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The evaluation of the Human Epidermal growth factor Receptor-2 (HER2) expression is an important prognostic biomarker for breast cancer treatment selection. However, HER2 scoring has notoriously high interobserver variability due to stain variations between centers and the need to estimate visually the staining intensity in specific percentages of tumor area. In this paper, focusing on the interpretability of HER2 scoring by a pathologist, we propose a semi-automatic, two-stage deep learning approach that directly evaluates the clinical HER2 guidelines defined by the American Society of Clinical Oncology/ College of American Pathologists (ASCO/CAP). In the first stage, we segment the invasive tumor over the user-indicated Region of Interest (ROI). Then, in the second stage, we classify the tumor tissue into four HER2 classes. For the classification stage, we use weakly supervised, constrained optimization to find a model that classifies cancerous patches such that the tumor surface percentage meets the guidelines specification of each HER2 class. We end the second stage by freezing the model and refining its output logits in a supervised way to all slide labels in the training set. To ensure the quality of our dataset's labels, we conducted a multi-pathologist HER2 scoring consensus. For the assessment of doubtful cases where no consensus was found, our model can help by interpreting its HER2 class percentages output. We achieve a performance of 0.78 in F1-score on the test set while keeping our model interpretable for the pathologist, hopefully contributing to interpretable AI models in digital pathology., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Rutger Fick reports financial support was provided by Tribun Health. Manh Dan Pham reports financial support was provided by Tribun Health. Guillaume Balezo reports financial support was provided by Tribun Health. Cyprien Tilmant reports financial support was provided by Tribun Health. Stephanie Pett reports financial support was provided by Tribun Health. Saima Ben Hadj reports financial support was provided by Tribun Health., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The density of mitotic figures (MF) within tumor tissue is known to be highly correlated with tumor proliferation and thus is an important marker in tumor grading. Recognition of MF by pathologists is subject to a strong inter-rater bias, limiting its prognostic value. State-of-the-art deep learning methods can support experts but have been observed to strongly deteriorate when applied in a different clinical environment. The variability caused by using different whole slide scanners has been identified as one decisive component in the underlying domain shift. The goal of the MICCAI MIDOG 2021 challenge was the creation of scanner-agnostic MF detection algorithms. The challenge used a training set of 200 cases, split across four scanning systems. As test set, an additional 100 cases split across four scanning systems, including two previously unseen scanners, were provided. In this paper, we evaluate and compare the approaches that were submitted to the challenge and identify methodological factors contributing to better performance. The winning algorithm yielded an F 1 score of 0.748 (CI95: 0.704-0.781), exceeding the performance of six experts on the same task., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The French Society of Pathology (SFP) organized its first data challenge in 2020 with the help of the Health Data Hub (HDH). The organization of this event first consisted of recruiting nearly 5000 cervical biopsy slides obtained from 20 pathology centers. After ensuring that patients did not refuse to include their slides in the project, the slides were anonymized, digitized, and annotated by expert pathologists, and finally uploaded to a data challenge platform for competitors from around the world. Competing teams had to develop algorithms that could distinguish 4 diagnostic classes in cervical epithelial lesions. Among the many submissions from competitors, the best algorithms achieved an overall score close to 95%. The final part of the competition lasted only 6 weeks, and the goal of SFP and HDH is now to allow for the collection to be published in open access for the scientific community. In this report, we have performed a "post-competition analysis" of the results. We first described the algorithmic pipelines of 3 top competitors. We then analyzed several difficult cases that even the top competitors could not predict correctly. A medical committee of several expert pathologists looked for possible explanations for these erroneous results by reviewing the images, and we present their findings here targeted for a large audience of pathologists and data scientists in the field of digital pathology., (© 2022 The Author(s).)

Cervical cancer is the fourth most common cancer in women worldwide. To determine early treatment for patients, it is critical to accurately classify the cervical intraepithelial lesion status based on a microscopic biopsy. Lesion classification is a 4-class problem, with biopsies being designated as benign or increasingly malignant as class 1-3, with 3 being invasive cancer. Unfortunately, traditional biopsy analysis by a pathologist is time-consuming and subject to intra- and inter-observer variability. For this reason, it is of interest to develop automatic analysis pipelines to classify lesion status directly from a digitalized whole slide image (WSI). The recent TissueNet Challenge was organized to find the best automatic detection pipeline for this task, using a dataset of 1015 annotated WSI slides. In this work, we present our winning end-to-end solution for cervical slide classification composed of a two-step classification model: First, we classify individual slide patches using an ensemble CNN, followed by an SVM-based slide classification using statistical features of the aggregated patch-level predictions. Importantly, we present the key innovation of our approach, which is a novel partial label-based loss function that allows us to supplement the supervised WSI patch annotations with weakly supervised patches based on the WSI class. This led to us not requiring additional expert tissue annotation, while still reaching the winning score of 94.7%. Our approach is a step towards the clinical inclusion of automatic pipelines for cervical cancer treatment planning.Clinical relevance- The explanation of the winning Tis-sueNet AI algorithm for automated cervical cancer classification, which may provide insights for the next generation of computer assisted tools in digital pathology.

