The diagnosis of malignant and benign pulmonary nodules has always been a prominent research topic. Accurately distinguishing between these types of lesions, particularly small or ground glass nodules, is crucial for the early detection and proactive treatment of lung cancer, ultimately leading to improved patient survival. Although various imaging methods and tissue biopsies have advanced the diagnostic efficacy of pulmonary nodules, each approach possesses inherent limitations. In recent years, there has been a growing interest in liquid biopsy as a non‑invasive and easily obtainable alternative. Furthermore, in‑depth investigations into the mechanisms underlying tumor initiation and progression have contributed to the development of circulating biomarkers for monitoring treatment response and efficacy in lung cancer. This review provides a comprehensive overview of the current landscape of pulmonary nodule diagnosis while highlighting the latest advancements in liquid biopsy techniques, such as extracellular vesicles, tumor‑educated platelets, non‑coding RNA, circulating tumor DNA and circulating antibodies.

Lung adenocarcinoma (LUAD) is a morphologically heterogeneous disease, characterized by five primary histological growth patterns. The classification of such patterns is crucial due to their direct relation to prognosis but the high subjectivity and observer variability pose a major challenge. Related studies in the literature focus on machine learning methods for growth pattern classification, often formulating the problem as a slide-level predominant pattern classification problem. We propose a generalizable machine learning pipeline capable of classifying lung tissue into one of the five patterns or as non-tumor. The proposed pipeline's strength lies in a novel compact Cell Organization Maps (cellOMaps) representation that captures the cellular spatial patterns from Hematoxylin and Eosin (H&E) whole slide images (WSIs). The proposed pipeline provides state-of-the-art performance on LUAD growth pattern classification when evaluated on both internal unseen slides and external datasets, comparing favorably with the current approaches. In addition, our preliminary results show that the model's outputs can be used to predict patients Tumor Mutational Burden (TMB) levels.

The primary method for predicting POD (postoperative confusion) relies on the analysis of clinical features. Brain activity complexity is a promising factor associated with the state of consciousness. The aim of this study was to investigate the role of EEG (electroencephalography) complexity changes in predicting POD in elderly patients undergoing orthopedic surgery.

From January 2024 to August 2024, 289 elderly patients undergoing orthopedic surgery were recruited at the Second Affiliated Hospital of Nanjing Medical University. Intraoperative EEG data from patients were collected and then EEG nonlinear features were extracted by MATLAB custom scripts. The logistic regression and CNN (convolutional neural networks) were used to explore the predictive effect of nonlinear features on POD from both static and dynamic perspectives.

Low permutation Lempel-Ziv complexity (PLZC) among the EEG nonlinear features emerged as an independent risk factor for POD [OR = 0.210; 95% CI (0.050-0.850); p = 0.029]. Receiver operating characteristic curve (ROC) analysis revealed a poor area under the curve of 0.615 (95% CI 0.517-0.711) for PLZC in predicting POD. After the inclusion of temporal factors, the ROC analysis indicated that the EEG nonlinear indices had a moderate predictive effect on POD [AUC = 0.701; (95% CI 0.541-0.862)].

EEG nonlinear feature indices may be effective biomarkers for POD and could help predict POD in elderly patients undergoing orthopedic surgery.

In clinical practice, the three most prevalent forms of infectious spondylitis are tuberculous spondylitis (TS), brucellosis spondylitis (BS), and pyogenic spondylitis (PS). It is possible to successfully lessen neurological and spinal damage by detecting them early. In the medical field, radiomics has been applied extensively. It is crucial to find out if MRI imaging can be used to diagnose spinal infections early.

To explore the diagnostic value of establishing models based on MRI radiomics for different spinal infections.

This retrospective study collected clinical and magnetic resonance imaging information on a total of 136 patients diagnosed with spondylitis in April 2019 and August 2023, who were classified into specific spinal infections (TS or BS) and non-specific spinal infections (PS) based on treatment. 3D Slicer software was used to outline the region of interest (ROI) and extracted ROI features. All patients were randomly divided into a training set and a test set (7:3), and after standardized, the t-test and LASSO were sequentially performed in the training set to extract the optimal radiomic features. These features were used to calculate the Radscore and construct the features classifier model and evaluated by test set. Univariate and multivariate logistic regression of Radscore and clinical features to identify predictors contributing to the diagnosis were used to plot nomograms, the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA) to assess the nomogram. The same approach described above was used to diagnose both subgroups of BS and TS in SSI.

321 radiological features were extracted from the three different sequences. The remaining 7 optimal radiomics features were used to calculate the Radscore and establish three feature classifier models, with RF having the best performance (AUC=1 and 0.86). And after univariate and multivariate logistic regression, the final nomogram constructed by Radscore and had good discriminatory performance in the training set and the test set (AUC =0.924 and 0.868), and the calibration curve and DCA showed good clinical efficacy. In the subgroup, the AUC of the training and test sets was 0.929and0.863.

The diagnostic model based on MR radiomics can gradually differentiate tuberculous spondylitis, brucellosis spondylitis, and pyogenic spondylitis.

