Vision foundation models (VFMs) are pre-trained on extensive image datasets to learn general representations for diverse types of data. These models can subsequently be fine-tuned for specific downstream tasks, significantly boosting performance across a broad range of applications. However, existing vision foundation models that claim to be applicable to various radiology tasks are mostly pre-trained on 3D computed tomography (CT), which benefits from the availability of extensive 3D CT databases. Significant differences between CT and magnetic resonance imaging (MRI) in imaging principles, signal characteristics, and data distribution may hinder their practical performance and versatility in MRI-specific applications. Here, we propose Triad, a vision foundation model for 3D MRI. Triad adopts a widely used autoencoder architecture to learn robust representations from 131,170 3D MRI volumes and uses organ-independent imaging descriptions to constrain the semantic distribution of the visual modality. The above pre-training dataset is called Triad-131K, which is currently the largest 3D MRI pre-training dataset. We evaluate Triad across three tasks, namely, organ/tumor segmentation, organ/cancer classification, and medical image registration, in two data modalities (within-domain and out-of-domain) settings using 25 downstream datasets. By initializing models with Triad's pre-trained weights, nnUNet-Triad improves segmentation performance by 6.88% compared to nnUNet-Scratch across 17 datasets. Swin-B-Triad achieves a 3.97% improvement over Swin-B-Scratch in classification tasks across five datasets. SwinUNETR-Triad improves by 4.00% compared to SwinUNETR-Scratch in registration tasks across two datasets. Our study demonstrates that pre-training can maximize performance when the data modalities and organs of upstream and downstream tasks are consistent.
Cancers are characterized by remarkable heterogeneity and diverse prognosis. Accurate cancer classification is essential for patient stratification and clinical decision-making. Although digital pathology has been advancing cancer diagnosis and prognosis, the paradigm in cancer pathology has shifted from purely relying on histology features to incorporating molecular markers. There is an urgent need for digital pathology methods to meet the needs of the new paradigm. We introduce a novel digital pathology approach to jointly predict molecular markers and histology features and model their interactions for cancer classification. Firstly, to mitigate the challenge of cross-magnification information propagation, we propose a multi-scale disentangling module, enabling the extraction of multi-scale features from high-magnification (cellular-level) to low-magnification (tissue-level) whole slide images. Further, based on the multi-scale features, we propose an attention-based hierarchical multi-task multi-instance learning framework to simultaneously predict histology and molecular markers. Moreover, we propose a co-occurrence probability-based label correlation graph network to model the co-occurrence of molecular markers. Lastly, we design a cross-modal interaction module with the dynamic confidence constrain loss and a cross-modal gradient modulation strategy, to model the interactions of histology and molecular markers. Our experiments demonstrate that our method outperforms other state-of-the-art methods in classifying glioma, histology features and molecular markers. Our method promises to promote precise oncology with the potential to advance biomedical research and clinical applications. The code is available at https://github.com/LHY1007/M3C2
Computed tomography (CT) and clinical numeric data are essential modalities for cancer evaluation, but building large-scale multimodal training datasets for developing medical foundation models remains challenging due to the structural complexity of multi-slice CT data and high cost of expert annotation. In this study, we propose MEDFORM, a multimodal pre-training strategy that guides CT image representation learning using complementary information from clinical data for medical foundation model development. MEDFORM efficiently processes CT slice through multiple instance learning (MIL) and adopts a dual pre-training strategy: first pretraining the CT slice feature extractor using SimCLR-based self-supervised learning, then aligning CT and clinical modalities through cross-modal contrastive learning. Our model was pre-trained on three different cancer types: lung cancer (141,171 slices), breast cancer (8,100 slices), colorectal cancer (10,393 slices). The experimental results demonstrated that this dual pre-training strategy improves cancer classification performance and maintains robust performance in few-shot learning scenarios. Code available at https://github.com/DigitalHealthcareLab/25MultiModalFoundationModel.git
Problem: Pancreas radiological imaging is challenging due to the small size, blurred boundaries, and variability of shape and position of the organ among patients. Goal: In this work we present MiniGPT-Pancreas, a Multimodal Large Language Model (MLLM), as an interactive chatbot to support clinicians in pancreas cancer diagnosis by integrating visual and textual information. Methods: MiniGPT-v2, a general-purpose MLLM, was fine-tuned in a cascaded way for pancreas detection, tumor classification, and tumor detection with multimodal prompts combining questions and computed tomography scans from the National Institute of Health (NIH), and Medical Segmentation Decathlon (MSD) datasets. The AbdomenCT-1k dataset was used to detect the liver, spleen, kidney, and pancreas. Results: MiniGPT-Pancreas achieved an Intersection over Union (IoU) of 0.595 and 0.550 for the detection of pancreas on NIH and MSD datasets, respectively. For the pancreas cancer classification task on the MSD dataset, accuracy, precision, and recall were 0.876, 0.874, and 0.878, respectively. When evaluating MiniGPT-Pancreas on the AbdomenCT-1k dataset for multi-organ detection, the IoU was 0.8399 for the liver, 0.722 for the kidney, 0.705 for the spleen, and 0.497 for the pancreas. For the pancreas tumor detection task, the IoU score was 0.168 on the MSD dataset. Conclusions: MiniGPT-Pancreas represents a promising solution to support clinicians in the classification of pancreas images with pancreas tumors. Future research is needed to improve the score on the detection task, especially for pancreas tumors.
