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  • 1
    In: Gastroenterology, Elsevier BV, Vol. 164, No. 4 ( 2023-04), p. S25-S26
    Type of Medium: Online Resource
    ISSN: 0016-5085
    RVK:
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
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  • 2
    In: Inflammatory Bowel Diseases, Oxford University Press (OUP), Vol. 29, No. Supplement_1 ( 2023-01-26), p. S19-S20
    Abstract: Histology is emerging as a key therapeutic endpoint for ulcerative colitis driven by associations between histologic response and long-term outcomes. However, existing scoring systems are subjective and consequently have variable inter- and intra-reader variability. Geboes scoring is a well-established system for ulcerative colitis histologic assessment that has previously been used to define thresholds for histo-endoscopic mucosal improvement (Geboes Score ≤3.1, together with Mayo score 0 or 1) and histologic remission (Geboes Score & lt;2). Here we report the first machine learning (ML)-based prediction of the Geboes Score, and Geboes Score-derived thresholds of histologic improvement and remission, directly from whole slide images (WSI) of hematoxylin and eosin (H & E)-stained mucosal biopsies. METHODS 3,148 WSI were scored by three expert gastrointestinal pathologists and the median consensus score was used to determine the Geboes score for each slide as ground truth. ML models were trained on median consensus scores to predict the Geboes score and subscores for each slide. Model performance vs. pathologist median consensus score was measured using accuracy and the F1 score, which accounts for both false positive and false negative errors. RESULTS The ML-based model performance, measured against median consensus scores of three pathologists, showed strong performance at predicting overall Geboes Score, with a quadratic kappa of 0.89. The model was also able to predict both histologic improvement and histologic remission with high accuracy. For predicting histological improvement as defined by a Geboes Score of ≤3.1, the model showed accuracy of 0.92 and F1 score of 0.92 (Figure 1). For predicting histological remission as defined by a Geboes Score of & lt; 2, the model showed accuracy of 0.91 and F1 score of 0.89 (Figure 2). CONCLUSIONS We report a ML-based approach for predicting Geboes score and Geboes score-based key thresholds of histologic improvement and histologic remission. Model predictions show high accuracy compared to median consensus pathologist scores. This approach may enable standardized, reproducible and accurate prediction of these clinically relevant thresholds to better measure histologic disease activity and treatment response in clinical trials.
    Type of Medium: Online Resource
    ISSN: 1078-0998 , 1536-4844
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1340971-2
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  • 3
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 82, No. 12_Supplement ( 2022-06-15), p. 464-464
    Abstract: Morphological features of cancer cell nuclei are linked to gene expression signatures and genomic alterations. In addition, pathologists have leveraged nuclear morphology as diagnostic and prognostic markers. To enable the use of nuclear morphology in digital pathology, we developed a pan-tissue, deep-learning-based digital pathology pipeline for exhaustive nucleus detection, instance segmentation, and classification. We collected & gt; 29,000 manual nucleus annotations from hematoxylin and eosin (H & E)-stained pathology images from 21 tumor types at 40x and 20x magnification from The Cancer Genome Atlas (TCGA) project, as well as a proprietary set of H & E-stained tissue biopsies of skin, liver non-alcoholic steatohepatitis (NASH), colon inflammatory bowel disease (IBD), and kidney lupus. Annotations were used to train an object detection and segmentation model for identifying nuclei. Application of the model to held-out test data, including held-out tissue types, demonstrated performance comparable to state-of-the-art models described in the literature (mean Dice score = 0.80, aggregated Jaccard index = 0.60). We