precise polyp boundaries, incorporating multi-scale features, and modeling spatial dependencies that accurately reflect the intricate and diverse morphology of polyps. Methods: To address these limitations, we propose a novel Multiscale Network with Spatial-enhanced Attention (MNet-SAt) for polyp segmentation in colonoscopy images. This framework incorporates four key modules: Edge-Guided Feature Enrichment (EGFE) preserves edge information for improved boundary quality; Multi-Scale Feature Aggregator (MSFA) extracts and aggregates multi-scale features across channel spatial dimensions, focusing on salient regions; Spatial-Enhanced Attention (SEAt) captures spatial-aware global dependencies within the multi-scale aggregated features, emphasizing the region of interest; and Channel-Enhanced Atrous Spatial Pyramid Pooling (CE-ASPP) resamples and recalibrates attentive features across scales. Results: We evaluated MNet-SAt on the Kvasir-SEG and CVC-ClinicDB datasets, achieving Dice Similarity Coefficients of 96.61% and 98.60%, respectively. Conclusion: Both quantitative (DSC) and qualitative assessments highlight MNet-SAt's superior performance and generalization capabilities compared to existing methods. Significance: MNet-SAt's high accuracy in polyp segmentation holds promise for improving clinical workflows in early polyp detection and more effective treatment, contributing to reduced colorectal cancer mortality rates.

An Attention-Guided Deep Learning Approach for Classifying 39 Skin Lesion Types

The skin, as the largest organ of the human body, is vulnerable to a diverse array of conditions collectively known as skin lesions, which encompass various dermatoses. Diagnosing these lesions presents significant challenges for medical practitioners due to the subtle visual differences that are often imperceptible to the naked eye. While not all skin lesions are life-threatening, certain types can act as early indicators of severe diseases, including skin cancers, underscoring the critical need for timely and accurate diagnostic methods. Deep learning algorithms have demonstrated remarkable potential in facilitating the early detection and prognosis of skin lesions. This study advances the field by curating a comprehensive and diverse dataset comprising 39 categories of skin lesions, synthesized from five publicly available datasets. Using this dataset, the performance of five state-of-the-art deep learning models -- MobileNetV2, Xception, InceptionV3, EfficientNetB1, and Vision Transformer - is rigorously evaluated. To enhance the accuracy and robustness of these models, attention mechanisms such as the Efficient Channel Attention (ECA) and the Convolutional Block Attention Module (CBAM) are incorporated into their architectures. Comprehensive evaluation across multiple performance metrics reveals that the Vision Transformer model integrated with CBAM outperforms others, achieving an accuracy of 93.46%, precision of 94%, recall of 93%, F1-score of 93%, and specificity of 93.67%. These results underscore the significant potential of the proposed system in supporting medical professionals with accurate and efficient prognostic tools for diagnosing a broad spectrum of skin lesions. The dataset and code used in this study can be found at https://github.com/akabircs/Skin-Lesions-Classification.

Advancing Pancreatic Cancer Prediction with a Next Visit Token Prediction Head on top of Med-BERT

Background: Recently, numerous foundation models pretrained on extensive data have demonstrated efficacy in disease prediction using Electronic Health Records (EHRs). However, there remains some unanswered questions on how to best utilize such models especially with very small fine-tuning cohorts. Methods: We utilized Med-BERT, an EHR-specific foundation model, and reformulated the disease binary prediction task into a token prediction task and a next visit mask token prediction task to align with Med-BERT's pretraining task format in order to improve the accuracy of pancreatic cancer (PaCa) prediction in both few-shot and fully supervised settings. Results: The reformulation of the task into a token prediction task, referred to as Med-BERT-Sum, demonstrates slightly superior performance in both few-shot scenarios and larger data samples. Furthermore, reformulating the prediction task as a Next Visit Mask Token Prediction task (Med-BERT-Mask) significantly outperforms the conventional Binary Classification (BC) prediction task (Med-BERT-BC) by 3% to 7% in few-shot scenarios with data sizes ranging from 10 to 500 samples. These findings highlight that aligning the downstream task with Med-BERT's pretraining objectives substantially enhances the model's predictive capabilities, thereby improving its effectiveness in predicting both rare and common diseases. Conclusion: Reformatting disease prediction tasks to align with the pretraining of foundation models enhances prediction accuracy, leading to earlier detection and timely intervention. This approach improves treatment effectiveness, survival rates, and overall patient outcomes for PaCa and potentially other cancers.

