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  • 1
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 39, No. 15_suppl ( 2021-05-20), p. 106-106
    Abstract: 106 Background: PathR is an efficacy endpoint in Phase II and III neoadjuvant trials and is proposed as a surrogate for disease-free survival (DFS) and overall survival. Machine learning (ML)–based, automated approaches standardize quantification of areas of tumor bed and residual viable tumor. Here we show that automation may provide a scalable alternative to or complementary tool for manual assessment. Methods: We determined inter-reader variability for PathR among pathologists in the LCMC3 (NCT02927301) study and developed an AI-powered digital PathR assessment tool in line with manual consensus recommendations. Study cases were reviewed for PathR by a local site pathologist and 3 central expert pathologists (n = 127). When determined manually, major PathR (MPR) was defined as ≤10% viable tumor averaged per case. ML models were trained and validated by the PathAI research platform using digitized H & E-stained tumor sections. The digital PathR model predicted percent viable tumor for each case as the sum of the cancer epithelium area from each slide divided by the sum of tumor bed area for each slide. DFS (clinical cutoff: Oct 23, 2020) was reported for patients with manual and digital PathR assessment (n = 135). For digital MPR, we used a prevalence-matched cutoff that maintained the same proportion of patients as manual MPR. Results: Inter-reader agreement among 1 local and 3 central pathologists for manual PathR was good (n = 127; ICC = 0.87; 95% CI: 0.84-0.90). Agreement was 91% (κ = 0.82) on manual MPR and 98% (κ = 0.88) on pathologic complete response (pCR). 6 patients had unanimous pCR. Digital and manual PathR were strongly correlated (n = 135, Pearson r = 0.78) and digital PathR demonstrated an outstanding predictability for manual MPR (AUROC = 0.975). The range was 0%-60% for digital PathR and 0%-100% for manual PathR with a regression line slope 〈 1.0 (m = 0.303) indicating systematic differences between the methods, consistent with digital PathR using a high-resolution segmentation of cancer epithelium from stroma across each slide. Longer DFS was observed for MPR yes vs no with both digital and manual assessment (Table). Conclusions: This analysis showed good inter-reader agreement for manual and strong correlation of AI-powered digital and manual PathR. Comparable DFS rates for manual MPR and digital MPR are encouraging in the preliminary data. These data support further studies of digital PathR as a standardized and scalable tool to determine PathR. Clinical trial information: NCT02927301. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2021
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  • 2
    In: Journal of Thoracic Oncology, Elsevier BV, Vol. 19, No. 5 ( 2024-05), p. 719-731
    Type of Medium: Online Resource
    ISSN: 1556-0864
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2024
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  • 3
    In: Modern Pathology, Elsevier BV, Vol. 36, No. 6 ( 2023-06), p. 100124-
    Type of Medium: Online Resource
    ISSN: 0893-3952
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
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  • 4
    In: Inflammatory Bowel Diseases, Oxford University Press (OUP), Vol. 29, No. Supplement_1 ( 2023-01-26), p. S22-S23
    Abstract: Microscopic inflammation has been shown to be an important indicator of disease activity in ulcerative colitis (UC). However, manual histologic scoring is semi-quantitative and subject to interobserver variation, and AI-based solutions often lack interpretability. Here we report two distinct quantitative approaches to predict disease activity scores and histological remission using AI-powered digital pathology. Both the random forest classifier (RFC) and graph neural network (GNN) further provide explainability and biological insight by identifying histological features informing model predictions. METHODS Convolutional neural networks (CNNs) were developed using & gt;162k annotations on 820 WSI of H & E-stained colorectal biopsies for pixel-level identification of tissue regions (e.g. crypt abscesses, erosion/ulceration) and cell types (e.g. neutrophils, plasma cells). All WSI were scored by 5 board-certified pathologists using the Nancy Histological Index (NHI) to establish consensus ground truth. A rich, quantitative set of human interpretable features that capture CNN predictions of the tissue region and cell type across each WSI was extracted and used to train a RFC to predict slide-level NHI score. To test the hypothesis that tissue region spatial relationships and cellular composition can inform AI-based predictions of disease activity, a separate GNN was trained, using nodes defined by spatially-resolved CNN model-generated outputs, to predict NHI score. The RFC and GNN also predicted histologic remission (NHI & lt;2). Feature importance was calculated for all combinations of RFC (Fig. 1), and the GNNExplainer was applied to locate important interactions between regions in the tissue and identify features significantly contributing to GNN predictions (Fig. 2). RESULTS The RFC and GNN both predicted histologic remission with high accuracy (weighted kappa 0.87 and 0.85, respectively). Both models also identified histologic features relevant to disease activity predictions. Some features are well established, e.g. infiltrated epithelium or neutrophil cell features distinguish cases with histologic remission. The models also identified features beyond those assessed by the NHI, e.g. area proportion of basal plasmacytosis associated with predictions of NHI 2 and 3. Other features not previously implicated in UC disease activity were also identified, e.g. intraepithelial lymphocytes differentiate cases with NHI 3. CONCLUSIONS We report quantitative and interpretable AI-powered approaches for UC histological assessment. CNN identification of UC histology was used as input to two distinct disease activity classifiers that showed strong concordance with consensus pathologist scoring. Both approaches provide interpretable features that explain model predictions and that may be used to inform biomarker selection and clinical development efforts.
