Background: Current artificial intelligence (AI) in histopathology typically specializes on a single task, resulting in a heavy workload of collecting and labeling a sufficient number of images for each type of cancer. Heterogeneous transfer learning (HTL) is expected to alleviate the data bottlenecks and establish models with performance comparable to supervised learning (SL). Methods: An accurate source domain model was trained using 28,634 colorectal patches. Additionally, 1000 sentinel lymph node patches and 1008 breast patches were used to train two target domain models. The feature distribution difference between sentinel lymph node metastasis or breast cancer and CRC was reduced by heterogeneous domain adaptation, and the maximum mean difference between subdomains was used for knowledge transfer to achieve accurate classification across multiple cancers. Result: HTL on 1000 sentinel lymph node patches (L-HTL-1000) outperforms SL on 1000 sentinel lymph node patches (L-SL-1-1000) (average area under the curve (AUC) and standard deviation of L-HTL-1000 vs. L-SL-1-1000: 0.949 ± 0.004 vs. 0.931 ± 0.008, p value = 0.008). There is no significant difference between L-HTL-1000 and SL on 7104 patches (L-SL-2-7104) (0.949 ± 0.004 vs. 0.948 ± 0.008, p value = 0.742). Similar results are observed for breast cancer. B-HTL-1008 vs. B-SL-1-1008: 0.962 ± 0.017 vs. 0.943 ± 0.018, p value = 0.008; B-HTL-1008 vs. B-SL-2-5232: 0.962 ± 0.017 vs. 0.951 ± 0.023, p value = 0.148. Conclusions: HTL is capable of building accurate AI models for similar cancers using a small amount of data based on a large dataset for a certain type of cancer. HTL holds great promise for accelerating the development of AI in histopathology.

In transthoracic echocardiographic (TTE) examination, it is essential to identify the cardiac views accurately. Computer-aided recognition is expected to improve the accuracy of cardiac views of the TTE examination, particularly when obtained by non-trained providers. A new method for automatic recognition of cardiac views is proposed consisting of three processes. First, a spatial transform network is performed to learn cardiac shape changes during a cardiac cycle, which reduces intra-class variability. Second, a channel attention mechanism is introduced to adaptively recalibrate channel-wise feature responses. Finally, the structured signals by the similarities among cardiac views are transformed into the graph-based image embedding, which acts as unsupervised regularization constraints to improve the generalization accuracy. The proposed method is trained and tested in 171792 cardiac images from 584 subjects. The overall accuracy of the proposed method on cardiac image classification is 99.10%, and the mean AUC is 99.36%, better than known methods. Moreover, the overall accuracy is 97.73%, and the mean AUC is 98.59% on an independent test set with 37,883 images from 100 subjects. The proposed automated recognition model achieved comparable accuracy with true cardiac views, and thus can be applied clinically to help find standard cardiac views.

A low-cost pathological image digitalization method based on 5 times magnification scanning Kai Sun, Yanhua Gao, Ting Xie, Xun Wang, Qingqing Yang, Le Chen, Kuansong Wang, Gang Yu

Background: Accurate and robust pathological image analysis for colorectal cancer (CRC) diagnosis is time-consuming and knowledge-intensive, but is essential for CRC patients’ treatment. The current heavy workload of pathologists in clinics/hospitals may easily lead to unconscious misdiagnosis of CRC based on their daily image analyses. Methods: Based on a state-of-the-art transfer-learned deep convolutional neural network in artificial intelligence (AI), we proposed a novel patch aggregation strategy for clinic CRC prediction/diagnosis using weakly labeled pathological whole slide image (WSI) patches. This approach was trained and validated using an unprecedented and enormously large number of 170,099 patches, >14,680 WSIs, from >9,631 subjects that covered diverse and representative clinical cases from multi-independent-sources across China, U.S., and Germany. Results: Our innovative AI tool was consistently nearly perfectly agreed with (average Kappa-statistic 0.896) and even often better than most of the experienced expert pathologists when tested in diagnosing CRC WSIs from multi-centers. The average area under the receiver operating characteristics curve (AUC) of AI was greater than that of the pathologists (0.981 vs 0.970) and achieved the best performance among the application of other AI methods to CRC diagnosis. Our AI-generated heatmap highlights the image regions of cancer tissue/cells. Conclusions: This first-ever generalizable AI system can handle large amounts of WSIs consistently and robustly without potential bias due to fatigue commonly experienced by clinical pathologists. Hence, it will drastically alleviate the heavy clinical burden of daily pathology diagnosis, and improve the treatment for CRC patients. This tool is generalizable to other cancer diagnosis based on image recognition.

Background. Digital pathology has aroused widespread interest in modern pathology. The key of digitalization is to scan the whole slide image (WSI) at high magnification. The lager the magnification is, the richer details WSI will provide, but the scanning time is longer and the file size of obtained is larger. Methods. We design a strategy to scan slides with low resolution (5X) and a super-resolution method is proposed to restore the image details when in diagnosis. The method is based on a multi-scale generative adversarial network, which sequentially generates three high-resolution images such as 10X, 20X and 40X. Results. The peak-signal-to-noise-ratio of 10X to 40X generated images are 24.16, 22.27 and 20.44, and the structural-similarity-index are 0.845, 0.680 and 0.512, which are better than other super-resolution networks. Visual scoring average and standard deviation from three pathologists is 3.63 plus-minus 0.52, 3.70 plus-minus 0.57 and 3.74 plus-minus 0.56 and the p value of analysis of variance is 0.37, indicating that generated images include sufficient information for diagnosis. The average value of Kappa test is 0.99, meaning the diagnosis of generated images is highly consistent with that of the real images. Conclusion. This proposed method can generate high-quality 10X, 20X, 40X images from 5X images at the same time, in which the time and storage costs of digitalization can be effectively reduced up to 1/64 of the previous costs. The proposed method provides a better alternative for low-cost storage, faster image share of digital pathology. Keywords. Digital pathology; Super-resolution; Low resolution scanning; Low cost

Colorectal cancer (CRC) remains a leading cause of cancer mortality globally, yet current histopathological diagnostics capture only limited features. This study aimed to discover subtle, prognostically significant histomorphological patterns in CRC tissues using unsupervised deep learning. We developed a framework integrating convolutional neural networks with deep clustering, trained on 23,341 image patches from 493 patients. We identified 30 distinct histomorphological clusters from CRC tissue images. Through univariate and multivariate survival analyses, three clusters (Cluster13, Cluster19, and Cluster24) were consistently associated with patient prognosis. These clusters were integrated with clinical factors (T stage, N stage, and differentiation degree) to construct a prognostic risk model. Patients stratified into high-risk and low-risk groups based on model predictions showed significant survival differences in both the training set (N = 493) and an independent validation set (N = 2590). Furthermore, logistic regression and multivariate Cox analyses demonstrated that incorporating the three histomorphological clusters alongside clinical factors yielded a modest but statistically significant improvement in predictive performance compared to clinical factors alone, indicating their complementary value for prognosis. This work demonstrates that computational pathology can uncover novel, visually elusive morphological features with independent prognostic value, offering potential to refine CRC patient stratification and inform clinical decision-making.