A Graph-Based Multi-Scale Approach With Knowledge Distillation for WSI Classification.

The usage of Multi Instance Learning (MIL) for classifying Whole Slide Images (WSIs) has recently increased. Due to their gigapixel size, the pixel-level annotation of such data is extremely expensive and time-consuming, practically unfeasible. For this reason, multiple automatic approaches have been raised in the last years to support clinical practice and diagnosis. Unfortunately, most state-of-the-art proposals apply attention mechanisms without considering the spatial instance correlation and usually work on a single-scale resolution. To leverage the full potential of pyramidal structured WSI, we propose a graph-based multi-scale MIL approach, DAS-MIL. Our model comprises three modules: i) a self-supervised feature extractor, ii) a graph-based architecture that precedes the MIL mechanism and aims at creating a more contextualized representation of the WSI structure by considering the mutual (spatial) instance correlation both inter and intra-scale. Finally, iii) a (self) distillation loss between resolutions is introduced to compensate for their informative gap and significantly improve the final prediction. The effectiveness of the proposed framework is demonstrated on two well-known datasets, where we outperform SOTA on WSI classification, gaining a +2.7% AUC and +3.7% accuracy on the popular Camelyon16 benchmark.

Automated Prediction of Kidney Failure in IgA Nephropathy with Deep Learning from Biopsy Images.

BACKGROUND AND OBJECTIVES: Digital pathology and artificial intelligence offer new opportunities for automatic histologic scoring. We applied a deep learning approach to IgA nephropathy biopsy images to develop an automatic histologic prognostic score, assessed against ground truth (kidney failure) among patients with IgA nephropathy who were treated over 39 years. We assessed noninferiority in comparison with the histologic component of currently validated predictive tools. We correlated additional histologic features with our deep learning predictive score to identify potential additional predictive features. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Training for deep learning was performed with randomly selected, digitalized, cortical Periodic acid-Schiff-stained sections images (363 kidney biopsy specimens) to develop our deep learning predictive score. We estimated noninferiority using the area under the receiver operating characteristic curve (AUC) in a randomly selected group (95 biopsy specimens) against the gold standard Oxford classification (MEST-C) scores used by the International IgA Nephropathy Prediction Tool and the clinical decision supporting system for estimating the risk of kidney failure in IgA nephropathy. We assessed additional potential predictive histologic features against a subset (20 kidney biopsy specimens) with the strongest and weakest deep learning predictive scores. RESULTS: We enrolled 442 patients; the 10-year kidney survival was 78%, and the study median follow-up was 6.7 years. Manual MEST-C showed no prognostic relationship for the endocapillary parameter only. The deep learning predictive score was not inferior to MEST-C applied using the International IgA Nephropathy Prediction Tool and the clinical decision supporting system (AUC of 0.84 versus 0.77 and 0.74, respectively) and confirmed a good correlation with the tubolointerstitial score (r=0.41, P<0.01). We observed no correlations between the deep learning prognostic score and the mesangial, endocapillary, segmental sclerosis, and crescent parameters. Additional potential predictive histopathologic features incorporated by the deep learning predictive score included (1) inflammation within areas of interstitial fibrosis and tubular atrophy and (2) hyaline casts. CONCLUSIONS: The deep learning approach was noninferior to manual histopathologic reporting and considered prognostic features not currently included in MEST-C assessment. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_07_26_CJN01760222.mp3.

One DAG to Rule Them All.

In this paper, we present novel strategies for optimizing the performance of many binary image processing algorithms. These strategies are collected in an open-source framework, GRAPHGEN, that is able to automatically generate optimized C++ source code implementing the desired optimizations. Simply starting from a set of rules, the algorithms introduced with the GRAPHGEN framework can generate decision trees with minimum average path-length, possibly considering image pattern frequencies, apply state prediction and code compression by the use of Directed Rooted Acyclic Graphs (DRAGs). Moreover, the proposed algorithmic solutions allow to combine different optimization techniques and significantly improve performance. Our proposal is showcased on three classical and widely employed algorithms (namely Connected Components Labeling, Thinning, and Contour Tracing). When compared to existing approaches -in 2D and 3D-, implementations using the generated optimal DRAGs perform significantly better than previous state-of-the-art algorithms, both on CPU and GPU.

Evaluation of the Classification Accuracy of the Kidney Biopsy Direct Immunofluorescence through Convolutional Neural Networks.

BACKGROUND AND OBJECTIVES: Immunohistopathology is an essential technique in the diagnostic workflow of a kidney biopsy. Deep learning is an effective tool in the elaboration of medical imaging. We wanted to evaluate the role of a convolutional neural network as a support tool for kidney immunofluorescence reporting. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: High-magnification (×400) immunofluorescence images of kidney biopsies performed from the year 2001 to 2018 were collected. The report, adopted at the Division of Nephrology of the AOU Policlinico di Modena, describes the specimen in terms of "appearance," "distribution," "location," and "intensity" of the glomerular deposits identified with fluorescent antibodies against IgG, IgA, IgM, C1q and C3 complement fractions, fibrinogen, and κ- and λ-light chains. The report was used as ground truth for the training of the convolutional neural networks. RESULTS: In total, 12,259 immunofluorescence images of 2542 subjects undergoing kidney biopsy were collected. The test set analysis showed accuracy values between 0.79 ("irregular capillary wall" feature) and 0.94 ("fine granular" feature). The agreement test of the results obtained by the convolutional neural networks with respect to the ground truth showed similar values to three pathologists of our center. Convolutional neural networks were 117 times faster than human evaluators in analyzing 180 test images. A web platform, where it is possible to upload digitized images of immunofluorescence specimens, is available to evaluate the potential of our approach. CONCLUSIONS: The data showed that the accuracy of convolutional neural networks is comparable with that of pathologists experienced in the field.

Spaghetti Labeling: Directed Acyclic Graphs for Block-Based Connected Components Labeling.

Connected Components Labeling is an essential step of many Image Processing and Computer Vision tasks. Since the first proposal of a labeling algorithm, which dates back to the sixties, many approaches have optimized the computational load needed to label an image. In particular, the use of decision forests and state prediction have recently appeared as valuable strategies to improve performance. However, due to the overhead of the manual construction of prediction states and the size of the resulting machine code, the application of these strategies has been restricted to small masks, thus ignoring the benefit of using a block-based approach. In this paper, we combine a block-based mask with state prediction and code compression: the resulting algorithm is modeled as a Directed Rooted Acyclic Graph with multiple entry points, which is automatically generated without manual intervention. When tested on synthetic and real datasets, in comparison with optimized implementations of state-of-the-art algorithms, the proposed approach shows superior performance, surpassing the results obtained by all compared approaches in all settings.