    Type of Medium: Online Resource
    ISSN: 1078-0998 , 1536-4844
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 5
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 83, No. 5_Supplement ( 2023-03-01), p. P4-09-08-P4-09-08
    Abstract: Background: Morphological features of cancer cell nuclei are routinely used to assess disease severity and prognosis, and cancer nuclear morphology has been linked to genomic alterations. Quantitative analyses of the nuclear features of cancer cells and other tumor-resident cell types, such as cancer-associated fibroblasts (CAFs), may reveal novel biomarkers for prognosis and treatment response. Here, we applied a pan-cancer nucleus detection and segmentation algorithm and a cell classification model to hematoxylin and eosin (H & E)-stained whole slide images (WSIs) of breast cancer specimens, enabling the measurement of morphological features of nuclei of multiple cell types within a tumor. Methods: Convolutional Neural Network models for 1) nucleus detection and segmentation and 2) cell classification were deployed on H & E-stained WSIs from The Cancer Genome Atlas (TCGA) breast cancer dataset (primary surgical resections; N=890). Separate models were trained to segment regions of stromal subtypes, such as inflamed and fibroblastic stroma. Nuclear features (area, axis length, eccentricity, color, and texture) were computed and aggregated across each slide to summarize slide-level nuclear morphology for each cell type. Next-generation sequencing-based metrics of genomic instability (N=774) and gene expression (N=868) were acquired and paired with TCGA WSIs. Gene set enrichment analysis was performed using the Molecular Signatures Database. Spearman correlation compared nuclear features to genomic instability metrics. Linear regression was used to assess the relationship between nuclear features and bulk gene expression. Multivariable Cox regression with age and ordinal tumor stage as covariates was used to find association between overall survival (OS) and nuclear features. All reported results were significant (p & lt; 0.05) when adjusted for false discovery rate via the Benjamini-Hochberg procedure. Results: Variation in cancer cell nuclear area, a quantitative metric related to pathologist-assessed nuclear pleomorphism, was calculated by the standard deviation of the nuclear area of cancer cells across a WSI. This feature was associated with genomic instability, as measured by aneuploidy score (r=0.448) and homologous recombination deficiency score (r=0.382), and reduced OS. In contrast, the variability in fibroblast and lymphocyte nuclear areas did not correlate with either metric of genomic instability (all r & lt; 0.1, p & gt;0.05). Furthermore, an association between variation in cancer cell nuclear area with the expression of cell cycle and proliferation pathway genes was observed, suggesting that increased nuclear size heterogeneity may indicate a more aggressive cancer phenotype. Features quantifying CAF nuclear morphology were also assessed, revealing that CAF nucleus shape (larger minor axis length) was associated with lower OS, as well as the expression of gene sets involved in extracellular matrix remodeling and degradation. Conclusions: The nuclear morphologies of breast cancer cells and CAFs reflect underlying genomic and transcriptomic properties of the tumor and correlates with patient outcome. The application of digital pathology analysis of breast cancer histopathology slides enables the integrative study of genomics, transcriptomics, tumor morphology, and overall survival to support research into disease biology research and biomarker discovery. Citation Format: John Abel, Christian Kirkup, Filip Kos, Ylaine Gerardin, Sandhya Srinivasan, Jacqueline Brosnan-Cashman, Ken Leidal, Sanjana Vasudevan, Deepta Rajan, Suyog Jain, Aaditya Prakash, Harshith Padigela, Jake Conway, Neel Patel, Benjamin Trotter, Limin Yu, Amaro Taylor-Weiner, Emma L. Krause, Matthew Bronnimann, Laura Chambre, Ben Glass, Chintan Parmar, Stephanie Hennek, Archit Khosla, Murray Resnick, Andrew H. Beck, Michael Montalto, Fedaa Najdawi, Michael G. Drage, Ilan Wapinski. AI-based quantitation of cancer cell and fibroblast nuclear morphology reflects transcriptomic heterogeneity and predicts survival in breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-09-08.
