Deep learning as a tool for increased accuracy and efficiency of histopathological diagnosis
TL;DR: It is found that all slides containing prostate cancer and micro- and macro-metastases of breast cancer could be identified automatically while 30–40% of the slides containing benign and normal tissue could be excluded without the use of any additional immunohistochemical markers or human intervention.
Abstract: Pathologists face a substantial increase in workload and complexity of histopathologic cancer diagnosis due to the advent of personalized medicine. Therefore, diagnostic protocols have to focus equally on efficiency and accuracy. In this paper we introduce 'deep learning' as a technique to improve the objectivity and efficiency of histopathologic slide analysis. Through two examples, prostate cancer identification in biopsy specimens and breast cancer metastasis detection in sentinel lymph nodes, we show the potential of this new methodology to reduce the workload for pathologists, while at the same time increasing objectivity of diagnoses. We found that all slides containing prostate cancer and micro- and macro-metastases of breast cancer could be identified automatically while 30-40% of the slides containing benign and normal tissue could be excluded without the use of any additional immunohistochemical markers or human intervention. We conclude that 'deep learning' holds great promise to improve the efficacy of prostate cancer diagnosis and breast cancer staging.
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TL;DR: This paper reviews the major deep learning concepts pertinent to medical image analysis and summarizes over 300 contributions to the field, most of which appeared in the last year, to survey the use of deep learning for image classification, object detection, segmentation, registration, and other tasks.
8,730 citations
Radboud University Nijmegen1, Eindhoven University of Technology2, Utrecht University3, Beth Israel Deaconess Medical Center4, Massachusetts Institute of Technology5, Harvard University6, The Chinese University of Hong Kong7, Munich Business School8, Middle East Technical University9, University of Toronto10, University of Warwick11, Coventry Health Care12, Qatar University13, HTW Berlin - University of Applied Sciences14, Tampere University of Technology15, University of Tampere16, Technische Universität München17, Osaka University18, University of South Florida19, National Academy of Sciences of Belarus20, University of Castilla–La Mancha21, Pierre-and-Marie-Curie University22, Pontifical Catholic University of Peru23
TL;DR: In the setting of a challenge competition, some deep learning algorithms achieved better diagnostic performance than a panel of 11 pathologists participating in a simulation exercise designed to mimic routine pathology workflow; algorithm performance was comparable with an expert pathologist interpreting whole-slide images without time constraints.
Abstract: Importance Application of deep learning algorithms to whole-slide pathology images can potentially improve diagnostic accuracy and efficiency. Objective Assess the performance of automated deep learning algorithms at detecting metastases in hematoxylin and eosin–stained tissue sections of lymph nodes of women with breast cancer and compare it with pathologists’ diagnoses in a diagnostic setting. Design, Setting, and Participants Researcher challenge competition (CAMELYON16) to develop automated solutions for detecting lymph node metastases (November 2015-November 2016). A training data set of whole-slide images from 2 centers in the Netherlands with (n = 110) and without (n = 160) nodal metastases verified by immunohistochemical staining were provided to challenge participants to build algorithms. Algorithm performance was evaluated in an independent test set of 129 whole-slide images (49 with and 80 without metastases). The same test set of corresponding glass slides was also evaluated by a panel of 11 pathologists with time constraint (WTC) from the Netherlands to ascertain likelihood of nodal metastases for each slide in a flexible 2-hour session, simulating routine pathology workflow, and by 1 pathologist without time constraint (WOTC). Exposures Deep learning algorithms submitted as part of a challenge competition or pathologist interpretation. Main Outcomes and Measures The presence of specific metastatic foci and the absence vs presence of lymph node metastasis in a slide or image using receiver operating characteristic curve analysis. The 11 pathologists participating in the simulation exercise rated their diagnostic confidence as definitely normal, probably normal, equivocal, probably tumor, or definitely tumor. Results The area under the receiver operating characteristic curve (AUC) for the algorithms ranged from 0.556 to 0.994. The top-performing algorithm achieved a lesion-level, true-positive fraction comparable with that of the pathologist WOTC (72.4% [95% CI, 64.3%-80.4%]) at a mean of 0.0125 false-positives per normal whole-slide image. For the whole-slide image classification task, the best algorithm (AUC, 0.994 [95% CI, 0.983-0.999]) performed significantly better than the pathologists WTC in a diagnostic simulation (mean AUC, 0.810 [range, 0.738-0.884];P Conclusions and Relevance In the setting of a challenge competition, some deep learning algorithms achieved better diagnostic performance than a panel of 11 pathologists participating in a simulation exercise designed to mimic routine pathology workflow; algorithm performance was comparable with an expert pathologist interpreting whole-slide images without time constraints. Whether this approach has clinical utility will require evaluation in a clinical setting.
