CLIP-IT: CLIP-based Pairing for Histology Images Classification

Multimodal learning has shown significant promise for improving medical image analysis by integrating information from complementary data sources. This is widely employed for training vision-language models (VLMs) for cancer detection based on histology images and text reports. However, one of the main limitations in training these VLMs is the requirement for large paired datasets, raising concerns over privacy, and data collection, annotation, and maintenance costs. To address this challenge, we introduce CLIP-IT method to train a vision backbone model to classify histology images by pairing them with privileged textual information from an external source. At first, the modality pairing step relies on a CLIP-based model to match histology images with semantically relevant textual report data from external sources, creating an augmented multimodal dataset without the need for manually paired samples. Then, we propose a multimodal training procedure that distills the knowledge from the paired text modality to the unimodal image classifier for enhanced performance without the need for the textual data during inference. A parameter-efficient fine-tuning method is used to efficiently address the misalignment between the main (image) and paired (text) modalities. During inference, the improved unimodal histology classifier is used, with only minimal additional computational complexity. Our experiments on challenging PCAM, CRC, and BACH histology image datasets show that CLIP-IT can provide a cost-effective approach to leverage privileged textual information and outperform unimodal classifiers for histology.

MSAD-Net: Multiscale and Spatial Attention-based Dense Network for Lung Cancer Classification

Lung cancer, a severe form of malignant tumor that originates in the tissues of the lungs, can be fatal if not detected in its early stages. It ranks among the top causes of cancer-related mortality worldwide. Detecting lung cancer manually using chest X-Ray image or Computational Tomography (CT) scans image poses significant challenges for radiologists. Hence, there is a need for automatic diagnosis system of lung cancers from radiology images. With the recent emergence of deep learning, particularly through Convolutional Neural Networks (CNNs), the automated detection of lung cancer has become a much simpler task. Nevertheless, numerous researchers have addressed that the performance of conventional CNNs may be hindered due to class imbalance issue, which is prevalent in medical images. In this research work, we have proposed a novel CNN architecture ``Multi-Scale Dense Network (MSD-Net)'' (trained-from-scratch). The novelties we bring in the proposed model are (I) We introduce novel dense modules in the 4th block and 5th block of the CNN model. We have leveraged 3 depthwise separable convolutional (DWSC) layers, and one 1x1 convolutional layer in each dense module, in order to reduce complexity of the model considerably. (II) Additionally, we have incorporated one skip connection from 3rd block to 5th block and one parallel branch connection from 4th block to Global Average Pooling (GAP) layer. We have utilized dilated convolutional layer (with dilation rate=2) in the last parallel branch in order to extract multi-scale features. Extensive experiments reveal that our proposed model has outperformed latest CNN model ConvNext-Tiny, recent trend Vision Transformer (ViT), Pooling-based ViT (PiT), and other existing models by significant margins.

A Multi-Modal AI System for Screening Mammography: Integrating 2D and 3D Imaging to Improve Breast Cancer Detection in a Prospective Clinical Study

Although digital breast tomosynthesis (DBT) improves diagnostic performance over full-field digital mammography (FFDM), false-positive recalls remain a concern in breast cancer screening. We developed a multi-modal artificial intelligence system integrating FFDM, synthetic mammography, and DBT to provide breast-level predictions and bounding-box localizations of suspicious findings. Our AI system, trained on approximately 500,000 mammography exams, achieved 0.945 AUROC on an internal test set. It demonstrated capacity to reduce recalls by 31.7% and radiologist workload by 43.8% while maintaining 100% sensitivity, underscoring its potential to improve clinical workflows. External validation confirmed strong generalizability, reducing the gap to a perfect AUROC by 35.31%-69.14% relative to strong baselines. In prospective deployment across 18 sites, the system reduced recall rates for low-risk cases. An improved version, trained on over 750,000 exams with additional labels, further reduced the gap by 18.86%-56.62% across large external datasets. Overall, these results underscore the importance of utilizing all available imaging modalities, demonstrate the potential for clinical impact, and indicate feasibility of further reduction of the test error with increased training set when using large-capacity neural networks.