    Type of Medium: Online Resource
    ISSN: 1538-7445
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2023
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  • 6
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 83, No. 7_Supplement ( 2023-04-04), p. 5705-5705
    Abstract: Background: In recent years, a relationship between the tumor microenvironment (TME) and patient response to targeted cancer immunotherapy has been suggested. We applied machine-learning algorithms on H & E stained tissue to study the TME in metastatic non-small cell lung cancer (NSCLC) patients. Our goal was to identify digital pathology (DP) features associated with outcome under combination treatment or monotherapy with atezolizumab (atezo), an anti-PD-L1 therapy, and relate those features to other data modalities. We analyzed patient data from two phase 3 clinical trials, OAK (docetaxel versus atezo in 2L+ NSCLC) and IMpower150 (bevacizumab, carboplatin, and paclitaxel (BCP) versus BCP+atezo (ABCP) in advanced 1L non-squamous NSCLC). Methods: As part of our effort to build a DP-based tumor-immune microenvironment atlas, digitized H & E images were registered onto the PathAI research platform. Over 200K annotations from 90 pathologists were used to train convolutional neural networks (CNNs) that classify slide-level human-interpretable features (HIFs) of cells and tissue structures from images and deployed on images from OAK and IMpower150. HIFs and PD-L1 status were associated with outcome in all samples in each arm in OAK and results were validated in IMpower150, using Cox proportional hazard models. Bulk RNAseq was run using samples extracted from the same area as the H & E slide. Results: We identified a composite feature capturing the ratio of immune cells to fibroblasts in the stroma predictive of both overall survival (OS) (HR=0.74 p=0.0046) and progression-free survival (PFS) (HR=0.87 p=0.14). While patients primarily benefit from atezo if they are PD-L1 high, we found that even PD-L1 negative patients benefited from atezo when enriched for this feature (22C3 PD-L1 assay: OS HR=0.59 p=0.015, PFS HR=0.8 p=0.25; SP142 PD-L1 assay: OS HR=0.74 p=0.12, PFS HR=0.88 p=0.45). We thus recognized a DP feature that was predictive for positive outcome with atezo treatment, independent of PD-L1 levels. This association was then validated in IMpower150 comparing ABCP to BCP, both overall (OS HR=0.69 p=0.012) and in PD-L1 negative patients (SP263 assay OS HR=0.56 p=0.034). Integrating with RNAseq, patients enriched for this DP feature showed similar enrichment for B and T gene signatures and depletion in CAF-related gene signatures, thus showing the harmonization of TME between different data modalities. Conclusions: Using a deep learning-based assay for quantifying pathology features of the TME from H & E images in two NSCLC trials, we identified a novel biomarker predictive of outcome to PD-L1 targeting therapy, even in PD-L1 low & negative patients. Importantly, our work shows how different data modalities (DP, gene expression) can be integrated to further our understanding of the TME. Citation Format: Aditi Qamra, Minu K. Srivastava, Eloisa Fuentes, Ben Trotter, Raymond Biju, Guillaume Chhor, James Cowan, Steven Gendreau, Webster Lincoln, Lisa McGinnis, Luciana Molinero, Namrata S. Patil, Amber Schedlbauer, Katja Schulze, Adam Stanford-Moore, Laura Chambre, Ilan Wapinski, David S. Shames, Hartmut Koeppen, Stephanie Hennek, Jane Fridlyand, Jennifer M. Giltnane, Assaf Amitai. Digital pathology based prognostic & predictive biomarkers in metastatic non-small cell lung cancer. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5705.