In a rapidly evolving healthcare environment, artificial intelligence (AI) is transforming diagnostic techniques and personalized medicine. This is also seen in osseous biopsies. AI applications in radiomics, histopathology, predictive modelling, biopsy navigation, and interdisciplinary communication are reshaping how bone biopsies are conducted and interpreted. We provide a brief review of AI in image- guided biopsy of bone tumours (primary and secondary) and specimen handling, in the era of personalized medicine. This article explores AI's role in enhancing diagnostic accuracy, improving safety in biopsies, and enabling more precise targeting in bone lesion biopsies, ultimately contributing to better patient outcomes in personalized medicine. We dive into various AI technologies applied to osseous biopsies, such as traditional machine learning, deep learning, radiomics, simulation, and generative models. We explore their roles in tumour-board meetings, communication between clinicians, radiologists, and pathologists. Additionally, we inspect ethical considerations associated with the integration of AI in bone biopsy procedures, technical limitations, and we delve into health equity, generalizability, deployment issues, and reimbursement challenges in AI-powered healthcare. Finally, we explore potential future developments and offer a list of open-source AI tools and algorithms relevant to bone biopsies, which we include to encourage further discussion and research.

Histopathology is the reference standard for diagnosing the presence and nature of many diseases, including cancer. However, analyzing tissue samples under a microscope and summarizing the findings in a comprehensive pathology report is time-consuming, labor-intensive, and non-standardized. To address this problem, we present HistoGPT, a vision language model that generates pathology reports from a patient's multiple full-resolution histology images. It is trained on 15,129 whole slide images from 6705 dermatology patients with corresponding pathology reports. The generated reports match the quality of human-written reports for common and homogeneous malignancies, as confirmed by natural language processing metrics and domain expert analysis. We evaluate HistoGPT in an international, multi-center clinical study and show that it can accurately predict tumor subtypes, tumor thickness, and tumor margins in a zero-shot fashion. Our model demonstrates the potential of artificial intelligence to assist pathologists in evaluating, reporting, and understanding routine dermatopathology cases.

Pancreatic cancer treatment plans involving surgery and/or chemotherapy are highly dependent on disease stage. However, current staging systems are ineffective and poorly correlated with survival outcomes. We investigate how artificial intelligence (AI) can enhance prognostic accuracy in pancreatic cancer by integrating multiple data sources.

Patients with histopathology and/or radiology/follow-up confirmed pancreatic ductal adenocarcinoma (PDAC) from a Dutch center (2004-2023) were included in the development cohort. Two additional PDAC cohorts from a Dutch and Spanish center were used for external validation. Prognostic models including clinical variables, contrast-enhanced CT images, and a combination of both were developed to predict high-risk short-term survival. All models were trained using five-fold cross-validation and assessed by the area under the time-dependent receiver operating characteristic curve (AUC).

The models were developed on 401 patients (203 females, 198 males, median survival (OS) = 347 days, IQR: 171-585), with 98 (24.4%) short-term survivors (OS < 230 days) and 303 (75.6%) long-term survivors. The external validation cohorts included 361 patients (165 females, 138 males, median OS = 404 days, IQR: 173-736), with 110 (30.5%) short-term survivors and 251 (69.5%) longer survivors. The best AUC for predicting short vs. long-term survival was achieved with the multi-modal model (AUC = 0.637 (95% CI: 0.500-0.774)) in the internal validation set. External validation showed AUCs of 0.571 (95% CI: 0.453-0.689) and 0.675 (95% CI: 0.593-0.757).

Multimodal AI can predict long vs. short-term survival in PDAC patients, showing potential as a prognostic tool in clinical decision-making.

Question Prognostic tools for pancreatic ductal adenocarcinoma (PDAC) remain limited, with TNM staging offering suboptimal accuracy in predicting patient survival outcomes. Findings The multimodal AI model demonstrated improved prognostic performance over TNM and unimodal models for predicting short- and long-term survival in PDAC patients. Clinical relevance Multimodal AI provides enhanced prognostic accuracy compared to current staging systems, potentially improving clinical decision-making and personalized management strategies for PDAC patients.

To explore the role of genes related to fatty acid metabolism in lung adenocarcinoma classification and prognosis.

Transcriptome and clinical data from the TCGA database and GEO database were collected, the expression of prognostic fatty acid metabolism-related genes in LUAD patients was analyzed, and key genes related to both fatty acid metabolism and subtype were identified. These key genes were further filtered via the LASSO regression method, and the retained genes were used to construct a risk-scoring model. The biological function of RPS4Y1 was verified by cell viability, colony formation, migration, and flow cytometry assays. Finally, immune infiltration and drug sensitivity were analyzed in the high- and low-risk groups.

31 key FAMGs associated with prognosis were identified in LUAD patients. LUAD cases were divided into 3 subtypes on the basis of the expression of these genes. The DEGs between the different subtypes were associated mainly with amino acid metabolic pathways. In addition, among the 46 DEGs between subtypes, 5 key FAMGs (SCGB3 A2, PGC, ADH7, RPS4Y1, and KRT6 A) were identified as the best prognostic markers via LASSO regression to establish a risk scoring model. Patients with low risk scores had a better prognosis and a greater degree of immune cell infiltration than those with high risk scores. RPS4Y1 is highly expressed in LUAD, and its knockdown significantly inhibits the growth of tumor cells. Moreover, we also analyzed drugs likely to be effective for the high- and low-risk groups.

FAMGs play important roles in LUAD, and the key genes identified may be new targets for LUAD treatment.

