Search

Simple Summary: This paper delves into the persistent issue of unequal access to medical imaging, with a particular focus on breast cancer screening and its impact on marginalized communities and racial/ethnic minorities. Central to our discussion is the role of scientific mobility among radiologists in fostering healthcare policy changes that promote diversity and cultural competence. We propose various strategies to bridge this gap, including cultural education, sensitivity training, and diversifying the radiology workforce. These measures aim to improve communication with diverse patient groups and reduce healthcare disparities. Additionally, we explore the challenges and advantages of teleradiology as a means to extend medical imaging services to underserved areas. In the context of artificial intelligence, we emphasize the critical need to validate algorithms across diverse populations to ensure unbiased and equitable healthcare outcomes. Overall, this paper underscores the importance of international collaboration in addressing global access barriers, presenting it as a key to mitigating disparities in medical imaging access and contributing to the pursuit of equitable healthcare. Access to medical imaging is pivotal in healthcare, playing a crucial role in the prevention, diagnosis, and management of diseases. However, disparities persist in this scenario, disproportionately affecting marginalized communities, racial and ethnic minorities, and individuals facing linguistic or cultural barriers. This paper critically assesses methods to mitigate these disparities, with a focus on breast cancer screening. We underscore scientific mobility as a vital tool for radiologists to advocate for healthcare policy changes: it not only enhances diversity and cultural competence within the radiology community but also fosters international cooperation and knowledge exchange among healthcare institutions. Efforts to ensure cultural competency among radiologists are discussed, including ongoing cultural education, sensitivity training, and workforce diversification. These initiatives are key to improving patient communication and reducing healthcare disparities. This paper also highlights the crucial role of policy changes and legislation in promoting equal access to essential screening services like mammography. We explore the challenges and potential of teleradiology in improving access to medical imaging in remote and underserved areas. In the era of artificial intelligence, this paper emphasizes the necessity of validating its models across a spectrum of populations to prevent bias and achieve equitable healthcare outcomes. Finally, the importance of international collaboration is illustrated, showcasing its role in sharing insights and strategies to overcome global access barriers in medical imaging. Overall, this paper offers a comprehensive overview of the challenges related to disparities in medical imaging access and proposes actionable strategies to address these challenges, aiming for equitable healthcare delivery. [ABSTRACT FROM AUTHOR]

Simple Summary: Breast cancer is a significant cause of female cancer-related deaths in the US. Checking how severe the cancer is helps in planning treatment. Modern AI methods are good at grading cancer, but they are not used much in hospitals yet. We developed and utilized ensemble deep learning algorithms for addressing the tasks of classifying (1) breast cancer subtype and (2) breast cancer invasiveness from whole slide image (WSI) histopathology slides. The ensemble models used were based on convolutional neural networks (CNNs) known for extracting distinctive features crucial for accurate classification. In this paper, we provide a comprehensive analysis of these models and the used methodology for breast cancer diagnosis tasks. Cancer diagnosis and classification are pivotal for effective patient management and treatment planning. In this study, a comprehensive approach is presented utilizing ensemble deep learning techniques to analyze breast cancer histopathology images. Our datasets were based on two widely employed datasets from different centers for two different tasks: BACH and BreakHis. Within the BACH dataset, a proposed ensemble strategy was employed, incorporating VGG16 and ResNet50 architectures to achieve precise classification of breast cancer histopathology images. Introducing a novel image patching technique to preprocess a high-resolution image facilitated a focused analysis of localized regions of interest. The annotated BACH dataset encompassed 400 WSIs across four distinct classes: Normal, Benign, In Situ Carcinoma, and Invasive Carcinoma. In addition, the proposed ensemble was used on the BreakHis dataset, utilizing VGG16, ResNet34, and ResNet50 models to classify microscopic images into eight distinct categories (four benign and four malignant). For both datasets, a five-fold cross-validation approach was employed for rigorous training and testing. Preliminary experimental results indicated a patch classification accuracy of 95.31% (for the BACH dataset) and WSI image classification accuracy of 98.43% (BreakHis). This research significantly contributes to ongoing endeavors in harnessing artificial intelligence to advance breast cancer diagnosis, potentially fostering improved patient outcomes and alleviating healthcare burdens. [ABSTRACT FROM AUTHOR]

Simple Summary: Risk assessment in early breast cancer is critical for clinical decisions, but defining risk categories poses a significant challenge. The integration of conventional histopathology and biomarkers with artificial intelligence (AI) techniques, including machine learning and deep learning, has the potential to offer more precise information. AI applications extend beyond detection to histological subtyping, grading, and molecular feature identification. The successful integration of AI into clinical practice requires collaboration between histopathologists, molecular pathologists, computational pathologists, and oncologists to optimize patient outcomes. Effective risk assessment in early breast cancer is essential for informed clinical decision-making, yet consensus on defining risk categories remains challenging. This paper explores evolving approaches in risk stratification, encompassing histopathological, immunohistochemical, and molecular biomarkers alongside cutting-edge artificial intelligence (AI) techniques. Leveraging machine learning, deep learning, and convolutional neural networks, AI is reshaping predictive algorithms for recurrence risk, thereby revolutionizing diagnostic accuracy and treatment planning. Beyond detection, AI applications extend to histological subtyping, grading, lymph node assessment, and molecular feature identification, fostering personalized therapy decisions. With rising cancer rates, it is crucial to implement AI to accelerate breakthroughs in clinical practice, benefiting both patients and healthcare providers. However, it is important to recognize that while AI offers powerful automation and analysis tools, it lacks the nuanced understanding, clinical context, and ethical considerations inherent to human pathologists in patient care. Hence, the successful integration of AI into clinical practice demands collaborative efforts between medical experts and computational pathologists to optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: A novel approach for automatic detection of neoplastic lesions in lymph nodes is presented, which incorporates machine learning methods and the new LN-RADS scale. The presented solution incorporates different network structures with diverse datasets to improve the overall effectiveness. Final findings demonstrate that incorporating the LN-RADS scale labels improved the overall diagnosis, especially when compared with current, standard practices. The presented solution is meant as an aid in the diagnosis process. The paper presents a novel approach for the automatic detection of neoplastic lesions in lymph nodes (LNs). It leverages the latest advances in machine learning (ML) with the LN Reporting and Data System (LN-RADS) scale. By integrating diverse datasets and network structures, the research investigates the effectiveness of ML algorithms in improving diagnostic accuracy and automation potential. Both Multinominal Logistic Regression (MLR)-integrated and fully connected neuron layers are included in the analysis. The methods were trained using three variants of combinations of histopathological data and LN-RADS scale labels to assess their utility. The findings demonstrate that the LN-RADS scale improves prediction accuracy. MLR integration is shown to achieve higher accuracy, while the fully connected neuron approach excels in AUC performance. All of the above suggests a possibility for significant improvement in the early detection and prognosis of cancer using AI techniques. The study underlines the importance of further exploration into combined datasets and network architectures, which could potentially lead to even greater improvements in the diagnostic process. [ABSTRACT FROM AUTHOR]

Simple Summary: In radiotherapy treatment, organs at risk and target volumes are contoured by the clinicians to prepare a dosimetry plan. In retrospective data, these structures are not often standardised to universal names across the patients plans, which is required to enable data mining and analysis. In this paper, a new method was proposed and evaluated to automatically standardise radiotherapy structures names using machine learning algorithms. The proposed approach was deployed over a dataset with 1613 patients collected from Liverpool & Macarthur Cancer Therapy Centres, New South Wales, Australia. It was concluded that machine learning techniques can standardise the dosimetry plan structures, taking into consideration the integration of multiple modalities representing each structure during the training process. In progressing the use of big data in health systems, standardised nomenclature is required to enable data pooling and analyses. In many radiotherapy planning systems and their data archives, target volumes (TV) and organ-at-risk (OAR) structure nomenclature has not been standardised. Machine learning (ML) has been utilised to standardise volumes nomenclature in retrospective datasets. However, only subsets of the structures have been targeted. Within this paper, we proposed a new approach for standardising all the structures nomenclature by using multi-modal artificial neural networks. A cohort consisting of 1613 breast cancer patients treated with radiotherapy was identified from Liverpool & Macarthur Cancer Therapy Centres, NSW, Australia. Four types of volume characteristics were generated to represent each target and OAR volume: textual features, geometric features, dosimetry features, and imaging data. Five datasets were created from the original cohort, the first four represented different subsets of volumes and the last one represented the whole list of volumes. For each dataset, 15 sets of combinations of features were generated to investigate the effect of using different characteristics on the standardisation performance. The best model reported 99.416% classification accuracy over the hold-out sample when used to standardise all the nomenclatures in a breast cancer radiotherapy plan into 21 classes. Our results showed that ML based automation methods can be used for standardising naming conventions in a radiotherapy plan taking into consideration the inclusion of multiple modalities to better represent each volume. [ABSTRACT FROM AUTHOR]

Simple Summary: Melanoma is the most dangerous type of skin cancer worldwide. Early detection of melanoma is crucial for better outcomes, but this often can be challenging. This research explores the use of artificial intelligence (AI) techniques combined with non-invasive imaging methods to improve melanoma detection. The authors aim to evaluate the current state of AI-based techniques using tools including dermoscopy, optical coherence tomography (OCT), and reflectance confocal microscopy (RCM). The findings demonstrate that several AI algorithms perform as well as or better than dermatologists in detecting melanoma, particularly in the analysis of dermoscopy images. This research highlights the potential of AI to enhance diagnostic accuracy, leading to improved patient outcomes. Further studies are needed to address limitations and ensure the reliability and effectiveness of AI-based techniques. Background: Melanoma, the deadliest form of skin cancer, poses a significant public health challenge worldwide. Early detection is crucial for improved patient outcomes. Non-invasive skin imaging techniques allow for improved diagnostic accuracy; however, their use is often limited due to the need for skilled practitioners trained to interpret images in a standardized fashion. Recent innovations in artificial intelligence (AI)-based techniques for skin lesion image interpretation show potential for the use of AI in the early detection of melanoma. Objective: The aim of this study was to evaluate the current state of AI-based techniques used in combination with non-invasive diagnostic imaging modalities including reflectance confocal microscopy (RCM), optical coherence tomography (OCT), and dermoscopy. We also aimed to determine whether the application of AI-based techniques can lead to improved diagnostic accuracy of melanoma. Methods: A systematic search was conducted via the Medline/PubMed, Cochrane, and Embase databases for eligible publications between 2018 and 2022. Screening methods adhered to the 2020 version of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies utilized AI-based algorithms for melanoma detection and directly addressed the review objectives. Results: We retrieved 40 papers amongst the three databases. All studies directly comparing the performance of AI-based techniques with dermatologists reported the superior or equivalent performance of AI-based techniques in improving the detection of melanoma. In studies directly comparing algorithm performance on dermoscopy images to dermatologists, AI-based algorithms achieved a higher ROC (>80%) in the detection of melanoma. In these comparative studies using dermoscopic images, the mean algorithm sensitivity was 83.01% and the mean algorithm specificity was 85.58%. Studies evaluating machine learning in conjunction with OCT boasted accuracy of 95%, while studies evaluating RCM reported a mean accuracy rate of 82.72%. Conclusions: Our results demonstrate the robust potential of AI-based techniques to improve diagnostic accuracy and patient outcomes through the early identification of melanoma. Further studies are needed to assess the generalizability of these AI-based techniques across different populations and skin types, improve standardization in image processing, and further compare the performance of AI-based techniques with board-certified dermatologists to evaluate clinical applicability. [ABSTRACT FROM AUTHOR]