2,116 citations
Additional excerpts
...Training (n = 270 images) RUMC 54 16 100 35 35 2 (1-20) 170...
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...Test (n=129 slides and images) RUMC 23 6 50 14 15 2 (1-14) 79...
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TL;DR: A general understanding of AI methods, particularly those pertaining to image-based tasks, is established and how these methods could impact multiple facets of radiology is explored, with a general focus on applications in oncology.
Abstract: Artificial intelligence (AI) algorithms, particularly deep learning, have demonstrated remarkable progress in image-recognition tasks. Methods ranging from convolutional neural networks to variational autoencoders have found myriad applications in the medical image analysis field, propelling it forward at a rapid pace. Historically, in radiology practice, trained physicians visually assessed medical images for the detection, characterization and monitoring of diseases. AI methods excel at automatically recognizing complex patterns in imaging data and providing quantitative, rather than qualitative, assessments of radiographic characteristics. In this Opinion article, we establish a general understanding of AI methods, particularly those pertaining to image-based tasks. We explore how these methods could impact multiple facets of radiology, with a general focus on applications in oncology, and demonstrate ways in which these methods are advancing the field. Finally, we discuss the challenges facing clinical implementation and provide our perspective on how the domain could be advanced.
1,599 citations
University of Hawaii at Manoa1, University of Pennsylvania2, University of Michigan3, Harvard University4, GlaxoSmithKline5, Imperial College London6, University of Toronto7, Princess Margaret Cancer Centre8, Vanderbilt University9, Drexel University10, Carnegie Mellon University11, Stanford University12, University of Virginia13, Broad Institute14, Toyota Technological Institute at Chicago15, Princeton University16, Trinity University17, National Institutes of Health18, Howard Hughes Medical Institute19, University of Florida20, University of Colorado Denver21, University of Münster22, Georgetown University Medical Center23, Washington University in St. Louis24, Brown University25, Morgridge Institute for Research26, University of Wisconsin-Madison27
TL;DR: It is found that deep learning has yet to revolutionize biomedicine or definitively resolve any of the most pressing challenges in the field, but promising advances have been made on the prior state of the art.
Abstract: Deep learning describes a class of machine learning algorithms that are capable of combining raw inputs into layers of intermediate features. These algorithms have recently shown impressive results across a variety of domains. Biology and medicine are data-rich disciplines, but the data are complex and often ill-understood. Hence, deep learning techniques may be particularly well suited to solve problems of these fields. We examine applications of deep learning to a variety of biomedical problems-patient classification, fundamental biological processes and treatment of patients-and discuss whether deep learning will be able to transform these tasks or if the biomedical sphere poses unique challenges. Following from an extensive literature review, we find that deep learning has yet to revolutionize biomedicine or definitively resolve any of the most pressing challenges in the field, but promising advances have been made on the prior state of the art. Even though improvements over previous baselines have been modest in general, the recent progress indicates that deep learning methods will provide valuable means for speeding up or aiding human investigation. Though progress has been made linking a specific neural network's prediction to input features, understanding how users should interpret these models to make testable hypotheses about the system under study remains an open challenge. Furthermore, the limited amount of labelled data for training presents problems in some domains, as do legal and privacy constraints on work with sensitive health records. Nonetheless, we foresee deep learning enabling changes at both bench and bedside with the potential to transform several areas of biology and medicine.
1,491 citations
Cites background from "Deep learning as a tool for increas..."
...Systems to aid in the analysis of histology slides are also promising use cases for deep learning [65]....
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TL;DR: Recent breakthroughs in AI technologies and their biomedical applications are outlined, the challenges for further progress in medical AI systems are identified, and the economic, legal and social implications of AI in healthcare are summarized.
Abstract: Artificial intelligence (AI) is gradually changing medical practice. With recent progress in digitized data acquisition, machine learning and computing infrastructure, AI applications are expanding into areas that were previously thought to be only the province of human experts. In this Review Article, we outline recent breakthroughs in AI technologies and their biomedical applications, identify the challenges for further progress in medical AI systems, and summarize the economic, legal and social implications of AI in healthcare.
