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Register a new userPredicting Prostate Cancer-Specific Mortality with A.I.-based Gleason Grading
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Added by
Yun Liu
Publication date
2020
fields
Informatics Engineering
and research's language is
English
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Gleason grading of prostate cancer is an important prognostic factor but suffers from poor reproducibility, particularly among non-subspecialist pathologists. Although artificial intelligence (A.I.) tools have demonstrated Gleason grading on-par with expert pathologists, it remains an open question whether A.I. grading translates to better prognostication. In this study, we developed a system to predict prostate-cancer specific mortality via A.I.-based Gleason grading and subsequently evaluated its ability to risk-stratify patients on an independent retrospective cohort of 2,807 prostatectomy cases from a single European center with 5-25 years of follow-up (median: 13, interquartile range 9-17). The A.I.s risk scores produced a C-index of 0.84 (95%CI 0.80-0.87) for prostate cancer-specific mortality. Upon discretizing these risk scores into risk groups analogous to pathologist Grade Groups (GG), the A.I. had a C-index of 0.82 (95%CI 0.78-0.85). On the subset of cases with a GG in the original pathology report (n=1,517), the A.I.s C-indices were 0.87 and 0.85 for continuous and discrete grading, respectively, compared to 0.79 (95%CI 0.71-0.86) for GG obtained from the reports. These represent improvements of 0.08 (95%CI 0.01-0.15) and 0.07 (95%CI 0.00-0.14) respectively. Our results suggest that A.I.-based Gleason grading can lead to effective risk-stratification and warrants further evaluation for improving disease management.
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The Gleason grading system using histological images is the most powerful diagnostic and prognostic predictor of prostate cancer. The current standard inspection is evaluating Gleason H&E-stained histopathology images by pathologists. However, it is complicated, time-consuming, and subject to observers. Deep learning (DL) based-methods that automatically learn image features and achieve higher generalization ability have attracted significant attention. However, challenges remain especially using DL to train the whole slide image (WSI), a predominant clinical source in the current diagnostic setting, containing billions of pixels, morphological heterogeneity, and artifacts. Hence, we proposed a convolutional neural network (CNN)-based automatic classification method for accurate grading of PCa using whole slide histopathology images. In this paper, a data augmentation method named Patch-Based Image Reconstruction (PBIR) was proposed to reduce the high resolution and increase the diversity of WSIs. In addition, a distribution correction (DC) module was developed to enhance the adaption of pretrained model to the target dataset by adjusting the data distribution. Besides, a Quadratic Weighted Mean Square Error (QWMSE) function was presented to reduce the misdiagnosis caused by equal Euclidean distances. Our experiments indicated the combination of PBIR, DC, and QWMSE function was necessary for achieving superior expert-level performance, leading to the best results (0.8885 quadratic-weighted kappa coefficient).
Prostate cancer (PCa) is the second deadliest form of cancer in males, and it can be clinically graded by examining the structural representations of Gleason tissues. This paper proposes RV{a new method} for segmenting the Gleason tissues RV{(patch-wise) in order to grade PCa from the whole slide images (WSI).} Also, the proposed approach encompasses two main contributions: 1) A synergy of hybrid dilation factors and hierarchical decomposition of latent space representation for effective Gleason tissues extraction, and 2) A three-tiered loss function which can penalize different semantic segmentation models for accurately extracting the highly correlated patterns. In addition to this, the proposed framework has been extensively evaluated on a large-scale PCa dataset containing 10,516 whole slide scans (with around 71.7M patches), where it outperforms state-of-the-art schemes by 3.22% (in terms of mean intersection-over-union) for extracting the Gleason tissues and 6.91% (in terms of F1 score) for grading the progression of PCa.
The Gleason score is the most important prognostic marker for prostate cancer patients but suffers from significant inter-observer variability. We developed a fully automated deep learning system to grade prostate biopsies. The system was developed using 5834 biopsies from 1243 patients. A semi-automatic labeling technique was used to circumvent the need for full manual annotation by pathologists. The developed system achieved a high agreement with the reference standard. In a separate observer experiment, the deep learning system outperformed 10 out of 15 pathologists. The system has the potential to improve prostate cancer prognostics by acting as a first or second reader.
Background: An increasing volume of prostate biopsies and a world-wide shortage of uro-pathologists puts a strain on pathology departments. Additionally, the high intra- and inter-observer variability in grading can result in over- and undertreatment of prostate cancer. Artificial intelligence (AI) methods may alleviate these problems by assisting pathologists to reduce workload and harmonize grading. Methods: We digitized 6,682 needle biopsies from 976 participants in the population based STHLM3 diagnostic study to train deep neural networks for assessing prostate biopsies. The networks were evaluated by predicting the presence, extent, and Gleason grade of malignant tissue for an independent test set comprising 1,631 biopsies from 245 men. We additionally evaluated grading performance on 87 biopsies individually graded by 23 experienced urological pathologists from the International Society of Urological Pathology. We assessed discriminatory performance by receiver operating characteristics (ROC) and tumor extent predictions by correlating predicted millimeter cancer length against measurements by the reporting pathologist. We quantified the concordance between grades assigned by the AI and the expert urological pathologists using Cohens kappa. Results: The performance of the AI to detect and grade cancer in prostate needle biopsy samples was comparable to that of international experts in prostate pathology. The AI achieved an area under the ROC curve of 0.997 for distinguishing between benign and malignant biopsy cores, and 0.999 for distinguishing between men with or without prostate cancer. The correlation between millimeter cancer predicted by the AI and assigned by the reporting pathologist was 0.96. For assigning Gleason grades, the AI achieved an average pairwise kappa of 0.62. This was within the range of the corresponding values for the expert pathologists (0.60 to 0.73).
We propose an unsupervised method using self-clustering convolutional adversarial autoencoders to classify prostate tissue as tumor or non-tumor without any labeled training data. The clustering method is integrated into the training of the autoencoder and requires only little post-processing. Our network trains on hematoxylin and eosin (H&E) input patches and we tested two different reconstruction targets, H&E and immunohistochemistry (IHC). We show that antibody-driven feature learning using IHC helps the network to learn relevant features for the clustering task. Our network achieves a F1 score of 0.62 using only a small set of validation labels to assign classes to clusters.
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