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IntroductionPathologists rely on whole slide images (WSIs) to diagnose cancer by identifying tumor cells and subtypes. Deep learning models, particularly weakly supervised ones, classify WSIs using image tiles but may overlook false positives and negatives due to the heterogeneous nature of tumors. Both cancerous and healthy cells can proliferate in patterns that extend beyond individual tiles, leading to errors at the tile level that result in inaccurate tumor-level classifications.MethodsTo address this limitation, we introduce NATMIL (Neighborhood Attention Transformer Multiple Instance Learning), which utilizes the Neighborhood Attention Transformer to incorporate contextual dependencies among WSI tiles. NATMIL enhances multiple instance learning by integrating a broader tissue context into the model. Our approach enhances the accuracy of tumor classification by considering the broader tissue context, thus reducing errors associated with isolated tile analysis.ResultsWe conducted a quantitative analysis to evaluate NATMIL’s performance against other weakly supervised algorithms. When applied to subtyping non-small cell lung cancer (NSCLC) and lymph node (LN) tumors, NATMIL demonstrated superior accuracy. Specifically, NATMIL achieved accuracy values of 89.6% on the Camelyon dataset and 88.1% on the TCGA-LUSC dataset, outperforming existing methods. These results underscore NATMIL’s potential as a robust tool for improving the precision of cancer diagnosis using WSIs.DiscussionOur findings demonstrate that NATMIL significantly improves tumor classification accuracy by reducing errors associated with isolated tile analysis. The integration of contextual dependencies enhances the precision of cancer diagnosis using WSIs, highlighting NATMILs´ potential as a robust tool in pathology.

KRAS is a pathogenic gene frequently implicated in non-small cell lung cancer (NSCLC). However, biopsy as a diagnostic method has practical limitations. Therefore, it is important to accurately determine the mutation status of the KRAS gene non-invasively by combining NSCLC CT images and genetic data for early diagnosis and subsequent targeted therapy of patients. This paper proposes a Semi-supervised Multimodal Multiscale Attention Model (S2MMAM). S2MMAM comprises a Supervised Multilevel Fusion Segmentation Network (SMF-SN) and a Semi-supervised Multimodal Fusion Classification Network (S2MF-CN). S2MMAM facilitates the execution of the classification task by transferring the useful information captured in SMF-SN to the S2MF-CN to improve the model prediction accuracy. In SMF-SN, we propose a Triple Attention-guided Feature Aggregation module for obtaining segmentation features that incorporate high-level semantic abstract features and low-level semantic detail features. Segmentation features provide pre-guidance and key information expansion for S2MF-CN. S2MF-CN shares the encoder and decoder parameters of SMF-SN, which enables S2MF-CN to obtain rich classification features. S2MF-CN uses the proposed Intra and Inter Mutual Guidance Attention Fusion (I2MGAF) module to first guide segmentation and classification feature fusion to extract hidden multi-scale contextual information. I2MGAF then guides the multidimensional fusion of genetic data and CT image data to compensate for the lack of information in single modality data. S2MMAM achieved 83.27% AUC and 81.67% accuracy in predicting KRAS gene mutation status in NSCLC. This method uses medical image CT and genetic data to effectively improve the accuracy of predicting KRAS gene mutation status in NSCLC. [ABSTRACT FROM AUTHOR]