    Type of Medium: Online Resource
    ISSN: 1538-7445
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2023
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  • 7
    In: Molecular Cancer Therapeutics, American Association for Cancer Research (AACR), Vol. 22, No. 12_Supplement ( 2023-12-01), p. B010-B010
    Abstract: Background: Newly developed molecular technologies, such as spatial multiplexed assays and single-cell sequencing, have provided increased resolution and output for tumor analysis. However, these assays are often cost-prohibitive, making them inadequate ways to detect clinical biomarkers. In contrast, hematoxylin and eosin (H & E) staining is routine for cancer diagnostics but does not provide molecular information, potentially limiting its utility in the targeted therapy era. Machine learning models could augment the information revealed by H & E, potentially allowing molecular information to be inferred. Here, we describe a novel approach to predict gene expression signatures (GES) in H & E-stained whole slide images (WSI) using an additive multiple instance learning (aMIL) end-to-end model (1). We present results in breast cancer predicting spatially resolved levels of a TGFb GES, a proposed biomarker for TGFb antagonists and immunotherapy. Methods: H & E-stained WSI from the TCGA BRCA cohort (N=1090) were split into training (60%), validation (20%), and test (20%) sets. TGFb-CAF GES (2) were computed, and median expression cut-off on training data was used to define “high” and “low” TGFb-CAF levels. aMIL models were optimized in training data for the binary classification of TGFb-CAF levels. Top-performing model iterations were compared on the validation set, and the optimal model was deployed on the held-out test set. aMIL heatmaps were merged with PathExplore tumor microenvironment (TME) model heatmaps to characterize cell, tissue, and nuclear spatial distributions and morphology in terms of human interpretable features (HIFs). HIFs were extracted from high-importance patches (top 25% of aMIL scores) for both TGFb-CAF-high and -low. Results: Our model accurately predicted TGFb-CAF-high vs. -low BRCA samples (test AUROC=0.80). Also, model deployment on WSI provided interpretable heatmaps depicting TGFb-CAF predictions in tissue, providing spatial resolution to TGFb-CAF expression. Patches contributing most to TGFb-CAF-high prediction were enriched for cancer stroma, as well as cancer-infiltrating and stromal fibroblasts. Furthermore, significant differences in HIFs relating to fibroblast nucleus size and lymphocyte nucleus shape were observed between patches contributing most to TGFb-CAF-high and -low predictions. Conclusions: We have developed a method to predict GES with spatial resolution in H & E-stained WSI. aMIL models provide exact marginal contributions of each patch towards every class prediction, allowing downstream analysis of tissue, cell, and nuclear features and providing biological interpretability not found in typical black-box models. The ability of our method to detect GES in H & E-stained WSI allows complex molecular information to be detected in routine clinical specimens with spatial specificity, providing a means for GES to potentially be realized as clinical biomarkers. References: 1) Javed, SA, et al. Adv Neural Inf Process Syst. 2022 35: 20689-702; 2) Krishnamurthy, AT, et al. Nature. 2022 611:148-54. Citation Format: Miles Markey, Juhyun Kim, Zvi Goldstein, Ylaine Gerardin, Jacqueline Brosnan-Cashman, Syed Ashar Javed, Dinkar Juyal, Harshith Padigela, Limin Yu, Bahar Rahsepar, John Abel, Stephanie Hennek, Archit Khosla, Chintan Parmar, Amaro Taylor-Weiner. Spatially-resolved prediction of gene expression signatures in H & E whole slide images using additive multiple instance learning models [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2023 Oct 11-15; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2023;22(12 Suppl):Abstract nr B010.
