Breast MRI provides high-resolution imaging critical for breast cancer screening and preoperative staging. However, existing segmentation methods for breast MRI remain limited in scope, often focusing on only a few anatomical structures, such as fibroglandular tissue or tumors, and do not cover the full range of tissues seen in scans. This narrows their utility for quantitative analysis. In this study, we present BreastSegNet, a multi-label segmentation algorithm for breast MRI that covers nine anatomical labels: fibroglandular tissue (FGT), vessel, muscle, bone, lesion, lymph node, heart, liver, and implant. We manually annotated a large set of 1123 MRI slices capturing these structures with detailed review and correction from an expert radiologist. Additionally, we benchmark nine segmentation models, including U-Net, SwinUNet, UNet++, SAM, MedSAM, and nnU-Net with multiple ResNet-based encoders. Among them, nnU-Net ResEncM achieves the highest average Dice scores of 0.694 across all labels. It performs especially well on heart, liver, muscle, FGT, and bone, with Dice scores exceeding 0.73, and approaching 0.90 for heart and liver. All model code and weights are publicly available, and we plan to release the data at a later date.

When David Fajgenbaum was a twenty-five-year-old medical student, at the University of Pennsylvania, he started to feel so tired that he could barely stand. Fajgenbaum, a former college quarterback, could still bench-press three hundred and seventy-five pounds; he was known for doing pullups on a tree near his workplace. But now he was desperately ill. The lymph nodes in his groin and neck swelled. Small red dots--blood moles--emerged on his chest, and he woke up soaked in sweat. One day, at the hospital where he was doing his rotation, he stumbled down the hall into the emergency room, and doctors told him that his liver, bone marrow, and kidneys were failing. Fluid had leaked out of his blood vessels, into his abdomen and around his heart; bleeding in his retina temporarily blinded him in his left eye.

Crohn's disease and intestinal tuberculosis share many overlapping features such as clinical, radiological, endoscopic, and histological features - particularly granulomas, making it challenging to clinically differentiate them. Our research leverages 3D CTE scans, computer vision, and machine learning to improve this differentiation to avoid harmful treatment mismanagement such as unnecessary anti-tuberculosis therapy for Crohn's disease or exacerbation of tuberculosis with immunosuppressants. Our study proposes a novel method to identify radiologist - identified biomarkers such as VF to SF ratio, necrosis, calcifications, comb sign and pulmonary TB to enhance accuracy. We demonstrate the effectiveness by using different ML techniques on the features extracted from these biomarkers, computing SHAP on XGBoost for understanding feature importance towards predictions, and comparing against SOTA methods such as pretrained ResNet and CTFoundation.

Breast cancer is one of the two cancers responsible for the most deaths in women, with about 42,000 deaths each year in the US. That there are over 300,000 breast cancers newly diagnosed each year suggests that only a fraction of the cancers result in mortality. Thus, most of the women undergo seemingly curative treatment for localized cancers, but a significant later succumb to metastatic disease for which current treatments are only temporizing for the vast majority. The current prognostic metrics are of little actionable value for 4 of the 5 women seemingly cured after local treatment, and many women are exposed to morbid and even mortal adjuvant therapies unnecessarily, with these adjuvant therapies reducing metastatic recurrence by only a third. Thus, there is a need for better prognostics to target aggressive treatment at those who are likely to relapse and spare those who were actually cured. While there is a plethora of molecular and tumor-marker assays in use and under-development to detect recurrence early, these are time consuming, expensive and still often un-validated as to actionable prognostic utility. A different approach would use large data techniques to determine clinical and histopathological parameters that would provide accurate prognostics using existing data. Herein, we report on machine learning, together with grid search and Bayesian Networks to develop algorithms that present a AUC of up to 0.9 in ROC analyses, using only extant data. Such algorithms could be rapidly translated to clinical management as they do not require testing beyond routine tumor evaluations.