Towards order of magnitude X-ray dose reduction in breast cancer imaging using phase contrast and deep denoising

Breast cancer is the most frequently diagnosed human cancer in the United States at present. Early detection is crucial for its successful treatment. X-ray mammography and digital breast tomosynthesis are currently the main methods for breast cancer screening. However, both have known limitations in terms of their sensitivity and specificity to breast cancers, while also frequently causing patient discomfort due to the requirement for breast compression. Breast computed tomography is a promising alternative, however, to obtain high-quality images, the X-ray dose needs to be sufficiently high. As the breast is highly radiosensitive, dose reduction is particularly important. Phase-contrast computed tomography (PCT) has been shown to produce higher-quality images at lower doses and has no need for breast compression. It is demonstrated in the present study that, when imaging full fresh mastectomy samples with PCT, deep learning-based image denoising can further reduce the radiation dose by a factor of 16 or more, without any loss of image quality. The image quality has been assessed both in terms of objective metrics, such as spatial resolution and contrast-to-noise ratio, as well as in an observer study by experienced medical imaging specialists and radiologists. This work was carried out in preparation for live patient PCT breast cancer imaging, initially at specialized synchrotron facilities.

An Integrated AI-Enabled System Using One Class Twin Cross Learning (OCT-X) for Early Gastric Cancer Detection

Early detection of gastric cancer, a leading cause of cancer-related mortality worldwide, remains hampered by the limitations of current diagnostic technologies, leading to high rates of misdiagnosis and missed diagnoses. To address these challenges, we propose an integrated system that synergizes advanced hardware and software technologies to balance speed-accuracy. Our study introduces the One Class Twin Cross Learning (OCT-X) algorithm. Leveraging a novel fast double-threshold grid search strategy (FDT-GS) and a patch-based deep fully convolutional network, OCT-X maximizes diagnostic accuracy through real-time data processing and seamless lesion surveillance. The hardware component includes an all-in-one point-of-care testing (POCT) device with high-resolution imaging sensors, real-time data processing, and wireless connectivity, facilitated by the NI CompactDAQ and LabVIEW software. Our integrated system achieved an unprecedented diagnostic accuracy of 99.70%, significantly outperforming existing models by up to 4.47%, and demonstrated a 10% improvement in multirate adaptability. These findings underscore the potential of OCT-X as well as the integrated system in clinical diagnostics, offering a path toward more accurate, efficient, and less invasive early gastric cancer detection. Future research will explore broader applications, further advancing oncological diagnostics. Code is available at https://github.com/liu37972/Multirate-Location-on-OCT-X-Learning.git.

Efficient Parameter Adaptation for Multi-Modal Medical Image Segmentation and Prognosis

Cancer detection and prognosis relies heavily on medical imaging, particularly CT and PET scans. Deep Neural Networks (DNNs) have shown promise in tumor segmentation by fusing information from these modalities. However, a critical bottleneck exists: the dependency on CT-PET data concurrently for training and inference, posing a challenge due to the limited availability of PET scans. Hence, there is a clear need for a flexible and efficient framework that can be trained with the widely available CT scans and can be still adapted for PET scans when they become available. In this work, we propose a parameter-efficient multi-modal adaptation (PEMMA) framework for lightweight upgrading of a transformer-based segmentation model trained only on CT scans such that it can be efficiently adapted for use with PET scans when they become available. This framework is further extended to perform prognosis task maintaining the same efficient cross-modal fine-tuning approach. The proposed approach is tested with two well-known segementation backbones, namely UNETR and Swin UNETR. Our approach offers two main advantages. Firstly, we leverage the inherent modularity of the transformer architecture and perform low-rank adaptation (LoRA) as well as decomposed low-rank adaptation (DoRA) of the attention weights to achieve parameter-efficient adaptation. Secondly, by minimizing cross-modal entanglement, PEMMA allows updates using only one modality without causing catastrophic forgetting in the other. Our method achieves comparable performance to early fusion, but with only 8% of the trainable parameters, and demonstrates a significant +28% Dice score improvement on PET scans when trained with a single modality. Furthermore, in prognosis, our method improves the concordance index by +10% when adapting a CT-pretrained model to include PET scans, and by +23% when adapting for both PET and EHR data.