deployed our model to segment nuclei in H & E slides from the breast cancer (BRCA, N = 941) and prostate adenocarcinoma (PRAD, N = 457) TCGA cohorts. We extracted interpretable features describing the shape (circularity, eccentricity), size, staining intensity (mean and standard deviation), and texture of each nucleus. Nuclei were assigned as cancer or other cell types using separately trained convolutional neural networks for BRCA and PRAD. We used the mean and standard deviation of each feature sampled from a random subset of cancer nuclei to summarize the nuclear morphology on each slide (mean (range) = 10,068 (5,981-10,452) cancer cells from each BRCA slide; mean (range) = 10,053 (5,029-10,495) cancer cells from each PRAD slide). We used nuclear features to construct random forest classification models for predicting markers of genomic instability and prognosis: whole-genome doubling (WGD) and homologous recombination deficiency (HRD) status separately in BRCA and PRAD, HER2 subtype in BRCA, and Gleason grade in PRAD. Nuclear features were predictive of WGD (area under the receiver operating characteristic curve (AUROC) = 0.78 BRCA, = 0.69 PRAD) and binarized HRD status (AUROC = 0.65 BRCA, = 0.68 PRAD) on held-out test sets. Nuclear features were predictive of HER2-enriched breast cancer vs. other molecular subtypes (AUROC = 0.72), and distinguished between low risk (6) and moderate/high risk (7-10) Gleason grade in PRAD (AUROC = 0.72). In summary, we present a powerful pan-tissue approach for nucleus segmentation and featurization, which enables the construction of predictive models and the identification of features linking nuclear morphology with clinically-relevant prognostic biomarkers across multiple cancer types. Citation Format: John Abel, Suyog Jain, Deepta Rajan, Ken Leidal, Harshith Padigela, Aaditya Prakash, Jake Conway, Michael Nercessian, Christian Kirkup, Robert Egger, Ben Trotter, Andrew Beck, Ilan Wapinski, Michael G. Drage, Limin Yu, Amaro Taylor-Weiner. AI-powered segmentation and analysis of nuclei morphology predicts genomic and clinical markers in multiple cancer types [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 464.
    Type of Medium: Online Resource
    ISSN: 1538-7445
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2022
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  • 4
    In: npj Precision Oncology, Springer Science and Business Media LLC, Vol. 8, No. 1 ( 2024-06-19)
    Abstract: While alterations in nucleus size, shape, and color are ubiquitous in cancer, comprehensive quantification of nuclear morphology across a whole-slide histologic image remains a challenge. Here, we describe the development of a pan-tissue, deep learning-based digital pathology pipeline for exhaustive nucleus detection, segmentation, and classification and the utility of this pipeline for nuclear morphologic biomarker discovery. Manually-collected nucleus annotations were used to train an object detection and segmentation model for identifying nuclei, which was deployed to segment nuclei in H & E-stained slides from the BRCA, LUAD, and PRAD TCGA cohorts. Interpretable features describing the shape, size, color, and texture of each nucleus were extracted from segmented nuclei and compared to measurements of genomic instability, gene expression, and prognosis. The nuclear segmentation and classification model trained herein performed comparably to previously reported models. Features extracted from the model revealed differences sufficient to distinguish between BRCA, LUAD, and PRAD. Furthermore, cancer cell nuclear area was associated with increased aneuploidy score and homologous recombination deficiency. In BRCA, increased fibroblast nuclear area was indicative of poor progression-free and overall survival and was associated with gene expression signatures related to extracellular matrix remodeling and anti-tumor immunity. Thus, we developed a powerful pan-tissue approach for nucleus segmentation and featurization, enabling the construction of predictive models and the identification of features linking nuclear morphology with clinically-relevant prognostic biomarkers across multiple cancer types.