The investigation and diagnosis of hematologic malignancy using blood cell image analysis are major and emerging subjects that lie at the intersection of artificial intelligence and medical research. This survey systematically examines the state-of-the-art in blood cancer detection through image-based analysis, aimed at identifying the most effective computational strategies and highlighting emerging trends. This review focuses on three principal objectives, namely, to categorize and compare traditional machine learning (ML), deep learning (DL), and hybrid learning approaches; to evaluate performance metrics such as accuracy, precision, recall, and area under the ROC curve; and to identify methodological gaps and propose directions for future research. Methodologically, we organize the literature by categorizing the malignancy types-leukemia, lymphoma, and multiple myeloma-and particularizing the preprocessing steps, feature extraction techniques, network architectures, and ensemble strategies employed. For ML methods, we discuss classical classifiers including support vector machines and random forests; for DL, we analyze convolutional neural networks (e.g., AlexNet, VGG, and ResNet) and transformer-based models; and for hybrid systems, we examine combinations of CNNs with attention mechanisms or traditional classifiers. Our synthesis reveals that DL models consistently outperform ML baselines, achieving classification accuracies above 95% in benchmark datasets, with hybrid models pushing peak accuracy to 99.7%. However, challenges remain in data scarcity, class imbalance, and generalizability to clinical settings. We conclude by recommending the integration of multimodal data, semisupervised learning, and rigorous external validation to advance toward deployable diagnostic tools. This survey also provides a comprehensive roadmap for researchers and clinicians striving to harness AI for reliable hematologic cancer detection.

This study aimed to classify patients' focal (frontal, temporal, parietal, occipital), multifocal, and generalized epileptiform activities based on EEG findings using artificial intelligence models. The study included 575 patients followed in the Neurology Epilepsy Polyclinics of Adana City Training and Research Hospital between June 2021 and July 2024. Patient history, examination findings, seizure characteristics and EEG results were retrospectively reviewed to create a comprehensive database. Initially, machine learning architectures were applied to differentiate generalized and focal epilepsy. Subsequently, EEG findings were categorized into eight subgroups, and machine learning methods were utilized for classification. Three AI models-Multilayer Perceptron (MLP), Random Forest, and Support Vector Machine (SVM)-were employed. The dataset was further improved through data augmentation with SMOTE. The initial deep learning model achieved 89 % accuracy, recall, and F1 scores. Then, Optuna framework was incorporated into model to optimize hyperparameters, thus the accuracy reached 96 %. In comparison, the proposed ensemble model combining MLP, SVM and XGBoost achieved the highest accuracy of 98 %. The study demonstrates that data augmentation and ensemble AI models can provide robust decision support for physicians in classifying epilepsy types.

In the age of big data, privacy, particularly medical data privacy, is becoming increasingly important. Differential privacy (DP) has emerged as a key method for safeguarding privacy during data analysis and publishing. Cancer identification and classification play a vital role in early detection and treatment. This paper introduces a novel algorithm, DPFCM_GK, which combines differential privacy with fuzzy c-means (FCM) clustering using a Gaussian kernel function. The algorithm enhances cancer detection while ensuring data privacy. Three publicly available lung cancer datasets, along with a dataset from our hospital, are used to test and demonstrate the effectiveness of DPFCM_GK. The experimental results show that DPFCM_GK achieves high clustering accuracy and enhanced privacy as the privacy budget (ε) increases. For the UCIML, NLST, and NSCLC datasets, it reaches optimal results at lower ε (1.52, 1.24, and 2.32) compared to DPFCM. In the lung cancer dataset, DPFCM_GK outperforms DPFCM within, 0.05 ≤ ε ≤ 2.5, with significant differences (χ2 = 4.54 ∼ 29.12; P < 0.05), and both methods converge to an accuracy of 94.5% as ε increases. Although differential privacy initially increases iteration counts, DPFCM_GK demonstrates faster convergence and fewer iterations compared to DPFCM, with significant reductions (T= 23.08, 43.47, and 48.93; P<0.05). For the UCIML dataset, DPFCM_GK significantly reduces runtime compared to other models (DPFCM, LDP-SGD, LDP-Fed, LDP-FedSGD, MGM-DPL, LDP-FL) under the same privacy budget. The runtime reduction is statistically significant with T-values of (T = 21.08, 316.24, 102.35, 222.37, 162.23, 159.25; P < 0.05). DPFCM_GK still maintains excellent time efficiency when applied to the NLST and NSCLC datasets(P < 0.05). For the LLCS dataset, For the LLCS dataset, the DPFCM_GK demonstrates significant improvement as the privacy budget increases, especially in low-budget scenarios, where the performance gap is most pronounced (T=4.20, 8.44, 10.92, 3.95, 7.16, 8.51, P < 0.05). These results confirm DPFCM_GK as a practical solution for medical data analysis, balancing accuracy, privacy, and efficiency.

Background: Malignant pleural effusions (MPEs) are common in advanced lung cancer patients. Cytological examination of pleural fluid is essential for identifying cell types but presents diagnostic challenges, particularly when reactive mesothelial cells mimic neoplastic cells. AI-powered diagnostic systems have emerged as valuable tools in digital cytopathology. This study explores the applicability of machine-learning (ML) models and highlights the importance of accessible tools for clinicians, enabling them to develop AI solutions and make advanced diagnostic tools available even in resource-limited settings. The focus is on differentiating normal/reactive cells from neoplastic cells in pleural effusions linked to lung adenocarcinoma. Methods: A dataset from the Cytopathology Unit at the Sant'Andrea University Hospital comprising 969 raw images, annotated with 3130 single mesothelial cells and 3260 adenocarcinoma cells, was categorized into two classes based on morphological features. Object-detection models were developed using YOLOv8 and the latest YOLOv11 instance segmentation models. Results: The models achieved an Intersection over Union (IoU) score of 0.72, demonstrating robust performance in class prediction for both categories, with YOLOv11 showing performance improvements over YOLOv8 in different metrics. Conclusions: The application of machine learning in cytopathology offers clinicians valuable support in differential diagnosis while also expanding their ability to engage with AI tools and methodologies. The diagnosis of MPEs is marked by substantial morphological and technical variability, underscoring the need for high-quality datasets and advanced deep-learning models. These technologies have the potential to enhance data interpretation and support more effective clinical treatment strategies in the era of precision medicine.