Molecular subtyping of cancer is recognized as a critical and challenging upstream task for personalized therapy. Existing deep learning methods have achieved significant performance in this domain when abundant data samples are available. However, the acquisition of densely labeled samples for cancer molecular subtypes remains a significant challenge for conventional data-intensive deep learning approaches. In this work, we focus on the few-shot molecular subtype prediction problem in heterogeneous and small cancer datasets, aiming to enhance precise diagnosis and personalized treatment. We first construct a new few-shot dataset for cancer molecular subtype classification and auxiliary cancer classification, named TCGA Few-Shot, from existing publicly available datasets. To effectively leverage the relevant knowledge from both tasks, we introduce a task-specific embedding-based meta-learning framework (TSEML). TSEML leverages the synergistic strengths of a model-agnostic meta-learning (MAML) approach and a prototypical network (ProtoNet) to capture diverse and fine-grained features. Comparative experiments conducted on the TCGA Few-Shot dataset demonstrate that our TSEML framework achieves superior performance in addressing the problem of few-shot molecular subtype classification.
Precise breast cancer classification on histopathological images has the potential to greatly improve the diagnosis and patient outcome in oncology. The data imbalance problem largely stems from the inherent imbalance within medical image datasets, where certain tumor subtypes may appear much less frequently. This constitutes a considerable limitation in biased model predictions that can overlook critical but rare classes. In this work, we adopted EfficientNet, a state-of-the-art convolutional neural network (CNN) model that balances high accuracy with computational cost efficiency. To address data imbalance, we introduce an intensive data augmentation pipeline and cost-sensitive learning, improving representation and ensuring that the model does not overly favor majority classes. This approach provides the ability to learn effectively from rare tumor types, improving its robustness. Additionally, we fine-tuned the model using transfer learning, where weights in the beginning trained on a binary classification task were adopted to multi-class classification, improving the capability to detect complex patterns within the BreakHis dataset. Our results underscore significant improvements in the binary classification performance, achieving an exceptional recall increase for benign cases from 0.92 to 0.95, alongside an accuracy enhancement from 97.35 % to 98.23%. Our approach improved the performance of multi-class tasks from 91.27% with regular augmentation to 94.54% with intensive augmentation, reaching 95.04% with transfer learning. This framework demonstrated substantial gains in precision in the minority classes, such as Mucinous carcinoma and Papillary carcinoma, while maintaining high recall consistently across these critical subtypes, as further confirmed by confusion matrix analysis.
Purpose: This study investigated how nodule segmentation and surrounding peritumoral regions influence radionics-based lung cancer classification. Methods: Using 3D CT scans with bounding box annotated nodules, we generated 3D segmentations using four techniques: Otsu, Fuzzy C-Means (FCM), Gaussian Mixture Model (GMM), and K-Nearest Neighbors (KNN). Radiomics features were extracted using the PyRadiomics library, and multiple machine-learning-based classifiers, including Random Forest, Logistic Regression, and KNN, were employed to classify nodules as cancerous or non-cancerous. The best-performing segmentation and model were further analyzed by expanding the initial nodule segmentation into the peritumoral region (2, 4, 6, 8, 10, and 12 mm) to understand the influence of the surrounding area on classification. Additionally, we compared our results to deep learning-based feature extractors Foundation Model for Cancer Biomarkers (FMCB) and other state-of-the-art baseline models. Results: Incorporating peritumoral regions significantly enhanced performance, with the best result obtained at 8 mm expansion (AUC = 0.78). Compared to image-based deep learning models, such as FMCB (AUC = 0.71) and ResNet50-SWS++ (AUC = 0.71), our radiomics-based approach demonstrated superior classification accuracy. Conclusion: The study highlights the importance of peritumoral expansion in improving lung cancer classification using radiomics. These findings can inform the development of more robust AI-driven diagnostic tools.
