@unpublished{AubrevilleStathonikosDonovanetal.2023, author = {Aubreville, Marc and Stathonikos, Nikolas and Donovan, Taryn and Klopfleisch, Robert and Ganz, Jonathan and Ammeling, Jonas and Wilm, Frauke and Veta, Mitko and Jabari, Samir and Eckstein, Markus and Annuscheit, Jonas and Krumnow, Christian and Bozaba, Engin and Cayir, Sercan and Gu, Hongyan and Chen, Xiang and Jahanifar, Mostafa and Shephard, Adam and Kondo, Satoshi and Kasai, Satoshi and Kotte, Sujatha and Saipradeep, Vangala and Lafarge, Maxime W. and Koelzer, Viktor H. and Wang, Ziyue and Zhang, Yongbing and Yang, Sen and Wang, Xiyue and Breininger, Katharina and Bertram, Christof}, title = {Domain generalization across tumor types, laboratories, and species - Insights from the 2022 edition of the Mitosis Domain Generalization Challenge}, publisher = {arXiv}, address = {Ithaca}, doi = {https://doi.org/10.48550/arXiv.2309.15589}, year = {2023}, abstract = {Recognition of mitotic figures in histologic tumor specimens is highly relevant to patient outcome assessment. This task is challenging for algorithms and human experts alike, with deterioration of algorithmic performance under shifts in image representations. Considerable covariate shifts occur when assessment is performed on different tumor types, images are acquired using different digitization devices, or specimens are produced in different laboratories. This observation motivated the inception of the 2022 challenge on MItosis Domain Generalization (MIDOG 2022). The challenge provided annotated histologic tumor images from six different domains and evaluated the algorithmic approaches for mitotic figure detection provided by nine challenge participants on ten independent domains. Ground truth for mitotic figure detection was established in two ways: a three-expert consensus and an independent, immunohistochemistry-assisted set of labels. This work represents an overview of the challenge tasks, the algorithmic strategies employed by the participants, and potential factors contributing to their success. With an F1 score of 0.764 for the top-performing team, we summarize that domain generalization across various tumor domains is possible with today's deep learning-based recognition pipelines. When assessed against the immunohistochemistry-assisted reference standard, all methods resulted in reduced recall scores, but with only minor changes in the order of participants in the ranking.}, language = {en} } @article{BertramAubrevilleDonovanetal.2021, author = {Bertram, Christof and Aubreville, Marc and Donovan, Taryn and Bartel, Alexander and Wilm, Frauke and Marzahl, Christian and Assenmacher, Charles-Antoine and Becker, Kathrin and Bennett, Mark and Corner, Sarah M. and Cossic, Brieuc and Denk, Daniela and Dettwiler, Martina and Garcia Gonzalez, Beatriz and Gurtner, Corinne and Haverkamp, Ann-Kathrin and Heier, Annabelle and Lehmbecker, Annika and Merz, Sophie and Noland, Erica L. and Plog, Stephanie and Schmidt, Anja and Sebastian, Franziska and Sledge, Dodd G. and Smedley, Rebecca C. and Tecilla, Marco and Thaiwong, Tuddow and Fuchs-Baumgartinger, Andrea and Meuten, Donald J. and Breininger, Katharina and Kiupel, Matti and Maier, Andreas and Klopfleisch, Robert}, title = {Computer-assisted mitotic count using a deep learning-based algorithm improves interobserver reproducibility and accuracy}, volume = {59}, journal = {Veterinary Pathology}, number = {2}, publisher = {Sage}, address = {London}, issn = {1544-2217}, doi = {https://doi.org/10.1177/03009858211067478}, pages = {211 -- 226}, year = {2021}, abstract = {The mitotic count (MC) is an important histological parameter for prognostication of malignant neoplasms. However, it has inter- and intraobserver discrepancies due to difficulties in selecting the region of interest (MC-ROI) and in identifying or classifying mitotic figures (MFs). Recent progress in the field of artificial intelligence has allowed the development of high-performance algorithms that may improve