Simple Summary: Accurately grading gliomas, which are the most common and aggressive malignant brain tumors in adults, poses a significant challenge for radiologists. This study explores the application of Deep Learning techniques in assisting tumor grading using Magnetic Resonance Images (MRIs). By analyzing a glioma database sourced from multiple public datasets and comparing different settings, the aim of this study is to develop a robust and reliable grading system. The study demonstrates that by focusing on the tumor region of interest and augmenting the available data, there is a significant improvement in both the accuracy and confidence of tumor grade classifications. While successful in differentiating low-grade gliomas from high-grade gliomas, the accurate classification of grades 2, 3, and 4 remains challenging. The research findings have significant implications for advancing the development of a non-invasive, robust, and trustworthy data-driven system to support clinicians in the diagnosis and therapy planning of glioma patients. Glioma is the most common type of tumor in humans originating in the brain. According to the World Health Organization, gliomas can be graded on a four-stage scale, ranging from the most benign to the most malignant. The grading of these tumors from image information is a far from trivial task for radiologists and one in which they could be assisted by machine-learning-based decision support. However, the machine learning analytical pipeline is also fraught with perils stemming from different sources, such as inadvertent data leakage, adequacy of 2D image sampling, or classifier assessment biases. In this paper, we analyze a glioma database sourced from multiple datasets using a simple classifier, aiming to obtain a reliable tumor grading and, on the way, we provide a few guidelines to ensure such reliability. Our results reveal that by focusing on the tumor region of interest and using data augmentation techniques we significantly enhanced the accuracy and confidence in tumor classifications. Evaluation on an independent test set resulted in an AUC-ROC of 0.932 in the discrimination of low-grade gliomas from high-grade gliomas, and an AUC-ROC of 0.893 in the classification of grades 2, 3, and 4. The study also highlights the importance of providing, beyond generic classification performance, measures of how reliable and trustworthy the model's output is, thus assessing the model's certainty and robustness. [ABSTRACT FROM AUTHOR]

Simple Summary: Breast cancer is one of the most common health problems in the world. As a result, governments and researchers in different countries are trying to help prevent the disease. In this work, we develop a clinical decision support methodology based on machine learning tools. This methodology helps identify breast cancer patients and determine the risk factors for this disease. In addition, the proposed strategy can help detect the disease in its early stages using modern easy-to-interpret machine learning tools. Worldwide, the coronavirus has intensified the management problems of health services, significantly harming patients. Some of the most affected processes have been cancer patients' prevention, diagnosis, and treatment. Breast cancer is the most affected, with more than 20 million cases and at least 10 million deaths by 2020. Various studies have been carried out to support the management of this disease globally. This paper presents a decision support strategy for health teams based on machine learning (ML) tools and explainability algorithms (XAI). The main methodological contributions are: first, the evaluation of different ML algorithms that allow classifying patients with and without cancer from the available dataset; and second, an ML methodology mixed with an XAI algorithm, which makes it possible to predict the disease and interpret the variables and how they affect the health of patients. The results show that first, the XGBoost Algorithm has a better predictive capacity, with an accuracy of 0.813 for the train data and 0.81 for the test data; and second, with the SHAP algorithm, it is possible to know the relevant variables and their level of significance in the prediction, and to quantify the impact on the clinical condition of the patients, which will allow health teams to offer early and personalized alerts for each patient. [ABSTRACT FROM AUTHOR]

Simple Summary: Breast cancer is the most common cancer, which resulted in the death of 700,000 people around the world in 2020. Various imaging modalities have been utilized to detect and analyze breast cancer. However, the manual detection of cancer from large-size images produced by these imaging modalities is usually time-consuming and can be inaccurate. Early and accurate detection of breast cancer plays a critical role in improving the prognosis bringing the patient survival rate to 50%. Recently, some artificial-intelligence-based approaches such as deep learning algorithms have shown remarkable advancements in early breast cancer diagnosis. This review focuses first on the introduction of various breast cancer imaging modalities and their available public datasets, then on proposing the most recent studies considering deep-learning-based models for breast cancer analysis. This study systemically summarizes various imaging modalities, relevant public datasets, deep learning architectures used for different imaging modalities, model performances for different tasks such as classification and segmentation, and research directions. Breast cancer is among the most common and fatal diseases for women, and no permanent treatment has been discovered. Thus, early detection is a crucial step to control and cure breast cancer that can save the lives of millions of women. For example, in 2020, more than 65% of breast cancer patients were diagnosed in an early stage of cancer, from which all survived. Although early detection is the most effective approach for cancer treatment, breast cancer screening conducted by radiologists is very expensive and time-consuming. More importantly, conventional methods of analyzing breast cancer images suffer from high false-detection rates. Different breast cancer imaging modalities are used to extract and analyze the key features affecting the diagnosis and treatment of breast cancer. These imaging modalities can be divided into subgroups such as mammograms, ultrasound, magnetic resonance imaging, histopathological images, or any combination of them. Radiologists or pathologists analyze images produced by these methods manually, which leads to an increase in the risk of wrong decisions for cancer detection. Thus, the utilization of new automatic methods to analyze all kinds of breast screening images to assist radiologists to interpret images is required. Recently, artificial intelligence (AI) has been widely utilized to automatically improve the early detection and treatment of different types of cancer, specifically breast cancer, thereby enhancing the survival chance of patients. Advances in AI algorithms, such as deep learning, and the availability of datasets obtained from various imaging modalities have opened an opportunity to surpass the limitations of current breast cancer analysis methods. In this article, we first review breast cancer imaging modalities, and their strengths and limitations. Then, we explore and summarize the most recent studies that employed AI in breast cancer detection using various breast imaging modalities. In addition, we report available datasets on the breast-cancer imaging modalities which are important in developing AI-based algorithms and training deep learning models. In conclusion, this review paper tries to provide a comprehensive resource to help researchers working in breast cancer imaging analysis. [ABSTRACT FROM AUTHOR]

Simple Summary: Artificial intelligence techniques have changed the traditional way of diagnosis. The physicians' consultation decisions can now be supported with a particular algorithm that is beneficial for the patient in terms of accuracy and time saved. Many deep learning and machine learning algorithms are being validated and tested regularly; still, only a few can be implemented clinically. This review aims to shed light on the current and potential applications of deep learning and machine learning in tumor pathology. The revolution of artificial intelligence and its impacts on our daily life has led to tremendous interest in the field and its related subtypes: machine learning and deep learning. Scientists and developers have designed machine learning- and deep learning-based algorithms to perform various tasks related to tumor pathologies, such as tumor detection, classification, grading with variant stages, diagnostic forecasting, recognition of pathological attributes, pathogenesis, and genomic mutations. Pathologists are interested in artificial intelligence to improve the diagnosis precision impartiality and to minimize the workload combined with the time consumed, which affects the accuracy of the decision taken. Regrettably, there are already certain obstacles to overcome connected to artificial intelligence deployments, such as the applicability and validation of algorithms and computational technologies, in addition to the ability to train pathologists and doctors to use these machines and their willingness to accept the results. This review paper provides a survey of how machine learning and deep learning methods could be implemented into health care providers' routine tasks and the obstacles and opportunities for artificial intelligence application in tumor morphology. [ABSTRACT FROM AUTHOR]

Simple Summary: The High Throughput Truthing project aims to develop a dataset of stromal tumor-infiltrating lymphocytes (sTILs) density evaluations in hematoxylin and eosin-stained invasive breast cancer specimens fit for a regulatory purpose. After completion of the pilot study, the analysis demonstrated inconsistencies and gaps in the provided training to pathologists. Select regions of interest (ROIs) were reviewed by an expert panel, who provided annotations and commentary on the challenges of the sTILs assessment. We used these annotations to develop a training document and reference standard for new training materials. These materials will train crowd-sourced pathologists to help create an algorithm validation dataset and contribute to sTILs evaluations in clinical practice. The High Throughput Truthing project aims to develop a dataset for validating artificial intelligence and machine learning models (AI/ML) fit for regulatory purposes. The context of this AI/ML validation dataset is the reporting of stromal tumor-infiltrating lymphocytes (sTILs) density evaluations in hematoxylin and eosin-stained invasive breast cancer biopsy specimens. After completing the pilot study, we found notable variability in the sTILs estimates as well as inconsistencies and gaps in the provided training to pathologists. Using the pilot study data and an expert panel, we created custom training materials to improve pathologist annotation quality for the pivotal study. We categorized regions of interest (ROIs) based on their mean sTILs density and selected ROIs with the highest and lowest sTILs variability. In a series of eight one-hour sessions, the expert panel reviewed each ROI and provided verbal density estimates and comments on features that confounded the sTILs evaluation. We aggregated and shaped the comments to identify pitfalls and instructions to improve our training materials. From these selected ROIs, we created a training set and proficiency test set to improve pathologist training with the goal to improve data collection for the pivotal study. We are not exploring AI/ML performance in this paper. Instead, we are creating materials that will train crowd-sourced pathologists to be the reference standard in a pivotal study to create an AI/ML model validation dataset. The issues discussed here are also important for clinicians to understand about the evaluation of sTILs in clinical practice and can provide insight to developers of AI/ML models. [ABSTRACT FROM AUTHOR]

Simple Summary: This research aims to evaluate the effectiveness of a machine learning algorithm, XGBoost, in predicting treatment recommendations for patients with hepatocellular carcinoma (HCC). The study uses clinical and imaging data from patients discussed at a multidisciplinary tumor board. The findings suggest that the algorithm can accurately predict all eight treatment recommendations made by the board, potentially aiding clinical decision-making in settings lacking subspecialty expertise. This study addresses the potential of machine learning in predicting treatment recommendations for patients with hepatocellular carcinoma (HCC). Using an IRB-approved retrospective study of patients discussed at a multidisciplinary tumor board, clinical and imaging variables were extracted and used in a gradient-boosting machine learning algorithm, XGBoost. The algorithm's performance was assessed using confusion matrix metrics and the area under the Receiver Operating Characteristics (ROC) curve. The study included 140 patients (mean age 67.7 ± 8.9 years), and the algorithm was found to be predictive of all eight treatment recommendations made by the board. The model's predictions were more accurate than those based on published therapeutic guidelines by ESMO and NCCN. The study concludes that a machine learning model incorporating clinical and imaging variables can predict treatment recommendations made by an expert multidisciplinary tumor board, potentially aiding clinical decision-making in settings lacking subspecialty expertise. [ABSTRACT FROM AUTHOR]

