用多模式注意力学习诊断肺腺癌侵袭性特征,提升跨中心病理图像识别准确率。
STAMP: Multi-pattern Attention-aware Multiple Instance Learning for STAS Diagnosis in Multi-center Histopathology Images
- 双分支结构从不同语义空间学习病变特征,结合注意力机制精准定位病灶区域。
- 在三个独立医院数据集上AUC均超0.79,超越临床诊断水平。
- 适合病理医生辅助诊断与多中心医学影像智能分析研究者参考。
肺腺癌中的气道播散(STAS)是一种新型浸润模式,与肿瘤复发和生存率下降相关。然而,大规模STAS诊断仍依赖人工,易因病理特征复杂而漏诊误诊。为此,本研究整合中南大学第二、第三湘雅医院及TCGA-LUAD队列的组织病理图像,由三位资深病理科医生交叉标注,构建了STAS-SXY、STAS-TXY和STAS-TCGA数据集。提出多模式注意力感知的多实例学习框架STAMP,通过双分支结构在不同语义空间学习特征,利用Transformer编码实例并结合多模式注意力聚合模块动态选择与STAS相关的区域,抑制噪声干扰,增强全局表征判别力;同时引入相似性正则化约束,减少分支间特征冗余。大量实验表明,STAMP在三组数据集上分别取得0.8058、0.8017和0.7928的AUC,优于临床诊断水平。
原文摘要 · Abstract (English)
Spread through air spaces (STAS) constitutes a novel invasive pattern in lung adenocarcinoma (LUAD), associated with tumor recurrence and diminished survival rates. However, large-scale STAS diagnosis in LUAD remains a labor-intensive endeavor, compounded by the propensity for oversight and misdiagnosis due to its distinctive pathological characteristics and morphological features. Consequently, there is a pressing clinical imperative to leverage deep learning models for STAS diagnosis. This study initially assembled histopathological images from STAS patients at the Second Xiangya Hospital and the Third Xiangya Hospital of Central South University, alongside the TCGA-LUAD cohort. Three senior pathologists conducted cross-verification annotations to construct the STAS-SXY, STAS-TXY, and STAS-TCGA datasets. We then propose a multi-pattern attention-aware multiple instance learning framework, named STAMP, to analyze and diagnose the presence of STAS across multi-center histopathology images. Specifically, the dual-branch architecture guides the model to learn STAS-associated pathological features from distinct semantic spaces. Transformer-based instance encoding and a multi-pattern attention aggregation modules dynamically selects regions closely associated with STAS pathology, suppressing irrelevant noise and enhancing the discriminative power of global representations. Moreover, a similarity regularization constraint prevents feature redundancy across branches, thereby improving overall diagnostic accuracy. Extensive experiments demonstrated that STAMP achieved competitive diagnostic results on STAS-SXY, STAS-TXY and STAS-TCGA, with AUCs of 0.8058, 0.8017, and 0.7928, respectively, surpassing the clinical level.
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