    Type of Medium: Online Resource
    ISSN: 2397-768X
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2024
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  • 5
    In: Gastroenterology, Elsevier BV, Vol. 164, No. 6 ( 2023-05), p. S-894-S-895
    Type of Medium: Online Resource
    ISSN: 0016-5085
    RVK:
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 80112-4
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  • 6
    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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  • 7
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 84, No. 9_Supplement ( 2024-05-02), p. PO2-14-12-PO2-14-12
    Abstract: Background: HER2 expression level is a key factor in determining the optimal treatment course for breast cancer patients. Roughly 15% of breast cancers are HER2(+), and determination of HER2 status is routinely assessed by immunohistochemistry (IHC). Accurate assessment of the HER2 IHC score (0, 1+, 2+, 3+) by pathologists is therefore critical, especially in light of novel therapeutic approaches demonstrating efficacy in the HER2-low setting (IHC scores 1+, and 2+/FISH-)1,2. To assist pathologists with the consistent provision of reproducible and accurate scores across the entire HER2 scoring range, we developed a machine-learning model (“AIM-HER2”) to generate accurate, slide-level HER2 scores aligned with ASCO-CAP guidelines in clinical breast cancer HER2 IHC specimens. Methods: AIM-HER2 was developed using whole-slide images (WSI; N=4261) from clinical and commercial sources. WSI were split into training (N=2694, 63%) and optimization (N=1567, 37%) sets. An additive multiple instance learning (aMIL) model3 was trained to predict HER2 scores directly from WSI and create interpretable heatmaps that depict HER2 predictions in tissue images. Image artifacts and in situ carcinomas were identified using previously trained artifact and tissue segmentation models and were excluded, leaving only regions of invasive carcinoma to be analyzed. AIM-HER2 performance was assessed on additional slides obtained from five academic or commercial sources (N=804 total, 770 evaluable) on which HER2 IHC was performed. Board-certified pathologists (N=52) with relevant experience provided manual HER2 scores based on ASCO-CAP guidelines. Nested pairwise non-inferiority analysis4 was used to compare model performance to that of pathologists (N=3 pathologists per slide). In the nested pairwise framework, agreement among pathologists was compared to agreement between AIM-HER2 and pathologists via linear kappa, so that summary metrics account for inter-pathologist variability. Results: High concordance was observed between AIM-HER2-predicted and pathologist-labeled slide-level HER2 scores, both overall and for each scoring level. Similar results were observed when assessing AIM-HER2 performance on multiple slide scanners and after IHC with multiple HER2 IHC antibody clones. Results are summarized in Table 1. Conclusions: We developed AIM-HER2, a novel aMIL-based approach for predicting slide-level HER2 IHC scores. AIM-HER2 has similar levels of agreement with pathologists as pathologists have with each other for determining HER2 score. This result is upheld when slides imaged using multiple scanning platforms and stained using multiple HER2 antibody clones. The performance of AIM-HER2 on multiple scanners and after multiple assays supports broad applicability of this algorithm in clinical laboratories, including for the identification of HER2-low cases. Work is ongoing to perform similar analyses in an independent, real-world dataset. References: 1Fernandez, AI, et al. JAMA Oncol. 2022 8(4):1-4. 2Modi, S et al. N Engl J Med. 2022 387:9-20. 3Javed, SA, et al. Adv Neural Inf Process Syst. 2022 35: 20689-702. 4Gerardin, Y, et al. 2023 arXiv:2306.04709 Table 1. Agreement between AIM-HER2 and pathologists compared to agreement among pathologists. Linearly weighted kappa values and 95% confidence intervals are shown. Citation Format: Zahil Shanis, Ryan Cabeen, Shreya Chakraborty, John Shamshoian, Marc Thibault, Harshith Padigela, Dinkar Juyal, Syed Ashar Javed, William Qian, Juhyun Kim, Beckett Rucker, Jacqueline Brosnan-Cashman, Harsha Pokkalla, Jimish Mehta, Amaro Taylor-Weiner, Ben Glass, Santhosh Balasubramanian. Accurate quantification of slide-level HER2 scores in breast cancer using a machine-learning model, AIM-HER2 Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-14-12.
    Type of Medium: Online Resource
    ISSN: 1538-7445
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2024
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  • 8
    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
    detail.hit.zdb_id: 2062135-8
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