Simple Summary: The incidence of renal cell carcinoma (RCC) is increasing due to the expansion of cross-sectional imaging and advanced imaging techniques. They allow for the detection of tumors at an earlier stage, but there are often overlapping similarities in the appearance of benign and malignant renal tumors. This review presents and discusses the ever-evolving landscape of imaging techniques that can be used to detect and diagnose renal cell carcinoma, including its major histologic subtypes. It also provides insight into recently proposed or updated imaging algorithms and guidelines for the diagnosis of RCC. The review considers the major advances in spectral CT, photo- counting CT, multiparametric MRI, contrast-enhanced ultrasound, sestamibi SPECT/CT, PSMA PET/CT, radiomics, artificial intelligence, Bosniak classification version 2019, clear cell likelihood score, and AUA guidelines. The goal for radiologists is to be better equipped to guide the diagnosis and management of these patients. This review highlights recent advances in renal cell carcinoma (RCC) imaging. It begins with dual-energy computed tomography (DECT), which has demonstrated a high diagnostic accuracy in the evaluation of renal masses. Several studies have suggested the potential benefits of iodine quantification, particularly for distinguishing low-attenuation, true enhancing solid masses from hyperdense cysts. By determining whether or not a renal mass is present, DECT could avoid the need for additional imaging studies, thereby reducing healthcare costs. DECT can also provide virtual unenhanced images, helping to reduce radiation exposure. The review then provides an update focusing on the advantages of multiparametric magnetic resonance (MR) imaging performance in the histological subtyping of RCC and in the differentiation of benign from malignant renal masses. A proposed standardized stepwise reading of images helps to identify clear cell RCC and papillary RCC with a high accuracy. Contrast-enhanced ultrasound may represent a promising diagnostic tool for the characterization of solid and cystic renal masses. Several combined pharmaceutical imaging strategies using both sestamibi and PSMA offer new opportunities in the diagnosis and staging of RCC, but their role in risk stratification needs to be evaluated. Although radiomics and tumor texture analysis are hampered by poor reproducibility and need standardization, they show promise in identifying new biomarkers for predicting tumor histology, clinical outcomes, overall survival, and the response to therapy. They have a wide range of potential applications but are still in the research phase. Artificial intelligence (AI) has shown encouraging results in tumor classification, grade, and prognosis. It is expected to play an important role in assessing the treatment response and advancing personalized medicine. The review then focuses on recently updated algorithms and guidelines. The Bosniak classification version 2019 incorporates MRI, precisely defines previously vague imaging terms, and allows a greater proportion of masses to be placed in lower-risk classes. Recent studies have reported an improved specificity of the higher-risk categories and better inter-reader agreement. The clear cell likelihood score, which adds standardization to the characterization of solid renal masses on MRI, has been validated in recent studies with high interobserver agreement. Finally, the review discusses the key imaging implications of the 2017 AUA guidelines for renal masses and localized renal cancer. [ABSTRACT FROM AUTHOR]

Simple Summary: Cancer genome analysis often reveals structural variants (SVs) involving fusion genes that are difficult to classify as drivers or passengers. Obtaining accurate AI predictions and explanations, which are crucial for a reliable diagnosis, is challenging. We developed an explainable AI (XAI) system that predicts the pathogenicity of SVs with gene fusions, providing reasons for its predictions. Our XAI achieved high accuracy, comparable to existing tools, and generated plausible explanations based on pathogenic mechanisms. This research represents a promising step towards AI-supported decision making in genomic medicine, enabling efficient and accurate diagnosis. When analyzing cancer sample genomes in clinical practice, many structural variants (SVs), other than single nucleotide variants (SNVs), have been identified. To identify driver variants, the leading candidates must be narrowed down. When fusion genes are involved, selection is particularly difficult, and highly accurate predictions from AI is important. Furthermore, we also wanted to determine how the prediction can make more reliable diagnoses. Here, we developed an explainable AI (XAI) suitable for SVs with gene fusions, based on the XAI technology we previously developed for the prediction of SNV pathogenicity. To cope with gene fusion variants, we added new data to the previous knowledge graph for SVs and we improved the algorithm. Its prediction accuracy was as high as that of existing tools. Moreover, our XAI could explain the reasons for these predictions. We used some variant examples to demonstrate that the reasons are plausible in terms of pathogenic basic mechanisms. These results can be seen as a hopeful step toward the future of genomic medicine, where efficient and correct decisions can be made with the support of AI. [ABSTRACT FROM AUTHOR]

Simple Summary: Early characterization of the isocitrate dehydrogenase (IDHIDH) gene mutation status of glioma is crucial for personalized decision making and prognosis in clinical neurooncological treatment. Based on the known differences in energy metabolism between IDHIDH-mutated and IDHIDH-wildtype gliomas, we assessed physio-metabolic magnetic resonance imaging-based measures along with machine learning for potential reliable presurgical characterization of IDHIDH gene status. Traditional machine learning algorithms and simple deep learning models trained in analyzing physio-metabolic parameters demonstrated the best performance in classifying the IDHIDH gene status of gliomas in independent internal testing. In contrast, external testing revealed that traditional machine learning models trained on clinical MRI data had higher accuracy compared to physio-metabolic algorithms, reflecting differences in data acquisition methodology between the two sites. Our results outline the necessity of independent internal and external testing, thus calling for standardized and robust protocols for clinical MRI-driven AI applications. The mutational status of the isocitrate dehydrogenase (IDH) gene plays a key role in the treatment of glioma patients because it is known to affect energy metabolism pathways relevant to glioma. Physio-metabolic magnetic resonance imaging (MRI) enables the non-invasive analysis of oxygen metabolism and tissue hypoxia as well as associated neovascularization and microvascular architecture. However, evaluating such complex neuroimaging data requires computational support. Traditional machine learning algorithms and simple deep learning models were trained with radiomic features from clinical MRI (cMRI) or physio-metabolic MRI data. A total of 215 patients (first center: 166 participants + 16 participants for independent internal testing of the algorithms versus second site: 33 participants for independent external testing) were enrolled using two different physio-metabolic MRI protocols. The algorithms trained with physio-metabolic data demonstrated the best classification performance in independent internal testing: precision, 91.7%; accuracy, 87.5%; area under the receiver operating curve (AUROC), 0.979. In external testing, traditional machine learning models trained with cMRI data exhibited the best IDH classification results: precision, 84.9%; accuracy, 81.8%; and AUROC, 0.879. The poor performance for the physio-metabolic MRI approach appears to be explainable by site-dependent differences in data acquisition methodologies. The physio-metabolic MRI approach potentially supports reliable classification of IDH gene status in the presurgical stage of glioma patients. However, non-standardized protocols limit the level of evidence and underlie the need for a reproducible framework of data acquisition techniques. [ABSTRACT FROM AUTHOR]

Simple Summary: New technologies, particularly artificial intelligence (AI) and machine learning, enable the utilization of extensive data for personalized medicine. Future challenge involve acquiring limited biological data and extracting information for predictive models. This perspective focuses on triple-negative breast cancer (TNBC), a disease lacking specific treatment, where ongoing investigations explore therapies like immunotherapy. Drawing from the successful use of immunotherapy in melanoma, this perspective explores the identified strengths and weaknesses to inform more successful strategies. In this context, AI and predictive tools are invaluable. Advancements in melanoma immunotherapy serve as a foundation for developing effective immunotherapies for TNBC. Common principles, including immune system activation, checkpoint inhibitors, and personalized treatment, offer prospects for improving the outcomes in aggressive breast cancer cases, presenting new hope for challenging-to-treat patients, avoiding overtreatment, and reducing costs. Thanks to new technologies using artificial intelligence (AI) and machine learning, it is possible to use large amounts of data to try to extract information that can be used for personalized medicine. The great challenge of the future is, on the one hand, to acquire masses of biological data that nowadays are still limited and, on the other hand, to develop innovative strategies to extract information that can then be used for the development of predictive models. From this perspective, we discuss these aspects in the context of triple-negative breast cancer, a tumor where a specific treatment is still lacking and new therapies, such as immunotherapy, are under investigation. Since immunotherapy is already in use for other tumors such as melanoma, we discuss the strengths and weaknesses identified in the use of immunotherapy with melanoma to try to find more successful strategies. It is precisely in this context that AI and predictive tools can be extremely valuable. Therefore, the discoveries and advancements in immunotherapy for melanoma provide a foundation for developing effective immunotherapies for triple-negative breast cancer. Shared principles, such as immune system activation, checkpoint inhibitors, and personalized treatment, can be applied to TNBC to improve patient outcomes and offer new hope for those with aggressive, hard-to-treat breast cancer. [ABSTRACT FROM AUTHOR]

Simple Summary: The use of AI on medical images (CT, MRI, PET) has become a primary clinical and research interest. The main issues of these applications are strictly related to the reconstruction of imaging, the segmentation of tissues acquired, the selection of features, and the proper data analyses. Different approaches of AI have been proposed as the machine and deep learning, which utilize artificial neural networks inspired by neuronal architectures. Further validation of AI models for diagnosis and monitoring responses will be necessary to assess as MRI and PET/CT might provide a personalized treatment-response prediction superior to current methods. The lack of early detection and a high rate of recurrence/progression after surgery are defined as the most common causes of a very poor prognosis of Gliomas. The developments of quantification systems with special regards to artificial intelligence (AI) on medical images (CT, MRI, PET) are under evaluation in the clinical and research context in view of several applications providing different information related to the reconstruction of imaging, the segmentation of tissues acquired, the selection of features, and the proper data analyses. Different approaches of AI have been proposed as the machine and deep learning, which utilize artificial neural networks inspired by neuronal architectures. In addition, new systems have been developed using AI techniques to offer suggestions or make decisions in medical diagnosis, emulating the judgment of radiologist experts. The potential clinical role of AI focuses on the prediction of disease progression in more aggressive forms in gliomas, differential diagnosis (pseudoprogression vs. proper progression), and the follow-up of aggressive gliomas. This narrative Review will focus on the available applications of AI in brain tumor diagnosis, mainly related to malignant gliomas, with particular attention to the postoperative application of MRI and PET imaging, considering the current state of technical approach and the evaluation after treatment (including surgery, radiotherapy/chemotherapy, and prognostic stratification). [ABSTRACT FROM AUTHOR]

Simple Summary: This study proposes an innovative approach to automatically identify invasive carcinoma regions in breast cancer immunohistochemistry whole-slide images, which is crucial for fully automated immunohistochemistry quantification. The proposed method leverages a neural network that combines multi-scale morphological features with boundary features, enabling precise segmentation of invasive carcinoma regions without the need for additional staining slides. The model demonstrated an impressive intersection over union score on the test set, and a fully automated Ki-67 scoring system based on the model's predictions exhibited high consistency with the scores given by experienced pathologists. The proposed method brings the breast cancer fully immunohistochemistry quantitative scoring system one step closer to clinical application. Aims: The automation of quantitative evaluation for breast immunohistochemistry (IHC) plays a crucial role in reducing the workload of pathologists and enhancing the objectivity of diagnoses. However, current methods face challenges in achieving fully automated immunohistochemistry quantification due to the complexity of segmenting the tumor area into distinct ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) regions. Moreover, the quantitative analysis of immunohistochemistry requires a specific focus on invasive carcinoma regions. Methods and Results: In this study, we propose an innovative approach to automatically identify invasive carcinoma regions in breast cancer immunohistochemistry whole-slide images (WSIs). Our method leverages a neural network that combines multi-scale morphological features with boundary features, enabling precise segmentation of invasive carcinoma regions without the need for additional H&E and P63 staining slides. In addition, we introduced an advanced semi-supervised learning algorithm, allowing efficient training of the model using unlabeled data. To evaluate the effectiveness of our approach, we constructed a dataset consisting of 618 IHC-stained WSIs from 170 cases, including four types of staining (ER, PR, HER2, and Ki-67). Notably, the model demonstrated an impressive intersection over union (IoU) score exceeding 80% on the test set. Furthermore, to ascertain the practical utility of our model in IHC quantitative evaluation, we constructed a fully automated Ki-67 scoring system based on the model's predictions. Comparative experiments convincingly demonstrated that our system exhibited high consistency with the scores given by experienced pathologists. Conclusions: Our developed model excels in accurately distinguishing between DCIS and invasive carcinoma regions in breast cancer immunohistochemistry WSIs. This method paves the way for a clinically available, fully automated immunohistochemistry quantitative scoring system. [ABSTRACT FROM AUTHOR]