Molecular subtyping of pulmonary large-cell neuroendocrine carcinoma (LCNEC) based on retinoblastoma protein (pRb) expression may influence systemic treatment decisions. Current histomorphologic assessments of hematoxylin and eosin-stained tissue samples cannot reliably differentiate LCNEC molecular subtypes. This study explores the potential of deep learning (DL) to identify histologic patterns that distinguish these subtypes, by developing a custom convolutional neural network to predict the binary expression of pRb in small LCNEC tissue samples. Our model was trained, cross-validated, and tested on tissue microarray cores from 143 resection specimens and biopsies from 21 additional patients, with corresponding immunohistochemical pRb status. The best-performing DL model achieved a patient-wise balanced accuracy value of 0.75 and an area under the receiver operating characteristic curve value of 0.77 when tested on biopsies, significantly outperforming the hematoxylin and eosin-based subtype classification by lung pathologists. Explainable artificial intelligence techniques further highlighted coarse chromatin patterns and distinct nucleoli as distinguishing features for pRb retained status. Meanwhile, pRb lost cases were characterized by limited cytoplasm and morphologic similarities with small cell lung cancer. These findings suggest that DL analysis of small histopathology samples could ultimately replace immunohistochemical pRb testing. Such a development may assist in guiding chemotherapy decisions, particularly in metastatic cases.

Epidermal growth factor receptor (EGFR) mutations play a pivotal role in guiding targeted therapy for lung cancer, making their accurate detection essential for personalized treatment. Recently, artificial intelligence (AI) has emerged as a promising tool for identifying EGFR mutation status from digital pathology images. This systematic review and meta-analysis evaluate the diagnostic accuracy of AI models in predicting EGFR mutations from whole slide images (WSIs) in lung cancer patients.

A comprehensive search was conducted across four databases (EMBASE, PubMed, Web of Science, and Scopus) for studies published up to June 20th, 2024. Studies employing AI algorithms, including machine learning and deep learning techniques, to predict EGFR mutations from digital pathology images were included. The risk of bias and applicability concerns were assessed using the QUADAS-AI tool. Diagnostic accuracy metrics such as sensitivity, specificity, and the Area Under the Curve (AUC) were extracted. Random-effects models were applied to synthesize the AI model performance. This study is registered with PROSPERO (CRD42024570496).

Out of 1,828 identified studies, 16 met the inclusion criteria, with 4 eligible for meta-analysis. The pooled results demonstrated that AI algorithms achieved an AUC of 0.756 (95% CI: 0.669-0.824), a sensitivity of 66.3% (95% CI: X-Y), and a specificity of 68.1% (95% CI: X-Y). Subgroup analyses revealed that AI models using in-house datasets, surgical resection samples, the ResNet architecture, and tumor-focused regions exhibited improved predictive performance.

AI models exhibit potential for non-invasive prediction of EGFR mutations in lung cancer patients using WSIs, although current accuracy and precision warrant further refinement. Future research should aim to enhance AI algorithms, validate findings on larger datasets, and integrate these tools into clinical workflows to optimize lung cancer management.

Cancers are characterized by remarkable heterogeneity and diverse prognosis. Accurate cancer classification is essential for patient stratification and clinical decision-making. Although digital pathology has been advancing cancer diagnosis and prognosis, the paradigm in cancer pathology has shifted from purely relying on histology features to incorporating molecular markers. There is an urgent need for digital pathology methods to meet the needs of the new paradigm. We introduce a novel digital pathology approach to jointly predict molecular markers and histology features and model their interactions for cancer classification. Firstly, to mitigate the challenge of cross-magnification information propagation, we propose a multi-scale disentangling module, enabling the extraction of multi-scale features from high-magnification (cellular-level) to low-magnification (tissue-level) whole slide images. Further, based on the multi-scale features, we propose an attention-based hierarchical multi-task multi-instance learning framework to simultaneously predict histology and molecular markers. Moreover, we propose a co-occurrence probability-based label correlation graph network to model the co-occurrence of molecular markers. Lastly, we design a cross-modal interaction module with the dynamic confidence constrain loss and a cross-modal gradient modulation strategy, to model the interactions of histology and molecular markers. Our experiments demonstrate that our method outperforms other state-of-the-art methods in classifying glioma, histology features and molecular markers. Our method promises to promote precise oncology with the potential to advance biomedical research and clinical applications. The code is available at github.

In the context of chronic liver diseases, where variability in progression necessitates early and precise diagnosis, this study addresses the limitations of traditional histological analysis and the shortcomings of existing deep learning approaches. A novel patch-level classification model employing multi-scale feature extraction and fusion was developed to enhance the grading accuracy and interpretability of liver biopsies, analyzing 1322 cases across various staining methods. The study also introduces a slide-level aggregation framework, comparing different diagnostic models, to efficiently integrate local histological information. Results from extensive validation show that the slide-level model consistently achieved high F1 scores, notably 0.9 for inflammatory activity and steatosis, and demonstrated rapid diagnostic capabilities with less than one minute per slide on average. The patch-level model also performed well, with an F1 score of 0.64 for ballooning and 0.99 for other indicators, and proved transferable to public datasets. The conclusion drawn is that the proposed analytical framework offers a reliable basis for the diagnosis and treatment of chronic liver diseases, with the added benefit of robust interpretability, suggesting its practical utility in clinical settings.