Domain generalisation in computational histopathology is challenging because the images are substantially affected by differences among hospitals due to factors like fixation and staining of tissue and imaging equipment. We hypothesise that focusing on nuclei can improve the out-of-domain (OOD) generalisation in cancer detection. We propose a simple approach to improve OOD generalisation for cancer detection by focusing on nuclear morphology and organisation, as these are domain-invariant features critical in cancer detection. Our approach integrates original images with nuclear segmentation masks during training, encouraging the model to prioritise nuclei and their spatial arrangement. Going beyond mere data augmentation, we introduce a regularisation technique that aligns the representations of masks and original images. We show, using multiple datasets, that our method improves OOD generalisation and also leads to increased robustness to image corruptions and adversarial attacks. The source code is available at https://github.com/undercutspiky/SFL/
In the United States, skin cancer ranks as the most commonly diagnosed cancer, presenting a significant public health issue due to its high rates of occurrence and the risk of serious complications if not caught early. Recent advancements in dataset curation and deep learning have shown promise in quick and accurate detection of skin cancer. However, current open-source datasets have significant class imbalances which impedes the effectiveness of these deep learning models. In healthcare, generative artificial intelligence (AI) models have been employed to create synthetic data, addressing data imbalance in datasets by augmenting underrepresented classes and enhancing the overall quality and performance of machine learning models. In this paper, we build on top of previous work by leveraging new advancements in generative AI, notably Stable Diffusion and DreamBooth. We introduce Cancer-Net SCa-Synth, an open access synthetically generated 2D skin lesion dataset for skin cancer classification. Further analysis on the data effectiveness by comparing the ISIC 2020 test set performance for training with and without these synthetic images for a simple model highlights the benefits of leveraging synthetic data to improve performance. Cancer-Net SCa-Synth is publicly available at https://github.com/catai9/Cancer-Net-SCa-Synth as part of a global open-source initiative for accelerating machine learning for cancer care.
In this study, we introduce a novel method, called MamT$^4$, which is used for simultaneous analysis of four mammography images. A decision is made based on one image of a breast, with attention also devoted to three additional images: another view of the same breast and two images of the other breast. This approach enables the algorithm to closely replicate the practice of a radiologist who reviews the entire set of mammograms for a patient. Furthermore, this paper emphasizes the preprocessing of images, specifically proposing a cropping model (U-Net based on ResNet-34) to help the method remove image artifacts and focus on the breast region. To the best of our knowledge, this study is the first to achieve a ROC-AUC of 84.0 $\pm$ 1.7 and an F1 score of 56.0 $\pm$ 1.3 on an independent test dataset of Vietnam digital mammography (VinDr-Mammo), which is preprocessed with the cropping model.
This study evaluates the effectiveness of deep learning models in classifying histopathological images for early and accurate detection of breast cancer. Eight advanced models, including ResNet-50, DenseNet-121, ResNeXt-50, Vision Transformer (ViT), GoogLeNet (Inception v3), EfficientNet, MobileNet, and SqueezeNet, were compared using a dataset of 277,524 image patches. The Vision Transformer (ViT) model, with its attention-based mechanisms, achieved the highest validation accuracy of 94%, outperforming conventional CNNs. The study demonstrates the potential of advanced machine learning methods to enhance precision and efficiency in breast cancer diagnosis in clinical settings.
Deep learning models have achieved promising results in breast cancer classification, yet their 'black-box' nature raises interpretability concerns. This research addresses the crucial need to gain insights into the decision-making process of convolutional neural networks (CNNs) for mammogram classification, specifically focusing on the underlying reasons for the CNN's predictions of breast cancer. For CNNs trained on the Mammographic Image Analysis Society (MIAS) dataset, we compared the post-hoc interpretability techniques LIME, Grad-CAM, and Kernel SHAP in terms of explanatory depth and computational efficiency. The results of this analysis indicate that Grad-CAM, in particular, provides comprehensive insights into the behavior of the CNN, revealing distinctive patterns in normal, benign, and malignant breast tissue. We discuss the implications of the current findings for the use of machine learning models and interpretation techniques in clinical practice.
