We then annotated ten thousand WBC images with these attributes, resulting in 113k labels (11 attributes x 10.3k images). Annotating at this level of detail and scale is unprecedented, offering unique value to AI in pathology. Moreover, we conduct experiments to predict these attributes from cell images, and also demonstrate specific applications that can benefit from our detailed annotations.

Explaining deep learning models is essential for clinical integration of medical image analysis systems. A good explanation highlights if a model depends on spurious features that undermines generalization and harms a subset of patients or, conversely, may present novel biological insights. Although techniques like GradCAM can identify influential features, they are measurement tools that do not themselves form an explanation. We propose a human-machine-VLM interaction system tailored to explaining classifiers in computational pathology, including multi-instance learning for whole-slide images. Our proof of concept comprises (1) an AI-integrated slide viewer to run sliding-window experiments to test claims of an explanation, and (2) quantification of an explanation's predictiveness using general-purpose vision-language models. The results demonstrate that this allows us to qualitatively test claims of explanations and can quantifiably distinguish competing explanations. This offers a practical path from explainable AI to explained AI in digital pathology and beyond. Code and prompts are available at https://github.com/nki-ai/x2x.

In this study, we built an end - to - end tumor - infiltrating lymphocytes (TILs) assessment pipeline within QuPath, demonstrating the potential of easily accessible tools to perform complex tasks in a fully automatic fashion. First, we trained a pixel classifie r to segment tumor, tumor - associated stroma, and other tissue compartments in breast cancer H&E - stained whole - slide images (WSI) to isolate tumor - associated stroma for subsequent analysis. Next, we applied a pre - trained StarDist deep learning model in QuPa th for cell detection and used the extracted cell features to train a binary classifier distinguishing TILs from other cells. To evaluate our TILs assessment pipeline, we calculated the TIL density in each WSI and categorized them as low, medium, or high T IL levels. Our pipeline was evaluated against pathologist - assigned TIL scores, achieving a Cohen's kappa of 0.71 on the external test set, corroborating previous research findings. These results confirm that existing software can offer a practical solution for the assessment of TILs in H&E - stained WSIs of breast cancer.

The level of tumour-infiltrating lymphocytes (TILs) is a prognostic factor for patients with (triple-negative) breast cancer (BC). Computational TIL assessment (CTA) has the potential to assist pathologists in this labour-intensive task, but current CTA models rely heavily on many detailed annotations. We propose and validate a fundamentally simpler deep learning based CTA that can be trained in only ten minutes on hundredfold fewer pathologist annotations. We collected whole slide images (WSIs) with TILs scores and clinical data of 2,340 patients with BC from six cohorts including three randomised clinical trials. Morphological features were extracted from whole slide images (WSIs) using a pathology foundation model. Our label-efficient Computational stromal TIL assessment model (ECTIL) directly regresses the TILs score from these features. ECTIL trained on only a few hundred samples (ECTIL-TCGA) showed concordance with the pathologist over five heterogeneous external cohorts (r=0.54-0.74, AUROC=0.80-0.94). Training on all slides of five cohorts (ECTIL-combined) improved results on a held-out test set (r=0.69, AUROC=0.85). Multivariable Cox regression analyses indicated that every 10% increase of ECTIL scores was associated with improved overall survival independent of clinicopathological variables (HR 0.86, p<0.01), similar to the pathologist score (HR 0.87, p<0.001). We demonstrate that ECTIL is highly concordant with an expert pathologist and obtains a similar hazard ratio. ECTIL has a fundamentally simpler design than existing methods and can be trained on orders of magnitude fewer annotations. Such a CTA may be used to pre-screen patients for, e.g., immunotherapy clinical trial inclusion, or as a tool to assist clinicians in the diagnostic work-up of patients with BC. Our model is available under an open source licence (https://github.com/nki-ai/ectil).

The study presents a novel approach for quantifying cellular interactions in digital pathology using deep learning-based image cytometry. Traditional methods struggle with the diversity and heterogeneity of cells within tissues. To address this, we introduce the Spatial Interaction Potential (SIP) and the Co-Localization Index (CLI), leveraging deep learning classification probabilities. SIP assesses the potential for cell-to-cell interactions, similar to an electric field, while CLI incorporates distances between cells, accounting for dynamic cell movements. Our approach enhances traditional methods, providing a more sophisticated analysis of cellular interactions. We validate SIP and CLI through simulations and apply them to colorectal cancer specimens, demonstrating strong correlations with actual biological data. This innovative method offers significant improvements in understanding cellular interactions and has potential applications in various fields of digital pathology.