Effective representation of the four-dimensional diffusion MRI signal - varying over three-dimensional q-space and diffusion time τ - is a sought-after and still unsolved challenge in diffusion MRI (dMRI). We propose a functional basis approach that is specifically designed to represent the dMRI signal in this qτ-space. Following recent terminology, we refer to our qτ-functional basis as "qτ-dMRI". qτ-dMRI can be seen as a time-dependent realization of q-space imaging by Paul Callaghan and colleagues. We use GraphNet regularization - imposing both signal smoothness and sparsity - to drastically reduce the number of diffusion-weighted images (DWIs) that is needed to represent the dMRI signal in the qτ-space. As the main contribution, qτ-dMRI provides the framework to - without making biophysical assumptions - represent the qτ-space signal and estimate time-dependent q-space indices (qτ-indices), providing a new means for studying diffusion in nervous tissue. We validate our method on both in-silico generated data using Monte-Carlo simulations and an in-vivo test-retest study of two C57Bl6 wild-type mice, where we found good reproducibility of estimated qτ-index values and trends. In the hopes of opening up new τ-dependent venues of studying nervous tissues, qτ-dMRI is the first of its kind in being specifically designed to provide open interpretation of the qτ-diffusion signal., (Copyright © 2017 Elsevier B.V. All rights reserved.)

A large number of mathematical models have been proposed to describe the measured signal in diffusion-weighted (DW) magnetic resonance imaging (MRI). However, model comparison to date focuses only on specific subclasses, e.g. compartment models or signal models, and little or no information is available in the literature on how performance varies among the different types of models. To address this deficiency, we organized the 'White Matter Modeling Challenge' during the International Symposium on Biomedical Imaging (ISBI) 2015 conference. This competition aimed to compare a range of different kinds of models in their ability to explain a large range of measurable in vivo DW human brain data. Specifically, we assessed the ability of models to predict the DW signal accurately for new diffusion gradients and b values. We did not evaluate the accuracy of estimated model parameters, as a ground truth is hard to obtain. We used the Connectome scanner at the Massachusetts General Hospital, using gradient strengths of up to 300 mT/m and a broad set of diffusion times. We focused on assessing the DW signal prediction in two regions: the genu in the corpus callosum, where the fibres are relatively straight and parallel, and the fornix, where the configuration of fibres is more complex. The challenge participants had access to three-quarters of the dataset and their models were ranked on their ability to predict the remaining unseen quarter of the data. The challenge provided a unique opportunity for a quantitative comparison of diverse methods from multiple groups worldwide. The comparison of the challenge entries reveals interesting trends that could potentially influence the next generation of diffusion-based quantitative MRI techniques. The first is that signal models do not necessarily outperform tissue models; in fact, of those tested, tissue models rank highest on average. The second is that assuming a non-Gaussian (rather than purely Gaussian) noise model provides little improvement in prediction of unseen data, although it is possible that this may still have a beneficial effect on estimated parameter values. The third is that preprocessing the training data, here by omitting signal outliers, and using signal-predicting strategies, such as bootstrapping or cross-validation, could benefit the model fitting. The analysis in this study provides a benchmark for other models and the data remain available to build up a more complete comparison in the future., (Copyright © 2017 The Authors. NMR in Biomedicine Published by John Wiley & Sons, Ltd.)

The recovery of microstructure-related features of the brain's white matter is a current challenge in diffusion MRI. To robustly estimate these important features from multi-shell diffusion MRI data, we propose to analytically regularize the coefficient estimation of the Mean Apparent Propagator (MAP)-MRI method using the norm of the Laplacian of the reconstructed signal. We first compare our approach, which we call MAPL, with competing, state-of-the-art functional basis approaches. We show that it outperforms the original MAP-MRI implementation and the recently proposed modified Spherical Polar Fourier (mSPF) basis with respect to signal fitting and reconstruction of the Ensemble Average Propagator (EAP) and Orientation Distribution Function (ODF) in noisy, sparsely sampled data of a physical phantom with reference gold standard data. Then, to reduce the variance of parameter estimation using multi-compartment tissue models, we propose to use MAPL's signal fitting and extrapolation as a preprocessing step. We study the effect of MAPL on the estimation of axon diameter using a simplified Axcaliber model and axonal dispersion using the Neurite Orientation Dispersion and Density Imaging (NODDI) model. We show the positive effect of using it as a preprocessing step in estimating and reducing the variances of these parameters in the Corpus Callosum of six different subjects of the MGH Human Connectome Project. Finally, we correlate the estimated axon diameter, dispersion and restricted volume fractions with Fractional Anisotropy (FA) and clearly show that changes in FA significantly correlate with changes in all estimated parameters. Overall, we illustrate the potential of using a well-regularized functional basis together with multi-compartment approaches to recover important microstructure tissue parameters with much less variability, thus contributing to the challenge of better understanding microstructure-related features of the brain's white matter., (Copyright © 2016 Elsevier Inc. All rights reserved.)