Building deep learning models that can rapidly segment whole slide images (WSIs) using only a handful of training samples remains an open challenge in computational pathology. The difficulty lies in the histological images themselves: many morphological structures within a slide are closely related and very similar in appearance, making it difficult to distinguish between them. However, a skilled pathologist can quickly identify the relevant phenotypes. Through years of training, they have learned to organize visual features into a hierarchical taxonomy (e.g., identifying carcinoma versus healthy tissue, or distinguishing regions within a tumor as cancer cells, the microenvironment, …). Thus, each region is associated with multiple labels representing different tissue types. Pathologists typically deal with this by analyzing the specimen at multiple scales and comparing visual features between different magnifications. Inspired by this multi-scale diagnostic workflow, we introduce the Navigator, a vision model that navigates through WSIs like a domain expert: it searches for the region of interest at a low scale, zooms in gradually, and localizes ever finer microanatomical classes. As a result, the Navigator can detect coarse-grained patterns at lower resolution and fine-grained features at higher resolution. In addition, to deal with sparsely annotated samples, we train the Navigator with a novel semi-supervised framework called S5CL v2. The proposed model improves the F1 score by up to 8% on various datasets including our challenging new TCGA-COAD-30CLS and Erlangen cohorts.

Foundation models prepare neural networks for applications in specific domains, such as speech applications or image analysis, through self-supervised pretraining. These models can be adapted for specific applications, such as histopathological diagnostics. While adaptation still requires supervised training, AI applications based on foundation models achieve significantly better prediction accuracy with fewer training data compared to conventional approaches. This article introduces the topic and provides an overview of foundation models in pathology.

Ttyrosine kinase inhibitors (TKIs) represent the standard first-line treatment for patients with epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma. However, not all patients with EGFR mutations respond to TKIs. This study aims to develop a deep learning radiological-pathological-clinical (DLRPC) model that integrates computed tomography (CT) images, hematoxylin and eosin (H&E)-stained aspiration biopsy samples, and clinical data to predict the response in EGFR-mutant lung adenocarcinoma patients undergoing TKIs treatment.

We retrospectively analyzed data from 214 lung adenocarcinoma patients who received TKIs treatment from two medical centers between September 2013 and June 2023. The DLRPC model leverages paired CT, pathological images and clinical data, incorporating a clinical-based attention mask to further explore the cross-modality associations. To evaluate its diagnostic performance, we compared the DLRPC model against single-modality models and a decision level fusion model based on Dempster-Shafer theory. Model performances metrics, including area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were used for evaluation. The Delong test assessed statistically significantly differences in AUC among models.

The DLRPC model demonstrated strong performance, achieving an AUC value of 0.8424. It outperformed the single-modality models (AUC = 0.6894, 0.7753, 0.8052 for CT model, pathology model and clinical model, respectively. P < 0.05). Additionally, the DLRPC model surpassed the decision level fusion model (AUC = 0.8132, P < 0.05).

The DLRPC model effectively predicts the response of EGFR-mutant lung adenocarcinoma patients to TKIs, providing a promising tool for personalized treatment decisions in lung cancer management.

Artificial intelligence (AI) is rapidly transforming the fields of pathology and oncology, offering novel opportunities for advancing diagnosis, prognosis, and treatment of cancer.

Through a systematic review-based approach, the representatives from the European Society for Medical Oncology (ESMO) Precision Oncology Working Group (POWG) and international experts identified studies in pathology and oncology that applied AI-based algorithms for tumour diagnosis, molecular biomarker detection, and cancer prognosis assessment. These findings were synthesised to provide a comprehensive overview of current AI applications and future directions in cancer pathology.

The integration of AI tools in digital pathology is markedly improving the accuracy and efficiency of image analysis, allowing for automated tumour detection and classification, identification of prognostic molecular biomarkers, and prediction of treatment response and patient outcomes. Several barriers for the adoption of AI in clinical workflows, such as data availability, explainability, and regulatory considerations, still persist. There are currently no prognostic or predictive AI-based biomarkers supported by level IA or IB evidence. The ongoing advancements in AI algorithms, particularly foundation models, generalist models and transformer-based deep learning, offer immense promise for the future of cancer research and care. AI is also facilitating the integration of multi-omics data, leading to more precise patient stratification and personalised treatment strategies.

The application of AI in pathology is poised to not only enhance the accuracy and efficiency of cancer diagnosis and prognosis but also facilitate the development of personalised treatment strategies. Although barriers to implementation remain, ongoing research and development in this field coupled with addressing ethical and regulatory considerations will likely lead to a future where AI plays an integral role in cancer management and precision medicine. The continued evolution and adoption of AI in pathology and oncology are anticipated to reshape the landscape of cancer care, heralding a new era of precision medicine and improved patient outcomes.

The use of self-supervised learning to train pathology foundation models has increased substantially in the past few years. Notably, several models trained on large quantities of clinical data have been made publicly available in recent months. This will significantly enhance scientific research in computational pathology and help bridge the gap between research and clinical deployment. With the increase in availability of public foundation models of different sizes, trained using different algorithms on different datasets, it becomes important to establish a benchmark to compare the performance of such models on a variety of clinically relevant tasks spanning multiple organs and diseases. In this work, we present a collection of pathology datasets comprising clinical slides associated with clinically relevant endpoints including cancer diagnoses and a variety of biomarkers generated during standard hospital operation from three medical centers. We leverage these datasets to systematically assess the performance of public pathology foundation models and provide insights into best practices for training foundation models and selecting appropriate pretrained models. To enable the community to evaluate their models on our clinical datasets, we make available an automated benchmarking pipeline for external use.