A grid search, at the cost of training and testing a large number of models, is an effective way to optimize the prediction performance of deep learning models. A challenging task concerning grid search is the time management. Without a good time management scheme, a grid search can easily be set off as a mission that will not finish in our lifetime. In this study, we introduce a heuristic three-stage mechanism for managing the running time of low-budget grid searches, and the sweet-spot grid search (SSGS) and randomized grid search (RGS) strategies for improving model prediction performance, in predicting the 5-year, 10-year, and 15-year risk of breast cancer metastasis. We develop deep feedforward neural network (DFNN) models and optimize them through grid searches. We conduct eight cycles of grid searches by applying our three-stage mechanism and SSGS and RGS strategies. We conduct various SHAP analyses including unique ones that interpret the importance of the DFNN-model hyperparameters. Our results show that grid search can greatly improve model prediction. The grid searches we conducted improved the risk prediction of 5-year, 10-year, and 15-year breast cancer metastasis by 18.6%, 16.3%, and 17.3% respectively, over the average performance of all corresponding models we trained using the RGS strategy. We not only demonstrate best model performance but also characterize grid searches from various aspects such as their capabilities of discovering decent models and the unit grid search time. The three-stage mechanism worked effectively. It made our low-budget grid searches feasible and manageable, and in the meantime helped improve model prediction performance. Our SHAP analyses identified both clinical risk factors important for the prediction of future risk of breast cancer metastasis, and DFNN-model hyperparameters important to the prediction of performance scores.

Remarkable strides in computational pathology have been made in the task-agnostic foundation model that advances the performance of a wide array of downstream clinical tasks. Despite the promising performance, there are still several challenges. First, prior works have resorted to either vision-only or vision-captions data, disregarding invaluable pathology reports and gene expression profiles which respectively offer distinct knowledge for versatile clinical applications. Second, the current progress in pathology FMs predominantly concentrates on the patch level, where the restricted context of patch-level pretraining fails to capture whole-slide patterns. Here we curated the largest multimodal dataset consisting of H\&E diagnostic whole slide images and their associated pathology reports and RNA-Seq data, resulting in 26,169 slide-level modality pairs from 10,275 patients across 32 cancer types. To leverage these data for CPath, we propose a novel whole-slide pretraining paradigm which injects multimodal knowledge at the whole-slide context into the pathology FM, called Multimodal Self-TAught PRetraining (mSTAR). The proposed paradigm revolutionizes the workflow of pretraining for CPath, which enables the pathology FM to acquire the whole-slide context. To our knowledge, this is the first attempt to incorporate multimodal knowledge at the slide level for enhancing pathology FMs, expanding the modelling context from unimodal to multimodal knowledge and from patch-level to slide-level. To systematically evaluate the capabilities of mSTAR, extensive experiments including slide-level unimodal and multimodal applications, are conducted across 7 diverse types of tasks on 43 subtasks, resulting in the largest spectrum of downstream tasks. The average performance in various slide-level applications consistently demonstrates significant performance enhancements for mSTAR compared to SOTA FMs.

Background We aim to use Natural Language Processing (NLP) to automate the extraction and classification of thyroid cancer risk factors from pathology reports. Methods We analyzed 1,410 surgical pathology reports from adult papillary thyroid cancer patients at Mayo Clinic, Rochester, MN, from 2010 to 2019. Structured and non-structured reports were used to create a consensus-based ground truth dictionary and categorized them into modified recurrence risk levels. Non-structured reports were narrative, while structured reports followed standardized formats. We then developed ThyroPath, a rule-based NLP pipeline, to extract and classify thyroid cancer features into risk categories. Training involved 225 reports (150 structured, 75 unstructured), with testing on 170 reports (120 structured, 50 unstructured) for evaluation. The pipeline's performance was assessed using both strict and lenient criteria for accuracy, precision, recall, and F1-score. Results In extraction tasks, ThyroPath achieved overall strict F-1 scores of 93% for structured reports and 90 for unstructured reports, covering 18 thyroid cancer pathology features. In classification tasks, ThyroPath-extracted information demonstrated an overall accuracy of 93% in categorizing reports based on their corresponding guideline-based risk of recurrence: 76.9% for high-risk, 86.8% for intermediate risk, and 100% for both low and very low-risk cases. However, ThyroPath achieved 100% accuracy across all thyroid cancer risk categories with human-extracted pathology information. Conclusions ThyroPath shows promise in automating the extraction and risk recurrence classification of thyroid pathology reports at large scale. It offers a solution to laborious manual reviews and advancing virtual registries. However, it requires further validation before implementation.