In pathological research, education, and clinical practice, the decision-making process based on pathological images is critically important. This significance extends to digital pathology image analysis: its adequacy is demonstrated by the extensive information contained within tissue structures, which is essential for accurate cancer classification and grading. Additionally, its necessity is highlighted by the inherent requirement for interpretability in the conclusions generated by algorithms. For humans, determining tumor type and grade typically involves multi-scale analysis, which presents a significant challenge for AI algorithms. Traditional patch-based methods are inadequate for modeling such complex structures, as they fail to capture the intricate, multi-scale information inherent in whole slide images. Consequently, there is a pressing need for advanced AI techniques capable of efficiently and accurately replicating this complex analytical process. To address this issue, we introduce HistoGym, an open-source reinforcement learning environment for histopathological image analysis. Following OpenAI Gym APIs, HistoGym aims to foster whole slide image diagnosis by mimicking the real-life processes of doctors. Leveraging the pyramid feature of WSIs and the OpenSlide API, HistoGym provides a unified framework for various clinical tasks, including tumor detection and classification. We detail the observation, action, and reward specifications tailored for the histopathological image analysis domain and provide an open-source Python-based interface for both clinicians and researchers. To accommodate different clinical demands, we offer various scenarios for different organs and cancers, including both WSI-based and selected region-based scenarios, showcasing several noteworthy results.
Large-scale pre-training models have promoted the development of histopathology image analysis. However, existing self-supervised methods for histopathology images primarily focus on learning patch features, while there is a notable gap in the availability of pre-training models specifically designed for WSI-level feature learning. In this paper, we propose a novel self-supervised learning framework for pan-cancer WSI-level representation pre-training with the designed position-aware masked autoencoder (PAMA). Meanwhile, we propose the position-aware cross-attention (PACA) module with a kernel reorientation (KRO) strategy and an anchor dropout (AD) mechanism. The KRO strategy can capture the complete semantic structure and eliminate ambiguity in WSIs, and the AD contributes to enhancing the robustness and generalization of the model. We evaluated our method on 7 large-scale datasets from multiple organs for pan-cancer classification tasks. The results have demonstrated the effectiveness and generalization of PAMA in discriminative WSI representation learning and pan-cancer WSI pre-training. The proposed method was also compared with 8 WSI analysis methods. The experimental results have indicated that our proposed PAMA is superior to the state-of-the-art methods. The code and checkpoints are available at https://github.com/WkEEn/PAMA.
Detecting and classifying lesions in breast ultrasound images is a promising application of artificial intelligence (AI) for reducing the burden of cancer in regions with limited access to mammography. Such AI systems are more likely to be useful in a clinical setting if their predictions can be explained to a radiologist. This work proposes an explainable AI model that provides interpretable predictions using a standard lexicon from the American College of Radiology's Breast Imaging and Reporting Data System (BI-RADS). The model is a deep neural network featuring a concept bottleneck layer in which known BI-RADS features are predicted before making a final cancer classification. This enables radiologists to easily review the predictions of the AI system and potentially fix errors in real time by modifying the concept predictions. In experiments, a model is developed on 8,854 images from 994 women with expert annotations and histological cancer labels. The model outperforms state-of-the-art lesion detection frameworks with 48.9 average precision on the held-out testing set, and for cancer classification, concept intervention is shown to increase performance from 0.876 to 0.885 area under the receiver operating characteristic curve. Training and evaluation code is available at https://github.com/hawaii-ai/bus-cbm.
Skin cancer is a highly dangerous type of cancer that requires an accurate diagnosis from experienced physicians. To help physicians diagnose skin cancer more efficiently, a computer-aided diagnosis (CAD) system can be very helpful. In this paper, we propose a novel model, which uses a novel attention mechanism to pinpoint the differences in features across the spatial dimensions and symmetry of the lesion, thereby focusing on the dissimilarities of various classes based on symmetry, uniformity in texture and color, etc. Additionally, to take into account the variations in the boundaries of the lesions for different classes, we employ a gradient-based fusion of wavelet and soft attention-aided features to extract boundary information of skin lesions. We have tested our model on the multi-class and highly class-imbalanced dataset, called HAM10000, and achieved promising results, with a 91.17\% F1-score and 90.75\% accuracy. The code is made available at: https://github.com/AyushRoy2001/WAGF-Fusion.
Prostate cancer is a highly prevalent cancer and ranks as the second leading cause of cancer-related deaths in men globally. Recently, the utilization of multi-modality transrectal ultrasound (TRUS) has gained significant traction as a valuable technique for guiding prostate biopsies. In this study, we propose a novel learning framework for clinically significant prostate cancer (csPCa) classification using multi-modality TRUS. The proposed framework employs two separate 3D ResNet-50 to extract distinctive features from B-mode and shear wave elastography (SWE). Additionally, an attention module is incorporated to effectively refine B-mode features and aggregate the extracted features from both modalities. Furthermore, we utilize few shot segmentation task to enhance the capacity of classification encoder. Due to the limited availability of csPCa masks, a prototype correction module is employed to extract representative prototypes of csPCa. The performance of the framework is assessed on a large-scale dataset consisting of 512 TRUS videos with biopsy-proved prostate cancer. The results demonstrate the strong capability in accurately identifying csPCa, achieving an area under the curve (AUC) of 0.86. Moreover, the framework generates visual class activation mapping (CAM), which can serve as valuable assistance for localizing csPCa. These CAM images may offer valuable guidance during TRUS-guided targeted biopsies, enhancing the efficacy of the biopsy procedure.The code is available at https://github.com/2313595986/SmileCode.
