arXiv:2605.16444cs.CVcs.AI2026-05中稿 · Nature Communicati…

用AI精准识别肺癌空气播散,辅助术中诊断与术后分层

Diffusion Attention Expert Model for Predicting and Semi-automatic Localizing STAS in Lung Cancer Histopathological Images

  • 基于扩散注意力机制的双分支模型,融合多尺度病理特征
  • 在冷冻/石蜡切片上分别达0.8946和0.9112的AUC,泛化性强
  • 可半自动定位病变位置,支持肿瘤微环境定量分析

准确评估肺腺癌术中及术后空气播散(STAS)对指导手术决策和术后管理至关重要。但传统病理评估耗时且易误诊漏诊。本文提出扩散注意力专家模型(DAEM),用于冷冻切片(FS)与石蜡切片(PS)中STAS的检测。其扩散注意力专家模块通过全注意力聚合学习多尺度特征,双分支结构增强特征表达。在内部数据集上,DAEM在FS和PS上的AUC分别为0.8946和0.9112。在来自八家机构的外部多中心数据集上验证了强泛化性与可解释性。利用石蜡切片中的肿瘤微环境(TME)特征,进一步实现STAS位置的半自动定位及其与原发灶距离的量化。多个定量TME指标被识别为潜在生物标志物,包括微乳头型STAS。总体而言,DAEM构建了一个临床可操作的框架,可在冷冻与石蜡切片上实现准确、可解释的STAS评估,并通过基于TME的定量分析支持术后风险分层。

原文摘要 · Abstract (English)

Accurate intraoperative and postoperative diagnosis of spread through air spaces (STAS) is essential for guiding surgical decisions and postoperative management in lung cancer. However, histopathological assessment is labor-intensive and is prone to missed or incorrect diagnoses. We propose a Diffusion Attention Expert Model (DAEM) to detect STAS in frozen sections (FSs) and paraffin sections (PSs). Its diffusion attention expert module leverages full attention aggregation to learn multi-scale features from histopathological images, while a dual-branch architecture strengthens multi-scale feature representation. On an internal dataset, DAEM achieves AUCs of 0.8946 for FSs and 0.9112 for PSs. Validation on external multi-center datasets from eight institutions demonstrates strong generalizability and interpretability. Using tumor microenvironment (TME) features in PSs, we further enable semi-automatic measurement of STAS location and its distance from the primary tumor. Several quantitative TME metrics are identified as potential biomarkers for STAS, including micropapillary-type STAS. Overall, DAEM offers a clinically actionable framework for STAS assessment by enabling accurate and interpretable detection on FSs and PSs, supporting postoperative risk stratification through quantitative TME-based analysis.

病理图像分析肺癌AI辅助诊断肿瘤微环境

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