Accurate segmentation of metastatic lymph nodes in rectal cancer is crucial for the staging and treatment of rectal cancer. However, existing segmentation approaches face challenges due to the absence of pixel-level annotated datasets tailored for lymph nodes around the rectum. Additionally, metastatic lymph nodes are characterized by their relatively small size, irregular shapes, and lower contrast compared to the background, further complicating the segmentation task. To address these challenges, we present the first large-scale perirectal metastatic lymph node CT image dataset called Meply, which encompasses pixel-level annotations of 269 patients diagnosed with rectal cancer. Furthermore, we introduce a novel lymph-node segmentation model named CoSAM. The CoSAM utilizes sequence-based detection to guide the segmentation of metastatic lymph nodes in rectal cancer, contributing to improved localization performance for the segmentation model. It comprises three key components: sequence-based detection module, segmentation module, and collaborative convergence unit. To evaluate the effectiveness of CoSAM, we systematically compare its performance with several popular segmentation methods using the Meply dataset. Our code and dataset will be publicly available at: https://github.com/kanydao/CoSAM.

In order to optimize the radiotherapy delivery for cancer treatment, especially when dealing with complex treatments such as Total Marrow and Lymph Node Irradiation (TMLI), the accurate contouring of the Planning Target Volume (PTV) is crucial. Unfortunately, relying on manual contouring for such treatments is time-consuming and prone to errors. In this paper, we investigate the application of Deep Learning (DL) to automate the segmentation of the PTV in TMLI treatment, building upon previous work that introduced a solution to this problem based on a 2D U-Net model. We extend the previous research (i) by employing the nnU-Net framework to develop both 2D and 3D U-Net models and (ii) by evaluating the trained models on the PTV with the exclusion of bones, which consist mainly of lymp-nodes and represent the most challenging region of the target volume to segment. Our result show that the introduction of nnU-NET framework led to statistically significant improvement in the segmentation performance. In addition, the analysis on the PTV after the exclusion of bones showed that the models are quite robust also on the most challenging areas of the target volume. Overall, our study is a significant step forward in the application of DL in a complex radiotherapy treatment such as TMLI, offering a viable and scalable solution to increase the number of patients who can benefit from this treatment.

Although supervised machine learning is popular for information extraction from clinical notes, creating large annotated datasets requires extensive domain expertise and is time-consuming. Meanwhile, large language models (LLMs) have demonstrated promising transfer learning capability. In this study, we explored whether recent LLMs can reduce the need for large-scale data annotations. We curated a manually-labeled dataset of 769 breast cancer pathology reports, labeled with 13 categories, to compare zero-shot classification capability of the GPT-4 model and the GPT-3.5 model with supervised classification performance of three model architectures: random forests classifier, long short-term memory networks with attention (LSTM-Att), and the UCSF-BERT model. Across all 13 tasks, the GPT-4 model performed either significantly better than or as well as the best supervised model, the LSTM-Att model (average macro F1 score of 0.83 vs. 0.75). On tasks with high imbalance between labels, the differences were more prominent. Frequent sources of GPT-4 errors included inferences from multiple samples and complex task design. On complex tasks where large annotated datasets cannot be easily collected, LLMs can reduce the burden of large-scale data labeling. However, if the use of LLMs is prohibitive, the use of simpler supervised models with large annotated datasets can provide comparable results. LLMs demonstrated the potential to speed up the execution of clinical NLP studies by reducing the need for curating large annotated datasets. This may result in an increase in the utilization of NLP-based variables and outcomes in observational clinical studies.