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Treatment selection in breast cancer is guided by molecular subtypes and clinical characteristics. Recurrence risk assessment plays a crucial role in personalizing treatment. Current methods, including genomic assays, have limited accuracy and clinical utility, leading to suboptimal decisions for many patients. We developed a test for breast cancer patient stratification based on digital pathology and clinical characteristics using novel AI methods. Specifically, we utilized a vision transformer-based pan-cancer foundation model trained with self-supervised learning to extract features from digitized H&E-stained slides. These features were integrated with clinical data to form a multi-modal AI test predicting cancer recurrence and death. The test was developed and evaluated using data from a total of 8,161 breast cancer patients across 15 cohorts originating from seven countries. Of these, 3,502 patients from five cohorts were used exclusively for evaluation, while the remaining patients were used for training. Our test accurately predicted our primary endpoint, disease-free interval, in the five external cohorts (C-index: 0.71 [0.68-0.75], HR: 3.63 [3.02-4.37, p<0.01]). In a direct comparison (N=858), the AI test was more accurate than Oncotype DX, the standard-of-care 21-gene assay, with a C-index of 0.67 [0.61-0.74] versus 0.61 [0.49-0.73], respectively. Additionally, the AI test added independent information to Oncotype DX in a multivariate analysis (HR: 3.11 [1.91-5.09, p<0.01)]). The test demonstrated robust accuracy across all major breast cancer subtypes, including TNBC (C-index: 0.71 [0.62-0.81], HR: 3.81 [2.35-6.17, p=0.02]), where no diagnostic tools are currently recommended by clinical guidelines. These results suggest that our AI test can improve accuracy, extend applicability to a wider range of patients, and enhance access to treatment selection tools.

With nearly one million new cases diagnosed worldwide in 2020, head \& neck cancer is a deadly and common malignity. There are challenges to decision making and treatment of such cancer, due to lesions in multiple locations and outcome variability between patients. Therefore, automated segmentation and prognosis estimation approaches can help ensure each patient gets the most effective treatment. This paper presents a framework to perform these functions on arbitrary field of view (FoV) PET and CT registered scans, thus approaching tasks 1 and 2 of the HECKTOR 2022 challenge as team \texttt{VokCow}. The method consists of three stages: localization, segmentation and survival prediction. First, the scans with arbitrary FoV are cropped to the head and neck region and a u-shaped convolutional neural network (CNN) is trained to segment the region of interest. Then, using the obtained regions, another CNN is combined with a support vector machine classifier to obtain the semantic segmentation of the tumours, which results in an aggregated Dice score of 0.57 in task 1. Finally, survival prediction is approached with an ensemble of Weibull accelerated failure times model and deep learning methods. In addition to patient health record data, we explore whether processing graphs of image patches centred at the tumours via graph convolutions can improve the prognostic predictions. A concordance index of 0.64 was achieved in the test set, ranking 6th in the challenge leaderboard for this task., Comment: Published by Springer as part of the HECKTOR 2022 challenge proccedings https://link.springer.com/chapter/10.1007/978-3-031-27420-6_18

Retinal fundus images can be an invaluable diagnosis tool for screening epidemic diseases like hypertension or diabetes. And they become especially useful when the arterioles and venules they depict are clearly identified and annotated. However, manual annotation of these vessels is extremely time demanding and taxing, which calls for automatic segmentation. Although convolutional neural networks can achieve high overlap between predictions and expert annotations, they often fail to produce topologically correct predictions of tubular structures. This situation is exacerbated by the bifurcation versus crossing ambiguity which causes classification mistakes. This paper shows that including a topology preserving term in the loss function improves the continuity of the segmented vessels, although at the expense of artery-vein misclassification and overall lower overlap metrics. However, we show that by including an orientation score guided convolutional module, based on the anisotropic single sided cake wavelet, we reduce such misclassification and further increase the topology correctness of the results. We evaluate our model on public datasets with conveniently chosen metrics to assess both overlap and topology correctness, showing that our model is able to produce results on par with state-of-the-art from the point of view of overlap, while increasing topological accuracy., Comment: To be published in proceedings of SPIE Medical Imaging 2023 Image Processing