standardization of the MC. As algorithmic predictions are not flawless, computer-assisted review by pathologists may ensure reliability. In the present study, we compared partial (MC-ROI preselection) and full (additional visualization of MF candidates and display of algorithmic confidence values) computer-assisted MC analysis to the routine (unaided) MC analysis by 23 pathologists for whole-slide images of 50 canine cutaneous mast cell tumors (ccMCTs). Algorithmic predictions aimed to assist pathologists in detecting mitotic hotspot locations, reducing omission of MFs, and improving classification against imposters. The interobserver consistency for the MC significantly increased with computer assistance (interobserver correlation coefficient, ICC = 0.92) compared to the unaided approach (ICC = 0.70). Classification into prognostic stratifications had a higher accuracy with computer assistance. The algorithmically preselected hotspot MC-ROIs had a consistently higher MCs than the manually selected MC-ROIs. Compared to a ground truth (developed with immunohistochemistry for phosphohistone H3), pathologist performance in detecting individual MF was augmented when using computer assistance (F1-score of 0.68 increased to 0.79) with a reduction in false negatives by 38\%. The results of this study demonstrate that computer assistance may lead to more reproducible and accurate MCs in ccMCTs.}, language = {en} } @inproceedings{MarzahlWilmTharunetal.2021, author = {Marzahl, Christian and Wilm, Frauke and Tharun, Lars and Perner, Sven and Kr{\"o}ger, Christine and Voigt, J{\"o}rn and Klopfleisch, Robert and Maier, Andreas and Aubreville, Marc and Breininger, Katharina}, title = {Robust quad-tree based registration on whole slide images}, booktitle = {Proceedings of Machine Learning Research: Proceedings of COMPAY 2021}, number = {156}, publisher = {PMLR}, address = {[s. l.]}, url = {https://proceedings.mlr.press/v156/marzahl21a.html}, pages = {181 -- 190}, year = {2021}, language = {en} } @unpublished{WilmFragosoGarciaBertrametal.2022, author = {Wilm, Frauke and Fragoso-Garcia, Marco and Bertram, Christof and Stathonikos, Nikolas and {\"O}ttl, Mathias and Qiu, Jingna and Klopfleisch, Robert and Maier, Andreas and Aubreville, Marc and Breininger, Katharina}, title = {Mind the Gap: Scanner-induced domain shifts pose challenges for representation learning in histopathology}, publisher = {arXiv}, address = {Ithaca}, doi = {https://doi.org/10.48550/arXiv.2211.16141}, year = {2022}, language = {en} } @inproceedings{QiuWilmOettletal.2023, author = {Qiu, Jingna and Wilm, Frauke and {\"O}ttl, Mathias and Schlereth, Maja and Liu, Chang and Heimann, Tobias and Aubreville, Marc and Breininger, Katharina}, title = {Adaptive Region Selection for Active Learning in Whole Slide Image Semantic Segmentation}, booktitle = {Medical Image Computing and Computer Assisted Intervention - MICCAI 2023: Proceedings, Part II}, editor = {Greenspan, Hayit and Madabhushi, Anant and Mousavi, Parvin and Salcudean, Septimiu and Duncan, James and Syeda-Mahmood, Tanveer and Taylor, Russell}, publisher = {Springer}, address = {Cham}, isbn = {978-3-031-43895-0}, issn = {1611-3349}, doi = {https://doi.org/10.1007/978-3-031-43895-0_9}, pages = {90 -- 100}, year = {2023}, language = {en} } @inproceedings{WilmFragosoGarciaBertrametal.2023, author = {Wilm, Frauke and Fragoso-Garcia, Marco and Bertram, Christof and Stathonikos, Nikolas and {\"O}ttl, Mathias and Qiu, Jingna and Klopfleisch, Robert and Maier, Andreas and Aubreville, Marc and Breininger, Katharina}, title = {Mind the Gap: Scanner-Induced Domain Shifts Pose Challenges for Representation Learning in Histopathology}, booktitle = {2023 IEEE 20th International Symposium on Biomedical Imaging (ISBI)}, publisher = {IEEE}, address = {Piscataway}, isbn = {978-1-6654-7358-3}, doi = {https://doi.org/10.1109/ISBI53787.2023.10230458}, year = {2023}, language = {en} } @article{AubrevilleStathonikosDonovanetal.2024, author = {Aubreville, Marc