Optimizing Breast Cancer Detection in Mammograms: A Comprehensive Study of Transfer Learning, Resolution Reduction, and Multi-View Classification

This study explores open questions in the application of machine learning for breast cancer detection in mammograms. Current approaches often employ a two-stage transfer learning process: first, adapting a backbone model trained on natural images to develop a patch classifier, which is then used to create a single-view whole-image classifier. Additionally, many studies leverage both mammographic views to enhance model performance. In this work, we systematically investigate five key questions: (1) Is the intermediate patch classifier essential for optimal performance? (2) Do backbone models that excel in natural image classification consistently outperform others on mammograms? (3) When reducing mammogram resolution for GPU processing, does the learn-to-resize technique outperform conventional methods? (4) Does incorporating both mammographic views in a two-view classifier significantly improve detection accuracy? (5) How do these findings vary when analyzing low-quality versus high-quality mammograms? By addressing these questions, we developed models that outperform previous results for both single-view and two-view classifiers. Our findings provide insights into model architecture and transfer learning strategies contributing to more accurate and efficient mammogram analysis.

Cohort-attention Evaluation Metric against Tied Data: Studying Performance of Classification Models in Cancer Detection

Artificial intelligence (AI) has significantly improved medical screening accuracy, particularly in cancer detection and risk assessment. However, traditional classification metrics often fail to account for imbalanced data, varying performance across cohorts, and patient-level inconsistencies, leading to biased evaluations. We propose the Cohort-Attention Evaluation Metrics (CAT) framework to address these challenges. CAT introduces patient-level assessment, entropy-based distribution weighting, and cohort-weighted sensitivity and specificity. Key metrics like CATSensitivity (CATSen), CATSpecificity (CATSpe), and CATMean ensure balanced and fair evaluation across diverse populations. This approach enhances predictive reliability, fairness, and interpretability, providing a robust evaluation method for AI-driven medical screening models.

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.

Subgroup Performance of a Commercial Digital Breast Tomosynthesis Model for Breast Cancer Detection

While research has established the potential of AI models for mammography to improve breast cancer screening outcomes, there have not been any detailed subgroup evaluations performed to assess the strengths and weaknesses of commercial models for digital breast tomosynthesis (DBT) imaging. This study presents a granular evaluation of the Lunit INSIGHT DBT model on a large retrospective cohort of 163,449 screening mammography exams from the Emory Breast Imaging Dataset (EMBED). Model performance was evaluated in a binary context with various negative exam types (162,081 exams) compared against screen detected cancers (1,368 exams) as the positive class. The analysis was stratified across demographic, imaging, and pathologic subgroups to identify potential disparities. The model achieved an overall AUC of 0.91 (95% CI: 0.90-0.92) with a precision of 0.08 (95% CI: 0.08-0.08), and a recall of 0.73 (95% CI: 0.71-0.76). Performance was found to be robust across demographics, but cases with non-invasive cancers (AUC: 0.85, 95% CI: 0.83-0.87), calcifications (AUC: 0.80, 95% CI: 0.78-0.82), and dense breast tissue (AUC: 0.90, 95% CI: 0.88-0.91) were associated with significantly lower performance compared to other groups. These results highlight the need for detailed evaluation of model characteristics and vigilance in considering adoption of new tools for clinical deployment.