Simple Summary: The exponential growth in artificial intelligence development, particularly its application in capsule endoscopy, serves as a compelling model for gastroenterologists. This review focusses on the latest advancements in capsule endoscopy, analyzing the possible benefits and ethical challenges that artificial intelligence may bring to the field of minimally invasive capsule panendoscopy, while also offering insights into future directions. Specifically in the context of oncological gastrointestinal screening, there is still a need to explore alternative strategies for enhancing this process. Artificial intelligence-enhanced capsule panendoscopy has the potential to positively impact the future by addressing time constraints and improve accessibility through the use of highly efficient diagnostic models. In the early 2000s, the introduction of single-camera wireless capsule endoscopy (CE) redefined small bowel study. Progress continued with the development of double-camera devices, first for the colon and rectum, and then, for panenteric assessment. Advancements continued with magnetic capsule endoscopy (MCE), particularly when assisted by a robotic arm, designed to enhance gastric evaluation. Indeed, as CE provides full visualization of the entire gastrointestinal (GI) tract, a minimally invasive capsule panendoscopy (CPE) could be a feasible alternative, despite its time-consuming nature and learning curve, assuming appropriate bowel cleansing has been carried out. Recent progress in artificial intelligence (AI), particularly in the development of convolutional neural networks (CNN) for CE auxiliary reading (detecting and diagnosing), may provide the missing link in fulfilling the goal of establishing the use of panendoscopy, although prospective studies are still needed to validate these models in actual clinical scenarios. Recent CE advancements will be discussed, focusing on the current evidence on CNN developments, and their real-life implementation potential and associated ethical challenges. [ABSTRACT FROM AUTHOR]

Simple Summary: Ovarian cancer is one of leading cause of death among women and early detection is important for timely treatment. For its detection at early stages, machine learning can be significantly important to speed up the screening and provide more accurate results. A stacked model is designed in this study, combining the strengths of mutliple models to obtain better accuracy compared to existing models. With a 96.87% accuracy, the model proves to be robust and accurate. The use of explainable AI elaborates on the importance of various appropriate features to enhance cancer detection accuracy in this regard. The importance of detecting and preventing ovarian cancer is of utmost significance for women's overall health and wellness. Referred to as the "silent killer," ovarian cancer exhibits inconspicuous symptoms during its initial phases, posing a challenge for timely identification. Identification of ovarian cancer during its advanced stages significantly diminishes the likelihood of effective treatment and survival. Regular screenings, such as pelvic exams, ultrasound, and blood tests for specific biomarkers, are essential tools for detecting the disease in its early, more treatable stages. This research makes use of the Soochow University ovarian cancer dataset, containing 50 features for the accurate detection of ovarian cancer. The proposed predictive model makes use of a stacked ensemble model, merging the strengths of bagging and boosting classifiers, and aims to enhance predictive accuracy and reliability. This combination harnesses the benefits of variance reduction and improved generalization, contributing to superior ovarian cancer prediction outcomes. The proposed model gives 96.87% accuracy, which is currently the highest model result obtained on this dataset so far using all features. Moreover, the outcomes are elucidated utilizing the explainable artificial intelligence method referred to as SHAPly. The excellence of the suggested model is demonstrated through a comparison of its performance with that of other cutting-edge models. [ABSTRACT FROM AUTHOR]

Simple Summary: Plasma Epstein–Barr virus (EBV) DNA is an important prognostic marker for nasopharyngeal carcinoma (NPC). However, EBV DNA is less sensitive to locoregional recurrence compared to distant metastasis in NPC. Numerous findings suggest that the presence of tumour-infiltrating lymphocytes (TILs) is associated with NPC prognosis. Nevertheless, NPC is characterised by the presence of abundant TILs. This study aims to generate TIL scores in NPC from H&E-stained tissue slide images for NPC prognosis. We employed artificial intelligence and deep learning-based method for generating TIL score. Our results indicate that our methods have strong prognostic value compared to the EBV DNA copies in locoregional recurrence cases. Background: Locoregional recurrence of nasopharyngeal carcinoma (NPC) occurs in 10% to 50% of cases following primary treatment. However, the current main prognostic markers for NPC, both stage and plasma Epstein–Barr virus DNA, are not sensitive to locoregional recurrence. Methods: We gathered 385 whole-slide images (WSIs) from haematoxylin and eosin (H&E)-stained NPC sections (n = 367 cases), which were collected from Sun Yat-sen University Cancer Centre. We developed a deep learning algorithm to detect tumour nuclei and lymphocyte nuclei in WSIs, followed by density-based clustering to quantify the tumour-infiltrating lymphocytes (TILs) into 12 scores. The Random Survival Forest model was then trained on the TILs to generate risk score. Results: Based on Kaplan–Meier analysis, the proposed methods were able to stratify low- and high-risk NPC cases in a validation set of locoregional recurrence with a statically significant result (p < 0.001). This finding was also found in distant metastasis-free survival (p < 0.001), progression-free survival (p < 0.001), and regional recurrence-free survival (p < 0.05). Furthermore, in both univariate analysis (HR: 1.58, CI: 1.13–2.19, p < 0.05) and multivariate analysis (HR:1.59, CI: 1.11–2.28, p < 0.05), we also found that our methods demonstrated a strong prognostic value for locoregional recurrence. Conclusion: The proposed novel digital markers could potentially be utilised to assist treatment decisions in cases of NPC. [ABSTRACT FROM AUTHOR]

Simple Summary: In this comprehensive review, we aimed to summarize the advances made by artificial intelligence in the field of lung cancer screening, diagnosis, and management. We now understand the utility of AI as a tool that can supplement physicians to improve the quality of care provided, which is the core message of this review, along with the relevant literature supporting the advances. Lung cancer remains one of the leading causes of cancer-related deaths worldwide, emphasizing the need for improved diagnostic and treatment approaches. In recent years, the emergence of artificial intelligence (AI) has sparked considerable interest in its potential role in lung cancer. This review aims to provide an overview of the current state of AI applications in lung cancer screening, diagnosis, and treatment. AI algorithms like machine learning, deep learning, and radiomics have shown remarkable capabilities in the detection and characterization of lung nodules, thereby aiding in accurate lung cancer screening and diagnosis. These systems can analyze various imaging modalities, such as low-dose CT scans, PET-CT imaging, and even chest radiographs, accurately identifying suspicious nodules and facilitating timely intervention. AI models have exhibited promise in utilizing biomarkers and tumor markers as supplementary screening tools, effectively enhancing the specificity and accuracy of early detection. These models can accurately distinguish between benign and malignant lung nodules, assisting radiologists in making more accurate and informed diagnostic decisions. Additionally, AI algorithms hold the potential to integrate multiple imaging modalities and clinical data, providing a more comprehensive diagnostic assessment. By utilizing high-quality data, including patient demographics, clinical history, and genetic profiles, AI models can predict treatment responses and guide the selection of optimal therapies. Notably, these models have shown considerable success in predicting the likelihood of response and recurrence following targeted therapies and optimizing radiation therapy for lung cancer patients. Implementing these AI tools in clinical practice can aid in the early diagnosis and timely management of lung cancer and potentially improve outcomes, including the mortality and morbidity of the patients. [ABSTRACT FROM AUTHOR]

Simple Summary: There has been an exponential rise in the availability of artificial intelligence systems in endoscopy in recent years. As a result, maintaining an informed understanding of the utility and efficacy of existing systems has become increasingly complex. This review aims to summarise the expanse of research in this area to guide proceduralists in making informed decisions regarding the use of artificial intelligence in colonoscopy. It focuses primarily on the application of artificial intelligence for the detection and characterisation of colorectal polyps in order to improve the efficacy of colorectal cancer screening and prevention. Colorectal cancer remains a leading cause of cancer-related morbidity and mortality worldwide, despite the widespread uptake of population surveillance strategies. This is in part due to the persistent development of 'interval colorectal cancers', where patients develop colorectal cancer despite appropriate surveillance intervals, implying pre-malignant polyps were not resected at a prior colonoscopy. Multiple techniques have been developed to improve the sensitivity and accuracy of lesion detection and characterisation in an effort to improve the efficacy of colorectal cancer screening, thereby reducing the incidence of interval colorectal cancers. This article presents a comprehensive review of the transformative role of artificial intelligence (AI), which has recently emerged as one such solution for improving the quality of screening and surveillance colonoscopy. Firstly, AI-driven algorithms demonstrate remarkable potential in addressing the challenge of overlooked polyps, particularly polyp subtypes infamous for escaping human detection because of their inconspicuous appearance. Secondly, AI empowers gastroenterologists without exhaustive training in advanced mucosal imaging to characterise polyps with accuracy similar to that of expert interventionalists, reducing the dependence on pathologic evaluation and guiding appropriate resection techniques or referrals for more complex resections. AI in colonoscopy holds the potential to advance the detection and characterisation of polyps, addressing current limitations and improving patient outcomes. The integration of AI technologies into routine colonoscopy represents a promising step towards more effective colorectal cancer screening and prevention. [ABSTRACT FROM AUTHOR]

Simple Summary: The Internet of Things (IoT) uses connected devices and sensors, like high-resolution cameras and specific sensors in wearable devices, for the collection of skin images with abnormalities. Skin cancer detection is difficult because of differences in lesion size, shape, and lighting conditions. To address this, an innovative approach called "ODL-SCDC", combining deep learning with IoT technology, is developed. The proposed model uses advanced techniques like hyperparameter selection and feature extraction to improve skin cancer classification. The results show that ODL-SCDC outperforms other methods in accurately identifying skin lesions, which could have a significant impact on early cancer detection in the medical field. Internet of Things (IoT)-assisted skin cancer recognition integrates several connected devices and sensors for supporting the primary analysis and monitoring of skin conditions. A preliminary analysis of skin cancer images is extremely difficult because of factors such as distinct sizes and shapes of lesions, differences in color illumination, and light reflections on the skin surface. In recent times, IoT-based skin cancer recognition utilizing deep learning (DL) has been used for enhancing the early analysis and monitoring of skin cancer. This article presents an optimal deep learning-based skin cancer detection and classification (ODL-SCDC) methodology in the IoT environment. The goal of the ODL-SCDC technique is to exploit metaheuristic-based hyperparameter selection approaches with a DL model for skin cancer classification. The ODL-SCDC methodology involves an arithmetic optimization algorithm (AOA) with the EfficientNet model for feature extraction. For skin cancer detection, a stacked denoising autoencoder (SDAE) classification model has been used. Lastly, the dragonfly algorithm (DFA) is utilized for the optimal hyperparameter selection of the SDAE algorithm. The simulation validation of the ODL-SCDC methodology has been tested on a benchmark ISIC skin lesion database. The extensive outcomes reported a better solution of the ODL-SCDC methodology compared with other models, with a maximum sensitivity of 97.74%, specificity of 99.71%, and accuracy of 99.55%. The proposed model can assist medical professionals, specifically dermatologists and potentially other healthcare practitioners, in the skin cancer diagnosis process. [ABSTRACT FROM AUTHOR]