and Stathonikos, Nikolas and Donovan, Taryn and Klopfleisch, Robert and Ammeling, Jonas and Ganz, Jonathan and Wilm, Frauke and Veta, Mitko and Jabari, Samir and Eckstein, Markus and Annuscheit, Jonas and Krumnow, Christian and Bozaba, Engin and Cayir, Sercan and Gu, Hongyan and Chen, Xiang and Jahanifar, Mostafa and Shephard, Adam and Kondo, Satoshi and Kasai, Satoshi and Kotte, Sujatha and Saipradeep, Vangala and Lafarge, Maxime W. and Koelzer, Viktor H. and Wang, Ziyue and Zhang, Yongbing and Yang, Sen and Wang, Xiyue and Breininger, Katharina and Bertram, Christof}, title = {Domain generalization across tumor types, laboratories, and species — Insights from the 2022 edition of the Mitosis Domain Generalization Challenge}, volume = {2024}, pages = {103155}, journal = {Medical Image Analysis}, number = {94}, publisher = {Elsevier}, address = {Amsterdam}, issn = {1361-8423}, doi = {https://doi.org/10.1016/j.media.2024.103155}, year = {2024}, abstract = {Recognition of mitotic figures in histologic tumor specimens is highly relevant to patient outcome assessment. This task is challenging for algorithms and human experts alike, with deterioration of algorithmic performance under shifts in image representations. Considerable covariate shifts occur when assessment is performed on different tumor types, images are acquired using different digitization devices, or specimens are produced in different laboratories. This observation motivated the inception of the 2022 challenge on MItosis Domain Generalization (MIDOG 2022). The challenge provided annotated histologic tumor images from six different domains and evaluated the algorithmic approaches for mitotic figure detection provided by nine challenge participants on ten independent domains. Ground truth for mitotic figure detection was established in two ways: a three-expert majority vote and an independent, immunohistochemistry-assisted set of labels. This work represents an overview of the challenge tasks, the algorithmic strategies employed by the participants, and potential factors contributing to their success. With an score of 0.764 for the top-performing team, we summarize that domain generalization across various tumor domains is possible with today's deep learning-based recognition pipelines. However, we also found that domain characteristics not present in the training set (feline as new species, spindle cell shape as new morphology and a new scanner) led to small but significant decreases in performance. When assessed against the immunohistochemistry-assisted reference standard, all methods resulted in reduced recall scores, with only minor changes in the order of participants in the ranking.}, language = {en} } @article{StathonikosAubrevilledeVriesetal.2024, author = {Stathonikos, Nikolas and Aubreville, Marc and de Vries, Sjoerd and Wilm, Frauke and Bertram, Christof and Veta, Mitko and van Diest, Paul J}, title = {Breast cancer survival prediction using an automated mitosis detection pipeline}, volume = {10}, pages = {e70008}, journal = {The Journal of Pathology: Clinical Research}, number = {6}, publisher = {Wiley}, address = {Chichester}, issn = {2056-4538}, doi = {https://doi.org/10.1002/2056-4538.70008}, year = {2024}, abstract = {AbstractMitotic count (MC) is the most common measure to assess tumor proliferation in breast cancer patients and is highly predictive of patient outcomes. It is, however, subject to inter- and intraobserver variation and reproducibility challenges that may hamper its clinical utility. In past studies, artificial intelligence (AI)-supported MC has been shown to correlate well with traditional MC on glass slides. Considering the potential of AI to improve reproducibility of MC between pathologists, we undertook the next validation step by evaluating the prognostic value of a fully automatic method to detect and count mitoses on whole slide images using a deep learning model. The model was developed in the context of the Mitosis Domain Generalization