Advances in digital pathology and artificial intelligence (AI) offer promising opportunities for clinical decision support and enhancing diagnostic workflows. Previous studies already demonstrated AI's potential for automated Gleason grading, but lack state-of-the-art methodology and model reusability. To address this issue, we propose DeepGleason: an open-source deep neural network based image classification system for automated Gleason grading using whole-slide histopathology images from prostate tissue sections. Implemented with the standardized AUCMEDI framework, our tool employs a tile-wise classification approach utilizing fine-tuned image preprocessing techniques in combination with a ConvNeXt architecture which was compared to various state-of-the-art architectures. The neural network model was trained and validated on an in-house dataset of 34,264 annotated tiles from 369 prostate carcinoma slides. We demonstrated that DeepGleason is capable of highly accurate and reliable Gleason grading with a macro-averaged F1-score of 0.806, AUC of 0.991, and Accuracy of 0.974. The internal architecture comparison revealed that the ConvNeXt model was superior performance-wise on our dataset to established and other modern architectures like transformers. Furthermore, we were able to outperform the current state-of-the-art in tile-wise fine-classification with a sensitivity and specificity of 0.94 and 0.98 for benign vs malignant detection as well as of 0.91 and 0.75 for Gleason 3 vs Gleason 4 & 5 classification, respectively. Our tool contributes to the wider adoption of AI-based Gleason grading within the research community and paves the way for broader clinical application of deep learning models in digital pathology. DeepGleason is open-source and publicly available for research application in the following Git repository: https://github.com/frankkramer-lab/DeepGleason.

Prostate cancer is a dominant health concern calling for advanced diagnostic tools. Utilizing digital pathology and artificial intelligence, this study explores the potential of 11 deep neural network architectures for automated Gleason grading in prostate carcinoma focusing on comparing traditional and recent architectures. A standardized image classification pipeline, based on the AUCMEDI framework, facilitated robust evaluation using an in-house dataset consisting of 34,264 annotated tissue tiles. The results indicated varying sensitivity across architectures, with ConvNeXt demonstrating the strongest performance. Notably, newer architectures achieved superior performance, even though with challenges in differentiating closely related Gleason grades. The ConvNeXt model was capable of learning a balance between complexity and generalizability. Overall, this study lays the groundwork for enhanced Gleason grading systems, potentially improving diagnostic efficiency for prostate cancer.

Novel and high-performance medical image classification pipelines are heavily utilizing ensemble learning strategies. The idea of ensemble learning is to assemble diverse models or multiple predictions and, thus, boost prediction performance. However, it is still an open question to what extent as well as which ensemble learning strategies are beneficial in deep learning based medical image classification pipelines. In this work, we proposed a reproducible medical image classification pipeline for analyzing the performance impact of the following ensemble learning techniques: Augmenting, Stacking, and Bagging. The pipeline consists of state-of-the-art preprocessing and image augmentation methods as well as 9 deep convolution neural network architectures. It was applied on four popular medical imaging datasets with varying complexity. Furthermore, 12 pooling functions for combining multiple predictions were analyzed, ranging from simple statistical functions like unweighted averaging up to more complex learning-based functions like support vector machines. Our results revealed that Stacking achieved the largest performance gain of up to 13% F1-score increase. Augmenting showed consistent improvement capabilities by up to 4% and is also applicable to single model based pipelines. Cross-validation based Bagging demonstrated to be the most complex ensemble learning method, which resulted in an F1-score decrease in all analyzed datasets (up to -10%). Furthermore, we demonstrated that simple statistical pooling functions are equal or often even better than more complex pooling functions. We concluded that the integration of Stacking and Augmentation ensemble learning techniques is a powerful method for any medical image classification pipeline to improve robustness and boost performance.

Preventable or undiagnosed visual impairment and blindness affect billion of people worldwide. Automated multi-disease detection models offer great potential to address this problem via clinical decision support in diagnosis. In this work, we proposed an innovative multi-disease detection pipeline for retinal imaging which utilizes ensemble learning to combine the predictive capabilities of several heterogeneous deep convolutional neural network models. Our pipeline includes state-of-the-art strategies like transfer learning, class weighting, real-time image augmentation and Focal loss utilization. Furthermore, we integrated ensemble learning techniques like heterogeneous deep learning models, bagging via 5-fold cross-validation and stacked logistic regression models. Through internal and external evaluation, we were able to validate and demonstrate high accuracy and reliability of our pipeline, as well as the comparability with other state-of-the-art pipelines for retinal disease prediction.