Lymphoma is a malignant tumor of the immune system and its incidence is increasing year after year, causing a major threat to people's health. Conventional diagnosis of lymphoma basically depends on histological images consuming long-time and tedious manipulations (e.g., 7-15 days) and large-field view (e.g., > 1000 × 1000 μm2). Artificial intelligence has recently revolutionized cancer diagnosis by training pathological image databases via deep learning. Current approaches, however, remain dependent on analyzing wide-field pathological images to detect distinct nuclear, cytologic, and histomorphologic traits for diagnostic categorization, limiting their applicability to minimally invasive lesion.

Herein, we develop a molecular imaging strategy for minimally invasive lymphoma diagnosis. By spreading lymphoma tissue sections tightly on a surface-enhanced Raman scattering (SERS) chip, label-free images of DNA double strand breaks (DSBs) in 30 × 30 μm2 tissue sections could be achieved in ~ 15 min. To establish a proof of concept, the Raman image datasets collected from clinical samples of normal lymphatic tissues and non-Hodgkin's lymphoma (NHL) tissues were well organized and trained in a deep convolutional neural network model, finally achieving a recognition rate of ~ 91.7 ± 2.1%.

The molecular imaging strategy for minimally invasive lymphoma diagnosis that can achieve a recognition rate of ~ 91.7 ± 2.1%. We anticipate that these results will catalyze the development of a series of histological SERS-AI technologies for diagnosing various diseases, including other types of cancer. In this work, we present a reliable tool to facilitate clinicians in the diagnosis of lymphoma.

Artificial intelligence is rapidly transforming quality assurance in healthcare, driving advancements in diagnostics, surgery, and patient care. This review presents a comprehensive analysis of artificial intelligence integration-particularly convolutional and recurrent neural networks-across key clinical domains, significantly enhancing diagnostic accuracy, surgical performance, and pathology evaluation. Artificial intelligence-based approaches have demonstrated clear superiority over conventional methods: convolutional neural networks achieved 91.56% accuracy in scanner fault detection, surpassing manual inspections; endoscopic lesion detection sensitivity rose from 2.3% to 6.1% with artificial intelligence assistance; and gastric cancer invasion depth classification reached 89.16% accuracy, outperforming human endoscopists by 17.25%. In pathology, artificial intelligence achieved 93.2% accuracy in identifying out-of-focus regions and an F1 score of 0.94 in lymphocyte quantification, promoting faster and more reliable diagnostics. Similarly, artificial intelligence improved surgical workflow recognition with over 81% accuracy and exceeded 95% accuracy in skill assessment classification. Beyond traditional diagnostics and surgical support, AI-powered wearable sensors, drug delivery systems, and biointegrated devices are advancing personalized treatment by optimizing physiological monitoring, automating care protocols, and enhancing therapeutic precision. Despite these achievements, challenges remain in areas such as data standardization, ethical governance, and model generalizability. Overall, the findings underscore artificial intelligence's potential to outperform traditional techniques across multiple parameters, emphasizing the need for continued development, rigorous clinical validation, and interdisciplinary collaboration to fully realize its role in precision medicine and patient safety.

Bacterial infections pose a significant biosafety concern, making early and accurate diagnosis essential for effective treatment and prognosis. Traditional diagnostic methods, while reliable, are often slow and fail to meet urgent clinical demands. In contrast, emerging technologies offer greater efficiency but are often costly and inaccessible. In this study, we utilized easily accessible pathology images to diagnose bacterial infections. Our initial findings indicate that, in the absence of postmortem phenomena, microscopic examination of pathological images can confirm the presence of a bacterial infection. However, distinguishing between different types of bacterial infections remains challenging due to similarities in pathological changes. To address this limitation, we applied a computational pathology approach by integrating pathology images with artificial intelligence (AI) algorithms. Our model classified bacterial infections at both the patch-level and whole slide image (WSI)-level. The results demonstrated strong performance, with an overall AUC consistently above 0.950 across training, testing, and external validation datasets, indicating high accuracy, robustness, and generalizability. This study highlights AI's potential in identifying bacterial infection types and provides valuable technical support for clinical diagnostics, paving the way for faster and more precise infection management.

Bladder cancer is one of the top ten cancers globally, with its incidence steadily rising in China. Early detection and prognosis risk assessment play a crucial role in guiding subsequent treatment decisions for bladder cancer. However, traditional diagnostic methods such as bladder endoscopy, imaging, or pathology examinations heavily rely on the clinical expertise and experience of clinicians, exhibiting subjectivity and poor reproducibility.

With the rise of artificial intelligence, novel approaches, particularly those employing deep learning technology, have shown significant advancements in clinical tasks related to bladder cancer, including tumor detection, molecular subtyping identification, tumor staging and grading, prognosis prediction, and recurrence assessment.

Artificial intelligence, with its robust data mining capabilities, enhances diagnostic efficiency and reproducibility when assisting clinicians in decision-making, thereby reducing the risks of misdiagnosis and underdiagnosis. This not only helps alleviate the current challenges of talent shortages and uneven distribution of medical resources but also fosters the development of precision medicine.

This study provides a comprehensive review of the latest research advances and prospects of artificial intelligence technology in the precise diagnosis and treatment of bladder cancer.

Lung cancer remains the leading cause of cancer-related mortality worldwide, with its early detection and effective treatment posing significant clinical challenges. Radiomics, the extraction of quantitative features from medical imaging, has emerged as a promising approach for enhancing diagnostic accuracy, predicting treatment responses, and personalising patient care. This review explores the role of radiomics in lung cancer diagnosis and management, with methods ranging from handcrafted radiomics to deep learning techniques that can capture biological intricacies. The key applications are highlighted across various stages of lung cancer care, including nodule detection, histology prediction, and disease staging, where artificial intelligence (AI) models demonstrate superior specificity and sensitivity. The article also examines future directions, emphasising the integration of large language models, explainable AI (XAI), and super-resolution imaging techniques as transformative developments. By merging diverse data sources and incorporating interpretability into AI models, radiomics stands poised to redefine clinical workflows, offering more robust and reliable tools for lung cancer diagnosis, treatment planning, and outcome prediction. These advancements underscore radiomics' potential in supporting precision oncology and improving patient outcomes through data-driven insights.