Challenge 2021 (MIDOG21) grand challenge and was expanded by a novel automatic area selector method to find the optimal mitotic hotspot and calculate the MC per 2 mm2. We employed this method on a breast cancer cohort with long-term follow-up from the University Medical Centre Utrecht (N = 912) and compared predictive values for overall survival of AI-based MC and light-microscopic MC, previously assessed during routine diagnostics. The MIDOG21 model was prognostically comparable to the original MC from the pathology report in uni- and multivariate survival analysis. In conclusion, a fully automated MC AI algorithm was validated in a large cohort of breast cancer with regard to retained prognostic value compared with traditional light-microscopic MC.}, language = {en} } @unpublished{QiuAubrevilleWilmetal.2024, author = {Qiu, Jingna and Aubreville, Marc and Wilm, Frauke and {\"O}ttl, Mathias and Utz, Jonas and Schlereth, Maja and Breininger, Katharina}, title = {Leveraging Image Captions for Selective Whole Slide Image Annotation}, publisher = {arXiv}, address = {Ithaca}, doi = {https://doi.org/10.48550/arXiv.2407.06363}, year = {2024}, language = {en} } @article{WilmIhlingMehesetal.2023, author = {Wilm, Frauke and Ihling, Christian and M{\´e}hes, G{\´a}bor and Terracciano, Luigi and Puget, Chlo{\´e} and Klopfleisch, Robert and Sch{\"u}ffler, Peter and Aubreville, Marc and Maier, Andreas and Mrowiec, Thomas and Breininger, Katharina}, title = {Pan-tumor T-lymphocyte detection using deep neural networks: Recommendations for transfer learning in immunohistochemistry}, volume = {2023}, pages = {100301}, journal = {Journal of Pathology Informatics}, number = {14}, publisher = {Elsevier}, address = {Amsterdam}, issn = {2153-3539}, doi = {https://doi.org/10.1016/j.jpi.2023.100301}, year = {2023}, abstract = {The success of immuno-oncology treatments promises long-term cancer remission for an increasing number of patients. The response to checkpoint inhibitor drugs has shown a correlation with the presence of immune cells in the tumor and tumor microenvironment. An in-depth understanding of the spatial localization of immune cells is therefore critical for understanding the tumor's immune landscape and predicting drug response. Computer-aided systems are well suited for efficiently quantifying immune cells in their spatial context. Conventional image analysis approaches are often based on color features and therefore require a high level of manual interaction. More robust image analysis methods based on deep learning are expected to decrease this reliance on human interaction and improve the reproducibility of immune cell scoring. However, these methods require sufficient training data and previous work has reported low robustness of these algorithms when they are tested on out-of-distribution data from different pathology labs or samples from different organs. In this work, we used a new image analysis pipeline to explicitly evaluate the robustness of marker-labeled lymphocyte quantification algorithms depending on the number of training samples before and after being transferred to a new tumor indication. For these experiments, we adapted the RetinaNet architecture for the task of T-lymphocyte detection and employed transfer learning to bridge the domain gap between tumor indications and reduce the annotation costs for unseen domains. On our test set, we achieved human-level performance for almost all tumor indications with an average precision of 0.74 in-domain and 0.72-0.74 cross-domain. From our results, we derive recommendations for model development regarding annotation extent, training sample selection, and label extraction for the development of robust algorithms for immune cell scoring. By extending the task of marker-labeled lymphocyte quantification to a multi-class detection task, the pre-requisite for subsequent analyses, e.g., distinguishing lymphocytes in the tumor stroma from tumor-infiltrating lymphocytes, is met.}, language = {en} }