1,315 citations
References
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Proceedings Article•
03 Dec 2012TL;DR: The state-of-the-art performance of CNNs was achieved by Deep Convolutional Neural Networks (DCNNs) as discussed by the authors, which consists of five convolutional layers, some of which are followed by max-pooling layers, and three fully-connected layers with a final 1000-way softmax.
Abstract: We trained a large, deep convolutional neural network to classify the 1.2 million high-resolution images in the ImageNet LSVRC-2010 contest into the 1000 different classes. On the test data, we achieved top-1 and top-5 error rates of 37.5% and 17.0% which is considerably better than the previous state-of-the-art. The neural network, which has 60 million parameters and 650,000 neurons, consists of five convolutional layers, some of which are followed by max-pooling layers, and three fully-connected layers with a final 1000-way softmax. To make training faster, we used non-saturating neurons and a very efficient GPU implementation of the convolution operation. To reduce overriding in the fully-connected layers we employed a recently-developed regularization method called "dropout" that proved to be very effective. We also entered a variant of this model in the ILSVRC-2012 competition and achieved a winning top-5 test error rate of 15.3%, compared to 26.2% achieved by the second-best entry.
73,978 citations
[...]
TL;DR: Deep learning is making major advances in solving problems that have resisted the best attempts of the artificial intelligence community for many years, and will have many more successes in the near future because it requires very little engineering by hand and can easily take advantage of increases in the amount of available computation and data.
Abstract: Deep learning allows computational models that are composed of multiple processing layers to learn representations of data with multiple levels of abstraction. These methods have dramatically improved the state-of-the-art in speech recognition, visual object recognition, object detection and many other domains such as drug discovery and genomics. Deep learning discovers intricate structure in large data sets by using the backpropagation algorithm to indicate how a machine should change its internal parameters that are used to compute the representation in each layer from the representation in the previous layer. Deep convolutional nets have brought about breakthroughs in processing images, video, speech and audio, whereas recurrent nets have shone light on sequential data such as text and speech.
46,982 citations
07 Jun 2015
TL;DR: Inception as mentioned in this paper is a deep convolutional neural network architecture that achieves the new state of the art for classification and detection in the ImageNet Large-Scale Visual Recognition Challenge 2014 (ILSVRC14).
Abstract: We propose a deep convolutional neural network architecture codenamed Inception that achieves the new state of the art for classification and detection in the ImageNet Large-Scale Visual Recognition Challenge 2014 (ILSVRC14). The main hallmark of this architecture is the improved utilization of the computing resources inside the network. By a carefully crafted design, we increased the depth and width of the network while keeping the computational budget constant. To optimize quality, the architectural decisions were based on the Hebbian principle and the intuition of multi-scale processing. One particular incarnation used in our submission for ILSVRC14 is called GoogLeNet, a 22 layers deep network, the quality of which is assessed in the context of classification and detection.
40,257 citations
Book•
01 Jan 1993TL;DR: This article presents bootstrap methods for estimation, using simple arguments, with Minitab macros for implementing these methods, as well as some examples of how these methods could be used for estimation purposes.
Abstract: This article presents bootstrap methods for estimation, using simple arguments. Minitab macros for implementing these methods are given.
37,183 citations
TL;DR: Statistical theory attacks the problem from both ends as discussed by the authors, and provides optimal methods for finding a real signal in a noisy background, and also provides strict checks against the overinterpretation of random patterns.
Abstract: Statistics is the science of learning from experience, especially experience that arrives a little bit at a time. The earliest information
science was statistics, originating in about 1650. This century has
seen statistical techniques become the analytic methods of choice
in biomedical science, psychology, education, economics, communications theory, sociology, genetic studies, epidemiology, and other
areas. Recently, traditional sciences like geology, physics, and astronomy have begun to make increasing use of statistical methods
as they focus on areas that demand informational efficiency, such as
the study of rare and exotic particles or extremely distant galaxies.
Most people are not natural-born statisticians. Left to our own
devices we are not very good at picking out patterns from a sea
of noisy data. To put it another way, we are all too good at picking out non-existent patterns that happen to suit our purposes.
Statistical theory attacks the problem from both ends. It provides
optimal methods for finding a real signal in a noisy background,
and also provides strict checks against the overinterpretation of
random patterns.
6,361 citations