Deep learning (DL) algorithms have demonstrated remarkable proficiency in histopathology classification tasks, presenting an opportunity to discover disease-related features escaping visual inspection. However, the "black box" nature of DL obfuscates the basis of the classification. Here, we develop an algorithm for interpretable Deep Learning (IDL) that sheds light on the links between tissue morphology and cancer biology. We make use of a generative model trained to represent images via a combination of a semantic latent space and a noise vector to capture low level image details. We traversed the latent space so as to induce prototypical image changes associated with the disease state, which we identified via a second DL model. Applied to a dataset of clear cell renal cell carcinoma (ccRCC) tissue images the AI system pinpoints nuclear size and nucleolus density in tumor cells (but not other cell types) as the decisive features of tumor progression from grade 1 to grade 4 - mirroring the rules that have been used for decades in the clinic and are taught in textbooks. Moreover, the AI system posits a decrease in vasculature with increasing grade. While the association has been illustrated by some previous reports, the correlation is not part of currently implemented grading systems. These results indicate the potential of IDL to autonomously formalize the connection between the histopathological presentation of a disease and the underlying tissue architectural drivers.

Accurate histopathological evaluation of pancreatic ductal adenocarcinoma (PDAC), including primary tumor lesions and lymph node metastases, is critical for prognostic evaluation and personalized therapeutic strategies. Distinct from other solid tumors, PDAC presents unique diagnostic challenges owing to its extensive desmoplasia, unclear tumor boundary, and difficulty in differentiating from chronic pancreatitis. These characteristics not only complicate pathological diagnosis but also hinder the acquisition of pixel-level annotations required for training computational pathology models. In this study, we present PANseg, a multiscale weakly supervised deep learning framework for PDAC segmentation, trained and tested on 368 whole-slide images (WSIs) from 208 patients across 2 independent centers. Using only image-level labels (2048 × 2048 pixels), PANseg achieved comparable performance with fully supervised baseline (FSB) across the internal test set 1 (17 patients/58 WSIs; PANseg area under the receiver operating characteristic curve [AUROC]: 0.969 vs FSB AUROC: 0.968), internal test set 2 (40 patients/44 WSIs; PANseg AUROC: 0.991 vs FSB AUROC: 0.980), and external test set (20 patients/20 WSIs; PANseg AUROC: 0.950 vs FSB AUROC: 0.958). Moreover, the model demonstrated considerable generalizability with previously unseen sample types, attaining AUROCs of 0.878 on fresh-frozen specimens (20 patients/20 WSIs) and 0.821 on biopsy sections (20 patients/20 WSIs). In lymph node metastasis detection, PANseg augmented the diagnostic accuracy of 6 pathologists from 0.888 to 0.961, while reducing the average diagnostic time by 32.6% (72.0 vs 48.5 minutes). This study demonstrates that our weakly supervised model can achieve expert-level segmentation performance and substantially reduce annotation burden. The clinical implementation of PANseg holds great potential in enhancing diagnostic precision and workflow efficiency in the routine histopathological assessment of PDAC.

The last decade has witnessed major advances in the development of artificial intelligence (AI) technologies for use in health care. One of the most promising areas of research that has potential clinical utility is the use of AI in pathology to aid cancer diagnosis and management. While the value of using AI to improve the efficiency and accuracy of diagnosis cannot be underestimated, there are challenges in the development and implementation of such technologies. Notably, questions remain about public support for the use of AI to assist in pathological diagnosis and for the use of health care data, including data obtained from tissue samples, to train algorithms.

This study aimed to investigate public awareness of and attitudes toward AI in pathology research and practice.

A nationally representative, cross-sectional, web-based mixed methods survey (N=1518) was conducted to assess the UK public's awareness of and views on the use of AI in pathology research and practice. Respondents were recruited via Prolific, an online research platform. To be eligible for the study, participants had to be aged >18 years, be UK residents, and have the capacity to express their own opinion. Respondents answered 30 closed-ended questions and 2 open-ended questions. Sociodemographic information and previous experience with cancer were collected. Descriptive and inferential statistics were used to analyze quantitative data; qualitative data were analyzed thematically.

Awareness was low, with only 23.19% (352/1518) of the respondents somewhat or moderately aware of AI being developed for use in pathology. Most did not support a diagnosis of cancer (908/1518, 59.82%) or a diagnosis based on biomarkers (694/1518, 45.72%) being made using AI only. However, most (1478/1518, 97.36%) supported diagnoses made by pathologists with AI assistance. The adjusted odds ratio (aOR) for supporting AI in cancer diagnosis and management was higher for men (aOR 1.34, 95% CI 1.02-1.75). Greater awareness (aOR 1.25, 95% CI 1.10-1.42), greater trust in data security and privacy protocols (aOR 1.04, 95% CI 1.01-1.07), and more positive beliefs (aOR 1.27, 95% CI 1.20-1.36) also increased support, whereas identifying more risks reduced the likelihood of support (aOR 0.80, 95% CI 0.73-0.89). In total, 3 main themes emerged from the qualitative data: bringing the public along, the human in the loop, and more hard evidence needed, indicating conditional support for AI in pathology with human decision-making oversight, robust measures for data handling and protection, and evidence for AI benefit and effectiveness.