Artificial Intelligence (AI) has emerged as a valuable tool for assisting radiologists in breast cancer detection and diagnosis. However, the success of AI applications in this domain is restricted by the quantity and quality of available data, posing challenges due to limited and costly data annotation procedures that often lead to annotation shifts. This study simulates, analyses and mitigates annotation shifts in cancer classification in the breast mammography domain. First, a high-accuracy cancer risk prediction model is developed, which effectively distinguishes benign from malignant lesions. Next, model performance is used to quantify the impact of annotation shift. We uncover a substantial impact of annotation shift on multiclass classification performance particularly for malignant lesions. We thus propose a training data augmentation approach based on single-image generative models for the affected class, requiring as few as four in-domain annotations to considerably mitigate annotation shift, while also addressing dataset imbalance. Lastly, we further increase performance by proposing and validating an ensemble architecture based on multiple models trained under different data augmentation regimes. Our study offers key insights into annotation shift in deep learning breast cancer classification and explores the potential of single-image generative models to overcome domain shift challenges.
Lung and colon cancer are serious worldwide health challenges that require early and precise identification to reduce mortality risks. However, diagnosis, which is mostly dependent on histopathologists' competence, presents difficulties and hazards when expertise is insufficient. While diagnostic methods like imaging and blood markers contribute to early detection, histopathology remains the gold standard, although time-consuming and vulnerable to inter-observer mistakes. Limited access to high-end technology further limits patients' ability to receive immediate medical care and diagnosis. Recent advances in deep learning have generated interest in its application to medical imaging analysis, specifically the use of histopathological images to diagnose lung and colon cancer. The goal of this investigation is to use and adapt existing pre-trained CNN-based models, such as Xception, DenseNet201, ResNet101, InceptionV3, DenseNet121, DenseNet169, ResNet152, and InceptionResNetV2, to enhance classification through better augmentation strategies. The results show tremendous progress, with all eight models reaching impressive accuracy ranging from 97% to 99%. Furthermore, attention visualization techniques such as GradCAM, GradCAM++, ScoreCAM, Faster Score-CAM, and LayerCAM, as well as Vanilla Saliency and SmoothGrad, are used to provide insights into the models' classification decisions, thereby improving interpretability and understanding of malignant and benign image classification.
Lung cancer's high mortality rate can be mitigated by early detection, increasingly reliant on AI for diagnostic imaging. However, AI model performance depends on training and validation datasets. This study develops and validates AI models for both nodule detection and cancer classification tasks. For detection, two models (DLCSD-mD and LUNA16-mD) were developed using the Duke Lung Cancer Screening Dataset (DLCSD), with over 2,000 CT scans from 1,613 patients and more than 3,000 annotations. These models were evaluated on internal (DLCSD) and external datasets, including LUNA16 (601 patients, 1186 nodules) and NLST (969 patients, 1192 nodules), using FROC analysis and AUC metrics. For classification, five models were developed and tested: a randomly initialized 3D ResNet50, Genesis, MedNet3D, an enhanced ResNet50 using Strategic Warm-Start++ (SWS++), and a linear classifier analyzing features from the Foundation Model for Cancer Biomarkers (FMCB). These models were trained to distinguish between benign and malignant nodules and evaluated using AUC analysis on internal (DLCSD) and external datasets, including LUNA16 (433 patients, 677 nodules) and NLST. The DLCSD-mD model achieved an AUC of 0.93 (95% CI: 0.91-0.94) on the internal DLCSD dataset. External validation results were 0.97 (95% CI: 0.96-0.98) on LUNA16 and 0.75 (95% CI: 0.73-0.76) on NLST. For classification, the ResNet50-SWS++ model recorded AUCs of 0.71 (95% CI: 0.61-0.81) on DLCSD, 0.90 (95% CI: 0.87-0.93) on LUNA16, and 0.81 (95% CI: 0.79-0.82) on NLST. Other models showed varying performance across datasets, underscoring the importance of diverse model approaches. This benchmarking establishes DLCSD as a reliable resource for lung cancer AI research.