Artificial intelligence (AI) in digital pathology has gained attention owing to its potential in urological cancer diagnosis and management. This review highlights AI's applications and challenges in three major urological cancers. Prostate cancer studies have demonstrated reliable diagnostic performance and promising prognosis prediction. Renal cancer study shows potential but faces challenges in generalizability and prognosis. Bladder cancer studies are limited by the lack of large-scale datasets. Despite of these active studies, challenges remain regarding data availability, prognosis, and generalizability. Future efforts should emphasize multimodal approaches and multi-institutional collaboration with larger datasets to fully realize the potential of AI in urological cancers.

Accurately segmenting cancer lesions is essential for effective personalized treatment and enhanced patient outcomes. We propose a multi-resolution selective segmentation (MurSS) model to accurately segment breast cancer lesions from hematoxylin and eosin (H&E) stained whole-slide images (WSIs). We used The Cancer Genome Atlas breast invasive carcinoma (BRCA) public dataset for training and validation. We used the Korea University Medical Center, Guro Hospital, BRCA dataset for the final test evaluation. MurSS utilizes both low- and high-resolution patches to leverage multi-resolution features using adaptive instance normalization. This enhances segmentation performance while employing a selective segmentation method to automatically reject ambiguous tissue regions, ensuring stable training. MurSS rejects 5% of WSI regions and achieves a pixel-level accuracy of 96.88% (95% confidence interval (CI): 95.97–97.62%) and mean Intersection over Union of 0.7283 (95% CI: 0.6865–0.7640). In our study, MurSS exhibits superior performance over other deep learning models, showcasing its ability to reject ambiguous areas identified by expert annotations while using multi-resolution inputs.

Accurate prediction of the likelihood of recurrence is important in the selection of postoperative treatment for patients with early-stage breast cancer. In this study, we investigated whether deep learning algorithms can predict patients' risk of recurrence by analyzing the pathology images of their cancer histology.We analyzed 125 hematoxylin and eosin-stained whole slide images (WSIs) from 125 patients across two institutions (National Cancer Center and Korea University Medical Center Guro Hospital) to predict breast cancer recurrence risk using deep learning. Sensitivity reached 0.857, 0.746, and 0.529 for low, intermediate, and high-risk categories, respectively, with specificity of 0.816, 0.803, and 0.972, and a Pearson correlation of 0.61 with histological grade. Class activation maps highlighted features like tubule formation and mitotic rate, suggesting a cost-effective approach to risk stratification, pending broader validation. These findings suggest that deep learning models trained exclusively on hematoxylin and eosin stained whole slide images can approximate genomic assay results, offering a cost-effective and scalable tool for breast cancer recurrence risk assessment. However, further validation using larger and more balanced datasets is needed to confirm the clinical applicability of our approach.

We propose the Multi-resolution Selective Segmentation model (MurSS) for segmenting benign, Ductal Carcinoma In Situ, and Invasive Ductal Carcinoma in breast resection Hematoxylin and Eosin stained Whole Slide Images. MurSS simultaneously trains on context information from a wide area at low resolution and content information from a local area at high resolution, aiming for a more accurate diagnosis. Additionally, through the selection stage, it provides solutions for ambiguous tissue regions. Our proposed MurSS achieves a mean Intersection of Union performance of 91.1%, which is at least 16.8% and at most 19.0% higher than well-known image segmentation models.