MAg: a simple learning-based patient-level aggregation method for detecting microsatellite instability from whole-slide images

TL;DR

This paper introduces MAg, a simple machine learning-based patient-level aggregation method that enhances the accuracy of microsatellite instability detection from whole-slide images, making it more accessible and cost-effective.

Contribution

The paper proposes a novel histogram-based patient-level aggregation method (MAg) that improves MSI prediction accuracy across multiple deep neural networks.

Findings

MAg consistently improves patient-level MSI prediction accuracy.

The method is compatible with various deep neural networks.

It enhances the utility of H&E-stained WSIs for MSI detection.

Abstract

The prediction of microsatellite instability (MSI) and microsatellite stability (MSS) is essential in predicting both the treatment response and prognosis of gastrointestinal cancer. In clinical practice, a universal MSI testing is recommended, but the accessibility of such a test is limited. Thus, a more cost-efficient and broadly accessible tool is desired to cover the traditionally untested patients. In the past few years, deep-learning-based algorithms have been proposed to predict MSI directly from haematoxylin and eosin (H&E)-stained whole-slide images (WSIs). Such algorithms can be summarized as (1) patch-level MSI/MSS prediction, and (2) patient-level aggregation. Compared with the advanced deep learning approaches that have been employed for the first stage, only the na\"ive first-order statistics (e.g., averaging and counting) were employed in the second stage. In this paper, we propose a simple yet broadly generalizable patient-level MSI aggregation (MAg) method to effectively integrate the precious patch-level information. Briefly, the entire probabilistic distribution in the first stage is modeled as histogram-based features to be fused as the final outcome with machine learning (e.g., SVM). The proposed MAg method can be easily used in a plug-and-play manner, which has been evaluated upon five broadly used deep neural networks: ResNet, MobileNetV2, EfficientNet, Dpn and ResNext. From the results, the proposed MAg method consistently improves the accuracy of patient-level aggregation for two publicly available datasets. It is our hope that the proposed method could potentially leverage the low-cost H&E based MSI detection method. The code of our work has been made publicly available at https://github.com/Calvin-Pang/MAg.