Lymphoid infiltration at tumor margins is a key prognostic marker in solid tumors, playing a crucial role in guiding immunotherapy decisions. Current assessment methods, heavily reliant on immunohistochemistry (IHC), face challenges in tumor margin delineation and are affected by tissue preservation conditions. In contrast, we propose a Hematoxylin and Eosin (H&E) staining-based approach, underpinned by an advanced lymphocyte segmentation model trained on a public dataset for the precise detection of CD3+ and CD20+ lymphocytes. In our colorectal cancer study, we demonstrate that our H&E-based method offers a compelling alternative to traditional IHC, achieving comparable results in many cases. Our method's validity is further explored through a Turing test, involving blinded assessments by a pathologist of anonymized curves from H&E and IHC slides. This approach invites the medical community to consider Turing tests as a standard for evaluating medical applications involving expert human evaluation, thereby opening new avenues for enhancing cancer management and immunotherapy planning.

Recent approaches in domain-specific named entity recognition (NER), such as biomedical NER, have shown remarkable advances. However, they still lack of faithfulness, producing erroneous predictions. We assume that knowledge of entities can be useful in verifying the correctness of the predictions. Despite the usefulness of knowledge, resolving such errors with knowledge is nontrivial, since the knowledge itself does not directly indicate the ground-truth label. To this end, we propose VerifiNER, a post-hoc verification framework that identifies errors from existing NER methods using knowledge and revises them into more faithful predictions. Our framework leverages the reasoning abilities of large language models to adequately ground on knowledge and the contextual information in the verification process. We validate effectiveness of VerifiNER through extensive experiments on biomedical datasets. The results suggest that VerifiNER can successfully verify errors from existing models as a model-agnostic approach. Further analyses on out-of-domain and low-resource settings show the usefulness of VerifiNER on real-world applications.

With the advent of novel cancer treatment options such as immunotherapy, studying the tumour immune micro-environment is crucial to inform on prognosis and understand response to therapeutic agents. A key approach to characterising the tumour immune micro-environment may be through combining (1) digitised microscopic high-resolution optical images of hematoxylin and eosin (H&E) stained tissue sections obtained in routine histopathology examinations with (2) automated immune cell detection and classification methods. However, current individual immune cell classification models for digital pathology present relatively poor performance. This is mainly due to the limited size of currently available datasets of individual immune cells, a consequence of the time-consuming and difficult problem of manually annotating immune cells on digitised H&E whole slide images. In that context, we introduce Immunocto, a massive, multi-million automatically generated database of 6,848,454 human cells, including 2,282,818 immune cells distributed across 4 subtypes: CD4$^+$ T cell lymphocytes, CD8$^+$ T cell lymphocytes, B cell lymphocytes, and macrophages. For each cell, we provide a 64$\times$64 pixels H&E image at $\mathbf{40}\times$ magnification, along with a binary mask of the nucleus and a label. To create Immunocto, we combined open-source models and data to automatically generate the majority of contours and labels. The cells are obtained from a matched H&E and immunofluorescence colorectal dataset from the Orion platform, while contours are obtained using the Segment Anything Model. A classifier trained on H&E images from Immunocto produces an average F1 score of 0.74 to differentiate the 4 immune cell subtypes and other cells. Immunocto can be downloaded at: https://zenodo.org/uploads/11073373.

Efficient and precise quantification of lymphocytes in histopathology slides is imperative for the characterization of the tumor microenvironment and immunotherapy response insights. We developed a data-centric optimization pipeline that attain great lymphocyte detection performance using an off-the-shelf YOLOv5 model, without any architectural modifications. Our contribution that rely on strategic dataset augmentation strategies, includes novel biological upsampling and custom visual cohesion transformations tailored to the unique properties of tissue imagery, and enables to dramatically improve model performances. Our optimization reveals a pivotal realization: given intensive customization, standard computational pathology models can achieve high-capability biomarker development, without increasing the architectural complexity. We showcase the interest of this approach in the context of breast cancer where our strategies lead to good lymphocyte detection performances, echoing a broadly impactful paradigm shift. Furthermore, our data curation techniques enable crucial histological analysis benchmarks, highlighting improved generalizable potential.