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There is a paucity of guidelines relating to displays in digital pathology making procurement decisions, and display configuration challenging. Experience suggests pathologists have personal preferences for brightness when using a microscope which we hypothesised could be used as a predictor for display setup. We conducted an online survey across 6 NHS hospitals to capture brightness adjustment habits on both microscopes and screens. A subsample of respondents took part in a practical task to determine microscope brightness and display luminance preferences. The survey indicates 81% of respondents adjust the brightness on their microscope, compared with 11% adjusting their digital display. Display adjustments are more likely for visual comfort and ambient light compensation rather than for tissue factors, common for microscope adjustments. Twenty consultants took part in the practical brightness assessment. Light preferences on the microscope showed no correlation with screen preferences, except where a pathologist has a markedly brighter microscope preference. All of the preferences in this cohort were for a display luminance of less than 500cd/m$^2$, with 90% preferring 350cd/m$^2$ or less. There was no correlation between these preferences and the ambient lighting in the room. We conclude that microscope preferences can only be used to predict screen luminance requirements where the microscope is being used at very high brightness levels. A display capable of a brightness of 500cd/m$^2$ should be suitable for almost all pathologists with 300cd/m$^2$ suitable for the majority. The ability to adjust display luminance was felt to be important by the majority of respondents. Further work needs to be undertaken to establish the relationship between diagnostic performance, preferences and ambient lighting levels., Comment: Main paper 25 pages, 12 figures, 2 tables (including supplementary material)

Ensuring diagnostic performance of AI models before clinical use is key to the safe and successful adoption of these technologies. Studies reporting AI applied to digital pathology images for diagnostic purposes have rapidly increased in number in recent years. The aim of this work is to provide an overview of the diagnostic accuracy of AI in digital pathology images from all areas of pathology. This systematic review and meta-analysis included diagnostic accuracy studies using any type of artificial intelligence applied to whole slide images (WSIs) in any disease type. The reference standard was diagnosis through histopathological assessment and / or immunohistochemistry. Searches were conducted in PubMed, EMBASE and CENTRAL in June 2022. We identified 2976 studies, of which 100 were included in the review and 48 in the full meta-analysis. Risk of bias and concerns of applicability were assessed using the QUADAS-2 tool. Data extraction was conducted by two investigators and meta-analysis was performed using a bivariate random effects model. 100 studies were identified for inclusion, equating to over 152,000 whole slide images (WSIs) and representing many disease types. Of these, 48 studies were included in the meta-analysis. These studies reported a mean sensitivity of 96.3% (CI 94.1-97.7) and mean specificity of 93.3% (CI 90.5-95.4) for AI. There was substantial heterogeneity in study design and all 100 studies identified for inclusion had at least one area at high or unclear risk of bias. This review provides a broad overview of AI performance across applications in whole slide imaging. However, there is huge variability in study design and available performance data, with details around the conduct of the study and make up of the datasets frequently missing. Overall, AI offers good accuracy when applied to WSIs but requires more rigorous evaluation of its performance., Comment: 26 pages, 5 figures, 8 tables + Supplementary materials

The application of new artificial intelligence (AI) discoveries is transforming healthcare research. However, the standards of reporting are variable in this still evolving field, leading to potential research waste. The aim of this work is to highlight resources and reporting guidelines available to researchers working in computational pathology. The EQUATOR Network library of reporting guidelines and extensions was systematically searched up to August 2022 to identify applicable resources. Inclusion and exclusion criteria were used and guidance was screened for utility at different stages of research and for a range of study types. Items were compiled to create a summary for easy identification of useful resources and guidance. Over 70 published resources applicable to pathology AI research were identified. Guidelines were divided into key categories, reflecting current study types and target areas for AI research: Literature & Research Priorities, Discovery, Clinical Trial, Implementation and Post-Implementation & Guidelines. Guidelines useful at multiple stages of research and those currently in development were also highlighted. Summary tables with links to guidelines for these groups were developed, to assist those working in cancer AI research with complete reporting of research. Issues with replication and research waste are recognised problems in AI research. Reporting guidelines can be used as templates to ensure the essential information needed to replicate research is included within journal articles and abstracts. Reporting guidelines are available and useful for many study types, but greater awareness is needed to encourage researchers to utilise them and for journals to adopt them. This review and summary of resources highlights guidance to researchers, aiming to improve completeness of reporting., Comment: 23 pages, 2 figures, 8 tables

Determining early-stage prognostic markers and stratifying patients for effective treatment are two key challenges for improving outcomes for melanoma patients. Previous studies have used tumour transcriptome data to stratify patients into immune subgroups, which were associated with differential melanoma specific survival and potential treatment strategies. However, acquiring transcriptome data is a time-consuming and costly process. Moreover, it is not routinely used in the current clinical workflow. Here we attempt to overcome this by developing deep learning models to classify gigapixel H&E stained pathology slides, which are well established in clinical workflows, into these immune subgroups. Previous subtyping approaches have employed supervised learning which requires fully annotated data, or have only examined single genetic mutations in melanoma patients. We leverage a multiple-instance learning approach, which only requires slide-level labels and uses an attention mechanism to highlight regions of high importance to the classification. Moreover, we show that pathology-specific self-supervised models generate better representations compared to pathology-agnostic models for improving our model performance, achieving a mean AUC of 0.76 for classifying histopathology images as high or low immune subgroups. We anticipate that this method may allow us to find new biomarkers of high importance and could act as a tool for clinicians to infer the immune landscape of tumours and stratify patients, without needing to carry out additional expensive genetic tests., Comment: 8 pages (without appendices), 2 figures, submitted to MIDL 2022 conference proceedings

Digital whole-slide images of pathological tissue samples have recently become feasible for use within routine diagnostic practice. These gigapixel sized images enable pathologists to perform reviews using computer workstations instead of microscopes. Existing workstations visualize scanned images by providing a zoomable image space that reproduces the capabilities of the microscope. This paper presents a novel visualization approach that enables filtering of the scale-space according to color preference. The visualization method reveals diagnostically important patterns that are otherwise not visible. The paper demonstrates how this approach has been implemented into a fully functional prototype that lets the user navigate the visualization parameter space in real time. The prototype was evaluated for two common clinical tasks with eight pathologists in a within-subjects study. The data reveal that task efficiency increased by 15% using the prototype, with maintained accuracy. By analyzing behavioral strategies, it was possible to conclude that efficiency gain was caused by a reduction of the panning needed to perform systematic search of the images. The prototype system was well received by the pathologists who did not detect any risks that would hinder use in clinical routine.