Simple Summary: Intensity Modulated Radiation Therapy (IMRT) is a cancer treatment that targets cancer cells while protecting nearby healthy organs using a linear accelerator. Traditional IMRT planning involves a sequential process: optimizing beam intensities (Fluence Map Optimization) for a set of angles and then sequencing (Multi-Leaf Sequencing). Unfortunately, treatment plans obtained by the sequencing step are severely impaired. One approach that addresses the problem described is the Direct Aperture Optimisation (DAO) approach. The DAO problem aims at simultaneously determining deliverable aperture shapes and a set of radiation intensities. This approach considers physical and delivery time constraints, allowing clinically acceptable treatment plans to be generated. In this work, we adapt the Particle Swarm Optimisation to solve the DAO and introduce a reparation heuristic to enhance treatment plans. We tested our method on prostate cancer patients and found that it delivers radiation more efficiently than the traditional approach, reducing treatment time and improving outcomes. Intensity modulated radiation therapy (IMRT) is one of the most used techniques for cancer treatment. Using a linear accelerator, it delivers radiation directly at the cancerogenic cells in the tumour, reducing the impact of the radiation on the organs surrounding the tumour. The complexity of the IMRT problem forces researchers to subdivide it into three sub-problems that are addressed sequentially. Using this sequential approach, we first need to find a beam angle configuration that will be the set of irradiation points (beam angles) over which the tumour radiation is delivered. This first problem is called the Beam Angle Optimisation (BAO) problem. Then, we must optimise the radiation intensity delivered from each angle to the tumour. This second problem is called the Fluence Map Optimisation (FMO) problem. Finally, we need to generate a set of apertures for each beam angle, making the intensities computed in the previous step deliverable. This third problem is called the Sequencing problem. Solving these three sub-problems sequentially allows clinicians to obtain a treatment plan that can be delivered from a physical point of view. However, the obtained treatment plans generally have too many apertures, resulting in long delivery times. One strategy to avoid this problem is the Direct Aperture Optimisation (DAO) problem. In the DAO problem, the idea is to merge the FMO and the Sequencing problem. Hence, optimising the radiation's intensities considers the physical constraints of the delivery process. The DAO problem is usually modelled as a Mixed-Integer optimisation problem and aims to determine the aperture shapes and their corresponding radiation intensities, considering the physical constraints imposed by the Multi-Leaf Collimator device. In solving the DAO problem, generating clinically acceptable treatments without additional sequencing steps to deliver to the patients is possible. In this work, we propose to solve the DAO problem using the well-known Particle Swarm Optimisation (PSO) algorithm. Our approach integrates the use of mathematical programming to optimise the intensities and utilizes PSO to optimise the aperture shapes. Additionally, we introduce a reparation heuristic to enhance aperture shapes with minimal impact on the treatment plan. We apply our proposed algorithm to prostate cancer cases and compare our results with those obtained in the sequential approach. Results show that the PSO obtains competitive results compared to the sequential approach, receiving less radiation time (beam on time) and using the available apertures with major efficiency. [ABSTRACT FROM AUTHOR]

Simple Summary: Protein kinases, which are molecules involved in cell growth and signaling, can go haywire in cancer cells, causing them to multiply uncontrollably. Using drugs to target these kinases shows promise for cancer treatment, but we still have a lot to learn about effectively targeting them. To prioritize kinases to focus on, we developed CancerOmicsNet, an artificial intelligence model that predicts the response of cancer cells to kinase inhibitor treatment. We tested the model extensively and validated its predictions in real experiments with different types of cancer. To understand how the model makes its decisions and the role of each kinase, we used a special tool called a saliency map. This map helps identify the most important kinases driving tumor growth. By examining a wide range of biomedical literature, CancerOmicsNet indeed has shown promise in selecting potential targets for further investigation in various types of cancer. Deregulated protein kinases are crucial in promoting cancer cell proliferation and driving malignant cell signaling. Although these kinases are essential targets for cancer therapy due to their involvement in cell development and proliferation, only a small part of the human kinome has been targeted by drugs. A comprehensive scoring system is needed to evaluate and prioritize clinically relevant kinases. We recently developed CancerOmicsNet, an artificial intelligence model employing graph-based algorithms to predict the cancer cell response to treatment with kinase inhibitors. The performance of this approach has been evaluated in large-scale benchmarking calculations, followed by the experimental validation of selected predictions against several cancer types. To shed light on the decision-making process of CancerOmicsNet and to better understand the role of each kinase in the model, we employed a customized saliency map with adjustable channel weights. The saliency map, functioning as an explainable AI tool, allows for the analysis of input contributions to the output of a trained deep-learning model and facilitates the identification of essential kinases involved in tumor progression. The comprehensive survey of biomedical literature for essential kinases selected by CancerOmicsNet demonstrated that it could help pinpoint potential druggable targets for further investigation in diverse cancer types. [ABSTRACT FROM AUTHOR]

Simple Summary: Breast cancer affects millions of women worldwide. We aim to provide radiologists with automatic support for mammography review. We propose deploying deep learning models with Multiple Instance Learning algorithms for breast cancer diagnosis (cancer versus non-cancer classification) based on digital mammography images, taking advantage of data annotated at an image level without indicating where the lesion is. We employed algorithms to analyse original, high-resolution images with minimal reduction in size. We used graphical suggestions of attentional maps to verify the correctness of the algorithm and to indicate the areas of the images where cancer lesions are. Finally, we performed comparative and validation studies on external datasets differing in the number of images, pixel intensity levels, and subtypes of existing lesions, showing high accuracy and potential for generalisability of the algorithms. Breast cancer is the most frequent female cancer, with a considerable disease burden and high mortality. Early diagnosis with screening mammography might be facilitated by automated systems supported by deep learning artificial intelligence. We propose a model based on a weakly supervised Clustering-constrained Attention Multiple Instance Learning (CLAM) classifier able to train under data scarcity effectively. We used a private dataset with 1174 non-cancer and 794 cancer images labelled at the image level with pathological ground truth confirmation. We used feature extractors (ResNet-18, ResNet-34, ResNet-50 and EfficientNet-B0) pre-trained on ImageNet. The best results were achieved with multimodal-view classification using both CC and MLO images simultaneously, resized by half, with a patch size of 224 px and an overlap of 0.25. It resulted in AUC-ROC = 0.896 ± 0.017, F1-score 81.8 ± 3.2, accuracy 81.6 ± 3.2, precision 82.4 ± 3.3, and recall 81.6 ± 3.2. Evaluation with the Chinese Mammography Database, with 5-fold cross-validation, patient-wise breakdowns, and transfer learning, resulted in AUC-ROC 0.848 ± 0.015, F1-score 78.6 ± 2.0, accuracy 78.4 ± 1.9, precision 78.8 ± 2.0, and recall 78.4 ± 1.9. The CLAM algorithm's attentional maps indicate the features most relevant to the algorithm in the images. Our approach was more effective than in many other studies, allowing for some explainability and identifying erroneous predictions based on the wrong premises. [ABSTRACT FROM AUTHOR]

Simple Summary: MR-Class is a deep learning-based MR image classification tool for brain images that facilitates and speeds up the initialization of big data MR-based studies by providing fast, robust and quality-assured imaging sequence classifications. Our studies observed up to 10% misclassification rates due to corrupt and misleading DICOM metadata. This highlights the need for a tool such as MR-Class to help with data curation. MR-Class can be integrated into workflows for DICOM inconsistency checks and flagging or completing missing DICOM metadata and thus contribute to the faster deployment of clinical artificial intelligence applications. Background: MR image classification in datasets collected from multiple sources is complicated by inconsistent and missing DICOM metadata. Therefore, we aimed to establish a method for the efficient automatic classification of MR brain sequences. Methods: Deep convolutional neural networks (DCNN) were trained as one-vs-all classifiers to differentiate between six classes: T1 weighted (w), contrast-enhanced T1w, T2w, T2w-FLAIR, ADC, and SWI. Each classifier yields a probability, allowing threshold-based and relative probability assignment while excluding images with low probability (label: unknown, open-set recognition problem). Data from three high-grade glioma (HGG) cohorts was assessed; C1 (320 patients, 20,101 MRI images) was used for training, while C2 (197, 11,333) and C3 (256, 3522) were for testing. Two raters manually checked images through an interactive labeling tool. Finally, MR-Class' added value was evaluated via radiomics model performance for progression-free survival (PFS) prediction in C2, utilizing the concordance index (C-I). Results: Approximately 10% of annotation errors were observed in each cohort between the DICOM series descriptions and the derived labels. MR-Class accuracy was 96.7% [95% Cl: 95.8, 97.3] for C2 and 94.4% [93.6, 96.1] for C3. A total of 620 images were misclassified; manual assessment of those frequently showed motion artifacts or alterations of anatomy by large tumors. Implementation of MR-Class increased the PFS model C-I by 14.6% on average, compared to a model trained without MR-Class. Conclusions: We provide a DCNN-based method for the sequence classification of brain MR images and demonstrate its usability in two independent HGG datasets. [ABSTRACT FROM AUTHOR]

Simple Summary: While deep learning has become a powerful tool in analysis of cancer imaging, deep learning models have potential vulnerabilities that pose security threats in the setting of clinical implementation. One weakness of deep learning models is that they can be deceived by adversarial images, which are manipulated images that have pixels intentionally perturbed to alter the output of the deep learning model. Recent research has shown that adversarial detection models can differentiate adversarial images from normal images to protect deep learning models from attack. We compared the effectiveness of different adversarial detection schemes, using three cancer imaging datasets (computed tomography, mammography, and magnetic resonance imaging). We found that that the detection schemes demonstrate strong performance overall but exhibit limited efficacy in detecting a subset of adversarial images. We believe our findings provide a useful basis in the application of adversarial defenses to deep learning models for medical images in oncology. Deep learning (DL) models have demonstrated state-of-the-art performance in the classification of diagnostic imaging in oncology. However, DL models for medical images can be compromised by adversarial images, where pixel values of input images are manipulated to deceive the DL model. To address this limitation, our study investigates the detectability of adversarial images in oncology using multiple detection schemes. Experiments were conducted on thoracic computed tomography (CT) scans, mammography, and brain magnetic resonance imaging (MRI). For each dataset we trained a convolutional neural network to classify the presence or absence of malignancy. We trained five DL and machine learning (ML)-based detection models and tested their performance in detecting adversarial images. Adversarial images generated using projected gradient descent (PGD) with a perturbation size of 0.004 were detected by the ResNet detection model with an accuracy of 100% for CT, 100% for mammogram, and 90.0% for MRI. Overall, adversarial images were detected with high accuracy in settings where adversarial perturbation was above set thresholds. Adversarial detection should be considered alongside adversarial training as a defense technique to protect DL models for cancer imaging classification from the threat of adversarial images. [ABSTRACT FROM AUTHOR]