Divide and Conquer: Grounding a Bleeding Areas in Gastrointestinal Image with Two-Stage Model

Accurate detection and segmentation of gastrointestinal bleeding are critical for diagnosing diseases such as peptic ulcers and colorectal cancer. This study proposes a two-stage framework that decouples classification and grounding to address the inherent challenges posed by traditional Multi-Task Learning models, which jointly optimizes classification and segmentation. Our approach separates these tasks to achieve targeted optimization for each. The model first classifies images as bleeding or non-bleeding, thereby isolating subsequent grounding from inter-task interference and label heterogeneity. To further enhance performance, we incorporate Stochastic Weight Averaging and Test-Time Augmentation, which improve model robustness against domain shifts and annotation inconsistencies. Our method is validated on the Auto-WCEBleedGen Challenge V2 Challenge dataset and achieving second place. Experimental results demonstrate significant improvements in classification accuracy and segmentation precision, especially on sequential datasets with consistent visual patterns. This study highlights the practical benefits of a two-stage strategy for medical image analysis and sets a new standard for GI bleeding detection and segmentation. Our code is publicly available at this GitHub repository.

SegCol Challenge: Semantic Segmentation for Tools and Fold Edges in Colonoscopy data

Colorectal cancer (CRC) remains a leading cause of cancer-related deaths worldwide, with polyp removal being an effective early screening method. However, navigating the colon for thorough polyp detection poses significant challenges. To advance camera navigation in colonoscopy, we propose the Semantic Segmentation for Tools and Fold Edges in Colonoscopy (SegCol) Challenge. This challenge introduces a dataset from the EndoMapper repository, featuring manually annotated, pixel-level semantic labels for colon folds and endoscopic tools across selected frames from 96 colonoscopy videos. By providing fold edges as anatomical landmarks and depth discontinuity information from both fold and tool labels, the dataset is aimed to improve depth perception and localization methods. Hosted as part of the Endovis Challenge at MICCAI 2024, SegCol aims to drive innovation in colonoscopy navigation systems. Details are available at https://www.synapse.org/Synapse:syn54124209/wiki/626563, and code resources at https://github.com/surgical-vision/segcol_challenge .

Unified Local and Global Attention Interaction Modeling for Vision Transformers

We present a novel method that extends the self-attention mechanism of a vision transformer (ViT) for more accurate object detection across diverse datasets. ViTs show strong capability for image understanding tasks such as object detection, segmentation, and classification. This is due in part to their ability to leverage global information from interactions among visual tokens. However, the self-attention mechanism in ViTs are limited because they do not allow visual tokens to exchange local or global information with neighboring features before computing global attention. This is problematic because tokens are treated in isolation when attending (matching) to other tokens, and valuable spatial relationships are overlooked. This isolation is further compounded by dot-product similarity operations that make tokens from different semantic classes appear visually similar. To address these limitations, we introduce two modifications to the traditional self-attention framework; a novel aggressive convolution pooling strategy for local feature mixing, and a new conceptual attention transformation to facilitate interaction and feature exchange between semantic concepts. Experimental results demonstrate that local and global information exchange among visual features before self-attention significantly improves performance on challenging object detection tasks and generalizes across multiple benchmark datasets and challenging medical datasets. We publish source code and a novel dataset of cancerous tumors (chimeric cell clusters).

Interpretable Droplet Digital PCR Assay for Trustworthy Molecular Diagnostics

Accurate molecular quantification is essential for advancing research and diagnostics in fields such as infectious diseases, cancer biology, and genetic disorders. Droplet digital PCR (ddPCR) has emerged as a gold standard for achieving absolute quantification. While computational ddPCR technologies have advanced significantly, achieving automatic interpretation and consistent adaptability across diverse operational environments remains a challenge. To address these limitations, we introduce the intelligent interpretable droplet digital PCR (I2ddPCR) assay, a comprehensive framework integrating front-end predictive models (for droplet segmentation and classification) with GPT-4o multimodal large language model (MLLM, for context-aware explanations and recommendations) to automate and enhance ddPCR image analysis. This approach surpasses the state-of-the-art models, affording 99.05% accuracy in processing complex ddPCR images containing over 300 droplets per image with varying signal-to-noise ratios (SNRs). By combining specialized neural networks and large language models, the I2ddPCR assay offers a robust and adaptable solution for absolute molecular quantification, achieving a sensitivity capable of detecting low-abundance targets as low as 90.32 copies/{\mu}L. Furthermore, it improves model's transparency through detailed explanation and troubleshooting guidance, empowering users to make informed decisions. This innovative framework has the potential to benefit molecular diagnostics, disease research, and clinical applications, especially in resource-constrained settings.