    Type of Medium: Online Resource
    ISSN: 1538-8514
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2023
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  • 8
    In: Communications Biology, Springer Science and Business Media LLC, Vol. 4, No. 1 ( 2021-02-01)
    Abstract: The use of digital pathology for the histomorphologic profiling of pathological specimens is expanding the precision and specificity of quantitative tissue analysis at an unprecedented scale; thus, enabling the discovery of new and functionally relevant histological features of both predictive and prognostic significance. In this study, we apply quantitative automated image processing and computational methods to profile the subcellular distribution of the multi-functional transcriptional regulator, Kaiso ( ZBTB33 ), in the tumors of a large racially diverse breast cancer cohort from a designated health disparities region in the United States. Multiplex multivariate analysis of the association of Kaiso’s subcellular distribution with other breast cancer biomarkers reveals novel functional and predictive linkages between Kaiso and the autophagy-related proteins, LC3A/B, that are associated with features of the tumor immune microenvironment, survival, and race. These findings identify effective modalities of Kaiso biomarker assessment and uncover unanticipated insights into Kaiso’s role in breast cancer progression.
    Type of Medium: Online Resource
    ISSN: 2399-3642
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
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  • 9
    In: Gastroenterology, Elsevier BV, Vol. 164, No. 4 ( 2023-04), p. S28-S29
    Type of Medium: Online Resource
    ISSN: 0016-5085
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    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
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  • 10
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 83, No. 7_Supplement ( 2023-04-04), p. 5422-5422
    Abstract: Renal cell carcinoma (RCC) is a heterogeneous disease with 16 different subtypes identified and diagnosed by assessment of tumor histology, and specific molecular and genetic markers. Three major subtypes - clear cell, papillary, and chromophobe carcinoma - have different prognoses and treatment regimens. Treatment response has been associated with mutations that may affect the tumor microenvironment (TME). Here, machine learning (ML) models quantified histologic features of the TME directly from RCC hematoxylin and eosin (H & E)-stained whole slide images (WSI). The potential for model outputs to predict clinically-relevant biomarkers was investigated. Machine learning models based on convolutional neural networks were trained using RCC and non-RCC kidney WSI of biopsies and resections from the cancer genome atlas (TCGA), proprietary, and commercial sources (tissue model N=3208; cell model N=789; vessel model N=839) to classify and quantify histologic features of the TME including cells, tissues, and blood vessels. Thousands of human interpretable features (HIFs) were extracted from model predictions that precisely describe the TME across each WSI (e.g., cell density within a tissue region). Associations between HIFs and PBRM1 loss of function (LOF) mutations and VEGFA mRNAseq expression in clear cell RCC were determined using univariate logistic regressions and Spearman correlations, respectively. False discovery rate in multiple hypothesis testing was controlled using an Empirical Brown’s Method and the Benjamini-Hochberg procedure. ML-models generated 3390 HIFs from 692 TCGA RCC WSI. After quality control to remove features with missing values, outlier slides and de-duplication, 237 HIFs (657 WSI) remained. Major RCC subtypes could be extracted directly from these HIFs using hierarchical clustering (p & lt;10-6, chi-squared test). Individual RCC subtypes were distinguished by features describing immune cells and vascularization. A mixed subcluster enriched for higher stage (p & lt;10-6, chi-squared test) papillary and clear cell RCC tumors was associated with increased prevalence of sarcomatoid regions and immune cells. In clear cell RCC, significant associations were found between HIFs describing a spatially specific increase in lymphocytes in the cancer epithelium (FDR-corrected p=0.004) and decrease in macrophages (FDR-corrected p=0.004) in the entire tumor area and PBRM1MUT, a mutation associated with response to immunotherapy; VEGFA expression, predictive of angiogenesis, positively associated with an increased abundance of lymphocytes near erythrocytes (Spearman r=0.37). ML model quantified RCC TME histology allowed identification of spatially specific differences that correlate with histological subtypes, mutations, and vascularization. Complementary ML-based TME assessment and genomic analyses may be used, after further validation, to explore novel biomarkers. Citation Format: Samuel Vilchez, Isaac Finberg, Miles Markey, Shima Nofallah, Kathleen Sucpito, Fedaa Najdawi, Geetika Singh, Ben Trotter, Victoria Mountain, Jake Conway, Robert Egger, Chintan Parmar, Ilan Wapinski, Stephanie Hennek, Jonathan Glickman. Machine learning models identify key histological features of renal cell carcinoma subtypes. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5422.
    Type of Medium: Online Resource
    ISSN: 1538-7445
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2023
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