Simple Summary: For automated cancer diagnosis on medical imaging, explainable artificial intelligence technology uses advanced image analysis methods like deep learning to make a diagnosis and analyze medical images, as well as provide a clear explanation for how it arrived at its diagnosis. The objective of XAI is to provide patients and doctors with a better understanding of the system's decision-making process and to increase transparency and trust in the diagnosis method. The manual classification of cancer using medical images is a tedious and tiresome process, which necessitates the design of automated tools for the decision-making process. In this study, we explored the significant application of explainable artificial intelligence and an ensemble of deep-learning models for automated cancer diagnosis. To demonstrate the enhanced performance of the proposed model, a widespread comparison study is made with recent models, and the results exhibit the significance of the proposed model on benchmark test images. Therefore, the proposed model has the potential as an automated, accurate, and rapid tool for supporting the detection and classification process of cancer. Explainable Artificial Intelligence (XAI) is a branch of AI that mainly focuses on developing systems that provide understandable and clear explanations for their decisions. In the context of cancer diagnoses on medical imaging, an XAI technology uses advanced image analysis methods like deep learning (DL) to make a diagnosis and analyze medical images, as well as provide a clear explanation for how it arrived at its diagnoses. This includes highlighting specific areas of the image that the system recognized as indicative of cancer while also providing data on the fundamental AI algorithm and decision-making process used. The objective of XAI is to provide patients and doctors with a better understanding of the system's decision-making process and to increase transparency and trust in the diagnosis method. Therefore, this study develops an Adaptive Aquila Optimizer with Explainable Artificial Intelligence Enabled Cancer Diagnosis (AAOXAI-CD) technique on Medical Imaging. The proposed AAOXAI-CD technique intends to accomplish the effectual colorectal and osteosarcoma cancer classification process. To achieve this, the AAOXAI-CD technique initially employs the Faster SqueezeNet model for feature vector generation. As well, the hyperparameter tuning of the Faster SqueezeNet model takes place with the use of the AAO algorithm. For cancer classification, the majority weighted voting ensemble model with three DL classifiers, namely recurrent neural network (RNN), gated recurrent unit (GRU), and bidirectional long short-term memory (BiLSTM). Furthermore, the AAOXAI-CD technique combines the XAI approach LIME for better understanding and explainability of the black-box method for accurate cancer detection. The simulation evaluation of the AAOXAI-CD methodology can be tested on medical cancer imaging databases, and the outcomes ensured the auspicious outcome of the AAOXAI-CD methodology than other current approaches. [ABSTRACT FROM AUTHOR]

Simple Summary: This study proposed the "Residual-Dense-Attention" (RDA) U-Net model architecture to automatically segment organs and lesions in computed tomography (CT) images. The RDA U-Net used ResBlock and DenseBlock at the encoder. Attention gates were used at the decoder position to help the model suppress irrelevant areas of the CT image. Forty-one patients' bladder images were provided for training. The RDA U-Net provided faster but satisfactory segmentation results for bladder cancers and lesions. In today's high-order health examination, imaging examination accounts for a large proportion. Computed tomography (CT), which can detect the whole body, uses X-rays to penetrate the human body to obtain images. Its presentation is a high-resolution black-and-white image composed of gray scales. It is expected to assist doctors in making judgments through deep learning based on the image recognition technology of artificial intelligence. It used CT images to identify the bladder and lesions and then segmented them in the images. The images can achieve high accuracy without using a developer. In this study, the U-Net neural network, commonly used in the medical field, was used to extend the encoder position in combination with the ResBlock in ResNet and the Dense Block in DenseNet, so that the training could maintain the training parameters while reducing the overall identification operation time. The decoder could be used in combination with Attention Gates to suppress the irrelevant areas of the image while paying attention to significant features. Combined with the above algorithm, we proposed a Residual-Dense Attention (RDA) U-Net model, which was used to identify organs and lesions from CT images of abdominal scans. The accuracy (ACC) of using this model for the bladder and its lesions was 96% and 93%, respectively. The values of Intersection over Union (IoU) were 0.9505 and 0.8024, respectively. Average Hausdorff distance (AVGDIST) was as low as 0.02 and 0.12, respectively, and the overall training time was reduced by up to 44% compared with other convolution neural networks. [ABSTRACT FROM AUTHOR]

Simple Summary: Histology sample images are usually diagnosed definitively based on the radiologist's extensive knowledge, yet, owing to the highly gritty visual appearance of such images, specialists sometimes differ on their evaluations. Automating the image diagnostic process and decreasing the analysis time may be achieved via the use of advanced deep learning algorithms. Diagnostic objectivity may be improved with the use of more effective and accurate automated technologies by lessening the differences between the humans. In this research, we propose a CNN model architecture for cancer image classification by accumulating layers closer together to further merge the semantic and spatial features. Regarding precision, our suggested cutting-edge model improves upon the current state-of-the-art approaches. The definitive diagnosis of histology specimen images is largely based on the radiologist's comprehensive experience; however, due to the fine to the coarse visual appearance of such images, experts often disagree with their assessments. Sophisticated deep learning approaches can help to automate the diagnosis process of the images and reduce the analysis duration. More efficient and accurate automated systems can also increase the diagnostic impartiality by reducing the difference between the operators. We propose a FabNet model that can learn the fine-to-coarse structural and textural features of multi-scale histopathological images by using accretive network architecture that agglomerate hierarchical feature maps to acquire significant classification accuracy. We expand on a contemporary design by incorporating deep and close integration to finely combine features across layers. Our deep layer accretive model structure combines the feature hierarchy in an iterative and hierarchically manner that infers higher accuracy and fewer parameters. The FabNet can identify malignant tumors from images and patches from histopathology images. We assessed the efficiency of our suggested model standard cancer datasets, which included breast cancer as well as colon cancer histopathology images. Our proposed avant garde model significantly outperforms existing state-of-the-art models in respect of the accuracy, F1 score, precision, and sensitivity, with fewer parameters. [ABSTRACT FROM AUTHOR]

Simple Summary: The overall incidence of spinal tumors in the United States was estimated to be 0.62 per 100,000 people. Surgical resection of spinal tumors intends to improve functional status, reduce pain, and, in some patients with isolated metastases or primary tumors, increase survival. Machine learning algorithms show great promise for predicting short-term postoperative outcomes in spinal tumor surgery. With this study, we aim to develop machine learning algorithms for predicting short-term postoperative outcomes and implement these models in an open-source web application. Background: Preoperative prediction of short-term postoperative outcomes in spinal tumor patients can lead to more precise patient care plans that reduce the likelihood of negative outcomes. With this study, we aimed to develop machine learning algorithms for predicting short-term postoperative outcomes and implement these models in an open-source web application. Methods: Patients who underwent surgical resection of spinal tumors were identified using the American College of Surgeons, National Surgical Quality Improvement Program. Three outcomes were predicted: prolonged length of stay (LOS), nonhome discharges, and major complications. Four machine learning algorithms were developed and integrated into an open access web application to predict these outcomes. Results: A total of 3073 patients that underwent spinal tumor resection were included in the analysis. The most accurately predicted outcomes in terms of the area under the receiver operating characteristic curve (AUROC) was the prolonged LOS with a mean AUROC of 0.745 The most accurately predicting algorithm in terms of AUROC was random forest, with a mean AUROC of 0.743. An open access web application was developed for getting predictions for individual patients based on their characteristics and this web application can be accessed here: huggingface.co/spaces/MSHS-Neurosurgery-Research/NSQIP-ST. Conclusion: Machine learning approaches carry significant potential for the purpose of predicting postoperative outcomes following spinal tumor resections. Development of predictive models as clinically useful decision-making tools may considerably enhance risk assessment and prognosis as the amount of data in spinal tumor surgery continues to rise. [ABSTRACT FROM AUTHOR]

Simple Summary: The primary purpose of this review is to provide an in-depth analysis of existing Artificial Intelligence (AI) algorithms used in the field of prostate cancer (PC) for diagnosis and treatment. This review aims to show the research community that AI-enabled technologies have the potential for widespread growth and penetration of PC diagnostics and therapeutics to simplify and accelerate existing healthcare processes. As medical science and technology progress towards the era of "big data", a multi-dimensional dataset pertaining to medical diagnosis and treatment is becoming accessible for mathematical modelling. However, these datasets are frequently inconsistent, noisy, and often characterized by a significant degree of redundancy. Thus, extensive data processing is widely advised to clean the dataset before feeding it into the mathematical model. In this context, Artificial intelligence (AI) techniques, including machine learning (ML) and deep learning (DL) algorithms based on artificial neural networks (ANNs) and their types, are being used to produce a precise and cross-sectional illustration of clinical data. For prostate cancer patients, datasets derived from the prostate-specific antigen (PSA), MRI-guided biopsies, genetic biomarkers, and the Gleason grading are primarily used for diagnosis, risk stratification, and patient monitoring. However, recording diagnoses and further stratifying risks based on such diagnostic data frequently involves much subjectivity. Thus, implementing an AI algorithm on a PC's diagnostic data can reduce the subjectivity of the process and assist in decision making. In addition, AI is used to cut down the processing time and help with early detection, which provides a superior outcome in critical cases of prostate cancer. Furthermore, this also facilitates offering the service at a lower cost by reducing the amount of human labor. Herein, the prime objective of this review is to provide a deep analysis encompassing the existing AI algorithms that are being deployed in the field of prostate cancer (PC) for diagnosis and treatment. Based on the available literature, AI-powered technology has the potential for extensive growth and penetration in PC diagnosis and treatment to ease and expedite the existing medical process. [ABSTRACT FROM AUTHOR]

Simple Summary: Colorectal cancer is one of the most frequent cancers worldwide, with a high incidence and mortality. Although many treatment options are available for metastatic disease, patient survival is still limited. The molecular classification of colorectal cancer proposed in 2015 has helped us to better understand colorectal cancer and realize a more effective implementation of therapeutic sequences. It has also been observed that the existing mutational landscape is closely correlated with the epigenetics of colorectal cancer. The identification of prognostic and predictive biomarkers in this context becomes a necessity closely related to therapeutics, and artificial intelligence can be used to discover new biomarkers. Colorectal cancer is a major cause of cancer-related death worldwide and is correlated with genetic and epigenetic alterations in the colonic epithelium. Genetic changes play a major role in the pathophysiology of colorectal cancer through the development of gene mutations, but recent research has shown an important role for epigenetic alterations. In this review, we try to describe the current knowledge about epigenetic alterations, including DNA methylation and histone modifications, as well as the role of non-coding RNAs as epigenetic regulators and the prognostic and predictive biomarkers in metastatic colorectal disease that can allow increases in the effectiveness of treatments. Additionally, the intestinal microbiota's composition can be an important biomarker for the response to strategies based on the immunotherapy of CRC. The identification of biomarkers in mCRC can be enhanced by developing artificial intelligence programs. We present the actual models that implement AI technology as a bridge connecting ncRNAs with tumors and conducted some experiments to improve the quality of the model used as well as the speed of the model that provides answers to users. In order to carry out this task, we implemented six algorithms: the naive Bayes classifier, the random forest classifier, the decision tree classifier, gradient boosted trees, logistic regression and SVM. [ABSTRACT FROM AUTHOR]

Simple Summary: Inducible T-cell COStimulator (ICOS) is a biomarker of interest in checkpoint inhibitor therapy, and as a means of assessing T-cell regulation as part of a complex process of adaptive immunity. The aim of our study is to segment the ICOS positive cells using a lightweight deep-learning segmentation network. We aim to assess the potential of a convolutional neural network and transformer together that permits the capture of relevant features from immunohistochemistry images. The proposed study achieved remarkable results compared to the existing biomedical segmentation methods on our in-house dataset and surpassed our previous analysis by only utilizing the Efficient-UNet network. In this article, we propose ICOSeg, a lightweight deep learning model that accurately segments the immune-checkpoint biomarker, Inducible T-cell COStimulator (ICOS) protein in colon cancer from immunohistochemistry (IHC) slide patches. The proposed model relies on the MobileViT network that includes two main components: convolutional neural network (CNN) layers for extracting spatial features; and a transformer block for capturing a global feature representation from IHC patch images. The ICOSeg uses an encoder and decoder sub-network. The encoder extracts the positive cell's salient features (i.e., shape, texture, intensity, and margin), and the decoder reconstructs important features into segmentation maps. To improve the model generalization capabilities, we adopted a channel attention mechanism that added to the bottleneck of the encoder layer. This approach highlighted the most relevant cell structures by discriminating between the targeted cell and background tissues. We performed extensive experiments on our in-house dataset. The experimental results confirm that the proposed model achieves more significant results against state-of-the-art methods, together with an 8× reduction in parameters. [ABSTRACT FROM AUTHOR]

Simple Summary: Artificial Intelligence (AI) algorithms can assist clinicians in their daily tasks by automatically detecting and/or classifying nodules in chest CT scans. Bias of such algorithms is one of the reasons why implementation of them in clinical practice is still not widely adopted. There is no published review on the bias that these algorithms may contain. This review aims to present different types of bias in such algorithms and present possible ways to mitigate them. Only then it would be possible to ensure that these algorithms work as intended under many different clinical settings. Artificial Intelligence (AI) algorithms for automatic lung nodule detection and classification can assist radiologists in their daily routine of chest CT evaluation. Even though many AI algorithms for these tasks have already been developed, their implementation in the clinical workflow is still largely lacking. Apart from the significant number of false-positive findings, one of the reasons for that is the bias that these algorithms may contain. In this review, different types of biases that may exist in chest CT AI nodule detection and classification algorithms are listed and discussed. Examples from the literature in which each type of bias occurs are presented, along with ways to mitigate these biases. Different types of biases can occur in chest CT AI algorithms for lung nodule detection and classification. Mitigation of them can be very difficult, if not impossible to achieve completely. [ABSTRACT FROM AUTHOR]

Simple Summary: Lung cancer screening has been shown to help reduce mortality in selected populations of smokers; however, performing screening programs at a larger scale with high accuracy is still a challenge. The use of artificial intelligence (AI) has been investigated to improve large scale screening. We have performed a meta-analysis of the diagnostic accuracy of deep learning (DL) algorithms to diagnose lung cancer. Combining six eligible studies, the pooled sensitivity and specificity of DL algorithms were 0.93 (95% CI 0.85–0.98) and 0.68 (95% CI 0.49–0.84), respectively. Despite remaining challenges in the field, AI is likely to play an important role in disease screening in the future. We conducted a systematic review and meta-analysis of the diagnostic performance of current deep learning algorithms for the diagnosis of lung cancer. We searched major databases up to June 2022 to include studies that used artificial intelligence to diagnose lung cancer, using the histopathological analysis of true positive cases as a reference. The quality of the included studies was assessed independently by two authors based on the revised Quality Assessment of Diagnostic Accuracy Studies. Six studies were included in the analysis. The pooled sensitivity and specificity were 0.93 (95% CI 0.85–0.98) and 0.68 (95% CI 0.49–0.84), respectively. Despite the significantly high heterogeneity for sensitivity (I2 = 94%, p < 0.01) and specificity (I2 = 99%, p < 0.01), most of it was attributed to the threshold effect. The pooled SROC curve with a bivariate approach yielded an area under the curve (AUC) of 0.90 (95% CI 0.86 to 0.92). The DOR for the studies was 26.7 (95% CI 19.7–36.2) and heterogeneity was 3% (p = 0.40). In this systematic review and meta-analysis, we found that when using the summary point from the SROC, the pooled sensitivity and specificity of DL algorithms for the diagnosis of lung cancer were 93% and 68%, respectively. [ABSTRACT FROM AUTHOR]

Simple Summary: The rapid development of technology has enabled numerous applications of artificial intelligence (AI), especially in medical science. Histopathological assessment of tissues remains the gold standard for diagnosis of gastrointestinal (GI) cancers for subsequent management. In a traditional anatomical pathology (AP) laboratory, histopathologists are required to manually assess, quantify and classify diseases under a microscope in a semiquantitative or qualitative manner. The conversion of analogue-to-digital pathology is on the rise, conforming with trends toward digitalization. The rapid adoption of digital pathology (DP) is driven by factors such as the worldwide shortage of pathologists and medical technologists, the increasing incidence of cancer and the critical need to improve laboratory efficiency. In this review, we aim to provide a comprehensive summary of algorithms for AI detection and classification of GI cancer. We will also provide critical insight into the application of algorithms for routine care in clinical practice. The implementation of DP will revolutionize current practice by providing pathologists with additional tools and algorithms to improve workflow. Furthermore, DP will open up opportunities for development of AI-based tools for more precise and reproducible diagnosis through computational pathology. One of the key features of AI is its capability to generate perceptions and recognize patterns beyond the human senses. Thus, the incorporation of AI into DP can reveal additional morphological features and information. At the current rate of AI development and adoption of DP, the interest in computational pathology is expected to rise in tandem. There have already been promising developments related to AI-based solutions in prostate cancer detection; however, in the GI tract, development of more sophisticated algorithms is required to facilitate histological assessment of GI specimens for early and accurate diagnosis. In this review, we aim to provide an overview of the current histological practices in AP laboratories with respect to challenges faced in image preprocessing, present the existing AI-based algorithms, discuss their limitations and present clinical insight with respect to the application of AI in early detection and diagnosis of GI cancer. [ABSTRACT FROM AUTHOR]

Simple Summary: We describe a risk profile reconstruction model for cancer-specific survival estimation for continuous time points after urologic cancer diagnosis. We used artificial intelligence (AI)-based algorithms, a national cancer registry data, and accessible clinical parameters for the risk-profile reconstruction. We derived a risk stratification model and estimated the minimum follow-up duration and the likelihood for risk stability in prostate, kidney, and testicular cancers. The estimated follow-up duration was in alignment with recognized clinical guidelines for these cancers. Moreover, the estimated follow-up duration was differed by the cancer origin and the disease dissemination status. Overall, the reconstruction of the population's risk profile for the cancer-specific prognostic score estimation is feasible using AI and has potential application in clinical settings to improve risk stratification and surveillance management. Background: Prognostication is essential to determine the risk profile of patients with urologic cancers. Methods: We utilized the SEER national cancer registry database with approximately 2 million patients diagnosed with urologic cancers (penile, testicular, prostate, bladder, ureter, and kidney). The cohort was randomly divided into the development set (90%) and the out-held test set (10%). Modeling algorithms and clinically relevant parameters were utilized for cancer-specific mortality prognosis. The model fitness for the survival estimation was assessed using the differences between the predicted and observed Kaplan–Meier estimates on the out-held test set. The overall concordance index (c-index) score estimated the discriminative accuracy of the survival model on the test set. A simulation study assessed the estimated minimum follow-up duration and time points with the risk stability. Results: We achieved a well-calibrated prognostic model with an overall c-index score of 0.800 (95% CI: 0.795–0.805) on the representative out-held test set. The simulation study revealed that the suggestions for the follow-up duration covered the minimum duration and differed by the tumor dissemination stages and affected organs. Time points with a high likelihood for risk stability were identifiable. Conclusions: A personalized temporal survival estimation is feasible using artificial intelligence and has potential application in clinical settings, including surveillance management. [ABSTRACT FROM AUTHOR]

Simple Summary: The need for predictive and prognostic biomarkers in colorectal carcinoma (CRC) brought us to an era where the use of artificial intelligence (AI) models is increasing. We investigated the expression of Claudin-7, a tight junction component, which plays a crucial role in maintaining the integrity of normal epithelial mucosa, and its potential prognostic role in advanced CRCs by drawing a parallel between statistical and AI algorithms. Claudin-7 immunohistochemical expression was evaluated in the tumor core and invasion front of CRCs and correlated with clinicopathological parameters and survival using statistical and AI algorithms. The Kaplan–Meier univariate survival analysis showed that the immunohistochemical overexpression of Claudin-7 in the tumor invasive front may represent a poor prognostic factor in advanced stages of CRCs. On the contrary, AI models could not predict the same outcome, probably because of the small number of patients included in our cohort. Aim: The need for predictive and prognostic biomarkers in colorectal carcinoma (CRC) brought us to an era where the use of artificial intelligence (AI) models is increasing. We investigated the expression of Claudin-7, a tight junction component, which plays a crucial role in maintaining the integrity of normal epithelial mucosa, and its potential prognostic role in advanced CRCs, by drawing a parallel between statistical and AI algorithms. Methods: Claudin-7 immunohistochemical expression was evaluated in the tumor core and invasion front of CRCs from 84 patients and correlated with clinicopathological parameters and survival. The results were compared with those obtained by using various AI algorithms. Results: the Kaplan–Meier univariate survival analysis showed a significant correlation between survival and Claudin-7 intensity in the invasive front (p = 0.00), a higher expression being associated with a worse prognosis, while Claudin-7 intensity in the tumor core had no impact on survival. In contrast, AI models could not predict the same outcome on survival. Conclusion: The study showed through statistical means that the immunohistochemical overexpression of Claudin-7 in the tumor invasive front may represent a poor prognostic factor in advanced stages of CRCs, contrary to AI models which could not predict the same outcome, probably because of the small number of patients included in our cohort. [ABSTRACT FROM AUTHOR]

Simple Summary: Large-scale medical data carries significant areas of underrepresentation and bias at all levels: clinical, biological, and management. Resulting data sets and outcome measures reflect these shortcomings in clinical, imaging, and omics data with class imbalance emerging as the single most significant issue inhibiting meaningful and reproducible conclusions while impacting the transfer of findings between the lab and clinic and limiting improvement in patient outcomes. When employing artificial intelligence methods, class imbalance can produce classifiers whose predicted class probabilities are geared toward the majority class ignoring the significance of minority classes, in turn generating algorithmic bias. The inability to mitigate this can guide an AI system in favor of or against various cohorts or variables. We review sources of bias and class imbalance and relate this to AI methods. We discuss avenues to mitigate these and propose a set of guidelines aimed at limiting and addressing data and algorithmic bias. Recent technological developments have led to an increase in the size and types of data in the medical field derived from multiple platforms such as proteomic, genomic, imaging, and clinical data. Many machine learning models have been developed to support precision/personalized medicine initiatives such as computer-aided detection, diagnosis, prognosis, and treatment planning by using large-scale medical data. Bias and class imbalance represent two of the most pressing challenges for machine learning-based problems, particularly in medical (e.g., oncologic) data sets, due to the limitations in patient numbers, cost, privacy, and security of data sharing, and the complexity of generated data. Depending on the data set and the research question, the methods applied to address class imbalance problems can provide more effective, successful, and meaningful results. This review discusses the essential strategies for addressing and mitigating the class imbalance problems for different medical data types in the oncologic domain. [ABSTRACT FROM AUTHOR]

Simple Summary: The assessment of breast lesions through mammographic images is currently challenging, especially in dense breasts. Contrast-enhanced mammography has been shown to overcome the limitations of standard mammography but it greatly depends on the interpretative skills of the physician. The aim of this study was to evaluate the potentialities of statistical and artificial intelligence algorithms as a tool for helping the radiologists in the interpretation of images. The most remarkable results were achieved in discriminating benign from malignant lesions and in the identification of the presence of the hormone receptor. A tool to support the physician's decision-making process may be designed starting from simple logistic regression and tree-based algorithms. This type of tool may help the radiologist in assessing the investigated breast and in choosing the appropriate follow-up without resorting to histology. Purpose: To evaluate radiomics features in order to: differentiate malignant versus benign lesions; predict low versus moderate and high grading; identify positive or negative hormone receptors; and discriminate positive versus negative human epidermal growth factor receptor 2 related to breast cancer. Methods: A total of 182 patients with known breast lesions and that underwent Contrast-Enhanced Mammography were enrolled in this retrospective study. The reference standard was pathology (118 malignant lesions and 64 benign lesions). A total of 837 textural metrics were extracted by manually segmenting the region of interest from both craniocaudally (CC) and mediolateral oblique (MLO) views. Non-parametric Wilcoxon–Mann–Whitney test, receiver operating characteristic, logistic regression and tree-based machine learning algorithms were used. The Adaptive Synthetic Sampling balancing approach was used and a feature selection process was implemented. Results: In univariate analysis, the classification of malignant versus benign lesions achieved the best performance when considering the original_gldm_DependenceNonUniformity feature extracted on CC view (accuracy of 88.98%). An accuracy of 83.65% was reached in the classification of grading, whereas a slightly lower value of accuracy (81.65%) was found in the classification of the presence of the hormone receptor; the features extracted were the original_glrlm_RunEntropy and the original_gldm_DependenceNonUniformity, respectively. The results of multivariate analysis achieved the best performances when using two or more features as predictors for classifying malignant versus benign lesions from CC view images (max test accuracy of 95.83% with a non-regularized logistic regression). Considering the features extracted from MLO view images, the best test accuracy (91.67%) was obtained when predicting the grading using a classification-tree algorithm. Combinations of only two features, extracted from both CC and MLO views, always showed test accuracy values greater than or equal to 90.00%, with the only exception being the prediction of the human epidermal growth factor receptor 2, where the best performance (test accuracy of 89.29%) was obtained with the random forest algorithm. Conclusions: The results confirm that the identification of malignant breast lesions and the differentiation of histological outcomes and some molecular subtypes of tumors (mainly positive hormone receptor tumors) can be obtained with satisfactory accuracy through both univariate and multivariate analysis of textural features extracted from Contrast-Enhanced Mammography images. [ABSTRACT FROM AUTHOR]

Simple Summary: Clear renal cell carcinoma (ccRCC) is the most common type of renal cancer. As with other malignancies, knowledge of the genetic makeup of ccRCC tumors may provide insights for tumor management and outcomes. However, this normally requires obtaining tissue specimens from the tumor by invasive interventions—surgery or biopsy. Radiogenomics is a field that aims to non-invasively predict the genetic makeup of the tumor based on the tumor's appearance on conventional imaging, such as CT scans. To achieve this, radiogenomics uses complex machine learning (artificial intelligence) algorithms to process imaging data and build predictive models that can infer a tumor's genetic makeup and clinical outcomes from its features on conventional imaging. In this article, we searched scientific literature databases for radiogenomic studies in ccRCC, offering a review and critical analysis of these studies. More research and validation are needed before applying radiogenomics in clinical practice. Radiogenomics is a field of translational radiology that aims to associate a disease's radiologic phenotype with its underlying genotype, thus offering a novel class of non-invasive biomarkers with diagnostic, prognostic, and therapeutic potential. We herein review current radiogenomics literature in clear cell renal cell carcinoma (ccRCC), the most common renal malignancy. A literature review was performed by querying PubMed, Medline, Cochrane Library, Google Scholar, and Web of Science databases, identifying all relevant articles using the following search terms: "radiogenomics", "renal cell carcinoma", and "clear cell renal cell carcinoma". Articles included were limited to the English language and published between 2009–2021. Of 141 retrieved articles, 16 fit our inclusion criteria. Most studies used computed tomography (CT) images from open-source and institutional databases to extract radiomic features that were then modeled against common genomic mutations in ccRCC using a variety of machine learning algorithms. In more recent studies, we noted a shift towards the prediction of transcriptomic and/or epigenetic disease profiles, as well as downstream clinical outcomes. Radiogenomics offers a platform for the development of non-invasive biomarkers for ccRCC, with promising results in small-scale retrospective studies. However, more research is needed to identify and validate robust radiogenomic biomarkers before integration into clinical practice. [ABSTRACT FROM AUTHOR]

Simple Summary: Diagnosing cancer at an early stage increases the chance of performing effective treatment in many tumour groups. Key approaches include screening patients who are at risk but have no symptoms, and rapidly and appropriately investigating those who do. Machine learning, whereby computers learn complex data patterns to make predictions, has the potential to revolutionise early cancer diagnosis. Here, we provide an overview of how such algorithms can assist doctors through analyses of routine health records, medical images, biopsy samples and blood tests to improve risk stratification and early diagnosis. Such tools will be increasingly utilised in the coming years. Improving the proportion of patients diagnosed with early-stage cancer is a key priority of the World Health Organisation. In many tumour groups, screening programmes have led to improvements in survival, but patient selection and risk stratification are key challenges. In addition, there are concerns about limited diagnostic workforces, particularly in light of the COVID-19 pandemic, placing a strain on pathology and radiology services. In this review, we discuss how artificial intelligence algorithms could assist clinicians in (1) screening asymptomatic patients at risk of cancer, (2) investigating and triaging symptomatic patients, and (3) more effectively diagnosing cancer recurrence. We provide an overview of the main artificial intelligence approaches, including historical models such as logistic regression, as well as deep learning and neural networks, and highlight their early diagnosis applications. Many data types are suitable for computational analysis, including electronic healthcare records, diagnostic images, pathology slides and peripheral blood, and we provide examples of how these data can be utilised to diagnose cancer. We also discuss the potential clinical implications for artificial intelligence algorithms, including an overview of models currently used in clinical practice. Finally, we discuss the potential limitations and pitfalls, including ethical concerns, resource demands, data security and reporting standards. [ABSTRACT FROM AUTHOR]

Simple Summary: The heterogeneity of complicated diseases like cancer negatively affects patients' responses to treatment. Finding homogeneous subgroups of patients within the cancer population and finding the appropriate treatment for each subgroup will improve patients' survival. In this study, we focus on triple-negative breast cancer (TNBC), where approximately 80% of patients do not entirely respond to chemotherapy. Our aim is to find subgroups of TNBC patients and identify drugs that have the potential to tailor treatments for each group through drug repositioning. After applying our method to TNBC, we found that different targeted mechanisms were suggested for different groups of patients. Our findings could help the research community to gain a better understanding of different subgroups within the TNBC population and can help the drugs to be repurposed with explainable results regarding the targeted mechanism. Breast cancer (BC) is the leading cause of death among female patients with cancer. Patients with triple-negative breast cancer (TNBC) have the lowest survival rate. TNBC has substantial heterogeneity within the BC population. This study utilized our novel patient stratification and drug repositioning method to find subgroups of BC patients that share common genetic profiles and that may respond similarly to the recommended drugs. After further examination of the discovered patient subgroups, we identified five homogeneous druggable TNBC subgroups. A drug repositioning algorithm was then applied to find the drugs with a high potential for each subgroup. Most of the top drugs for these subgroups were chemotherapy used for various types of cancer, including BC. After analyzing the biological mechanisms targeted by these drugs, ferroptosis was the common cell death mechanism induced by the top drugs in the subgroups with neoplasm subdivision and race as clinical variables. In contrast, the antioxidative effect on cancer cells was the common targeted mechanism in the subgroup of patients with an age less than 50. Literature reviews were used to validate our findings, which could provide invaluable insights to streamline the drug repositioning process and could be further studied in a wet lab setting and in clinical trials. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, we propose a general artificial intelligence (AI) based workflow for applying deep learning to the problem of cell identification in immunohistochemistry-stained slides as a basis for quantifying nuclear staining biomarkers. Our approach consists of two main parts: a simplified but robust annotation process, and the application of cell identification models. This results in an optimised process with a new user-friendly tool that can interact with other open-source software and assists pathologists and scientists in creating and exporting data for deep learning. We present a set of architectures for cell identification to quantify and analyse the trade-offs between different deep learning architectures, providing a more accurate and less time-consuming tool than using traditional methods. This approach can identify the best tool to deliver AI tools for clinical utility. Biomarkers identify patient response to therapy. The potential immune-checkpoint biomarker, Inducible T-cell COStimulator (ICOS), expressed on regulating T-cell activation and involved in adaptive immune responses, is of great interest. We have previously shown that open-source software for digital pathology image analysis can be used to detect and quantify ICOS using cell detection algorithms based on traditional image processing techniques. Currently, artificial intelligence (AI) based on deep learning methods is significantly impacting the domain of digital pathology, including the quantification of biomarkers. In this study, we propose a general AI-based workflow for applying deep learning to the problem of cell segmentation/detection in IHC slides as a basis for quantifying nuclear staining biomarkers, such as ICOS. It consists of two main parts: a simplified but robust annotation process, and cell segmentation/detection models. This results in an optimised annotation process with a new user-friendly tool that can interact with1 other open-source software and assists pathologists and scientists in creating and exporting data for deep learning. We present a set of architectures for cell-based segmentation/detection to quantify and analyse the trade-offs between them, proving to be more accurate and less time consuming than traditional methods. This approach can identify the best tool to deliver the prognostic significance of ICOS protein expression. [ABSTRACT FROM AUTHOR]