Awareness of AI's potential use in pathology was low, but attitudes were positive, with high but conditional support. Challenges remain, particularly among women, regarding AI use in cancer diagnosis and management. Apprehension persists about the access to and use of health care data by private organizations.

Lung squamous cell carcinoma in situ (SCIS) is the preinvasive precursor lesion of lung squamous cell carcinoma (SCC). Only around two-thirds of these lesions progress to invasive cancer, while one-third undergo spontaneous regression, which presents a significant clinical challenge due to the risk of overtreatment. The ability to predict the evolution of SCIS lesions can significantly impact patient management. Our study explores the use of computational pathology in predicting the evolution of SCIS. We used a dataset consisting of 112 H&E-stained whole slide images (WSIs) that were obtained from the Image Data Resource public repository. The dataset corresponded to tumors of patients who underwent biopsies of SCIS lesions and were subsequently followed up by bronchoscopy and CT scans to monitor for progression to SCC. We used this dataset to train two models: a pathomics-based ridge classifier trained on 80 principal components derived from almost 2000 extracted features and a deep convolutional neural network with a modified ResNet18 architecture. The performance of both approaches in predicting progression was assessed. The pathomics-based ridge classifier model obtained an F1-score of 0.77, precision of 0.80, and recall of 0.77. The deep learning model performance was similar, with a WSI-level F1-score of 0.80, precision of 0.71, and recall of 0.90. These findings highlight the potential of computational pathology approaches in providing insights into the evolution of SCIS. Larger datasets will be required in order to train highly accurate models. In the future, computational pathology could be used in predicting outcomes in other preinvasive lesions.

The past decade has seen the introduction of artificial intelligence (AI)-based approaches aimed at optimizing several workflows across many medical specialties. In clinical oncology, the most promising applications include those involving image analysis, such as digital pathology. In this Perspective, we provide a comprehensive examination of the developments in AI in digital pathology between 2019 and 2024. We evaluate the current landscape from the lens of technological innovations, regulatory trends, deployment and implementation, reimbursement and commercial implications. We assess the technological advances that have driven improvements in AI, enabling more robust and scalable solutions for digital pathology. We also examine regulatory developments, in particular those affecting in-house devices and laboratory-developed tests, which are shaping the landscape of AI-based tools in digital pathology. Finally, we discuss the role of reimbursement frameworks and commercial investment in the clinical adoption of AI-based technologies. In this Perspective, we highlight both the progress and challenges in AI-driven digital pathology over the past 5 years, outlining the path forward for its adoption into routine practice in clinical oncology.

Tumours of the appendix - a vestigial digestive organ attached to the colon - are rare. Although we estimate that around 3,000 new appendiceal cancer cases are diagnosed annually in the USA, the challenges of accurately diagnosing and identifying this tumour type suggest that this number may underestimate true population incidence. In the current absence of disease-specific screening and diagnostic imaging modalities, or well-established risk factors, the incidental discovery of appendix tumours is often prompted by acute presentations mimicking appendicitis or when the tumour has already spread into the abdominal cavity - wherein the potential misclassification of appendiceal tumours as malignancies of the colon and ovaries also increases. Notwithstanding these diagnostic difficulties, our understanding of appendix carcinogenesis has advanced in recent years. However, there persist considerable challenges to accelerating the pace of research discoveries towards the path to improved treatments and cures for patients with this group of orphan malignancies. The premise of this Expert Recommendation article is to discuss the current state of the field, to delineate unique challenges for the study of appendiceal tumours, and to propose key priority research areas that will deliver a more complete picture of appendix carcinogenesis and metastasis. The Appendix Cancer Pseudomyxoma Peritonei (ACPMP) Research Foundation Scientific Think Tank delivered a consensus of core research priorities for appendiceal tumours that are poised to be ground-breaking and transformative for scientific discovery and innovation. On the basis of these six research areas, here, we define the first 'cells to society' research framework for appendix tumours.

The field of genomic medicine produces large datasets, which need to be rapidly analysed to produce clinically actionable insights in cancer care. Artificial intelligence thrives on data, processing and learning from datasets with a degree of accuracy and efficiency that traditional computing algorithms can not achieve. Based on a patient's genome sequence, AI could allow earlier detection of cancer, inform personalised treatment plans and provide insights into prognostication. However, this valuable tool is met with skepticism, with stakeholders concerned over data security, liability for AI's mistakes due to hallucination and the threat to clinical jobs. This review highlights both the benefits and potential problems of using AI in genomic medicine for cancer care, with the aim to lessen the knowledge gap between clinicians and data scientists and facilitate the future deployment of AI in cancer care.

Over 90% of gastrointestinal stromal tumors (GISTs) harbor mutations in KIT or PDGFRA that can predict response to tyrosine kinase inhibitor (TKI) therapies, as recommended by NCCN (National Comprehensive Cancer Network) guidelines. However, gene sequencing for mutation testing is expensive and time-consuming and is susceptible to a variety of preanalytical factors. To overcome the challenges associated with genetic screening by sequencing, in the current study we developed an artificial intelligence-based deep-learning （DL） model that uses convolutional neural networks (CNN) to analyze digitized hematoxylin and eosin staining in tumor histological sections to predict potential response to imatinib or avapritinib treatment in GIST patients. Assessment with an independent testing set showed that our DL  model could predict imatinib sensitivity with an area under the curve (AUC) of 0.902 in case-wise analysis and 0.807 in slide-wise analysis. Case-level AUCs for predicting imatinib-dose-adjustment cases, avapritinib-sensitive cases, and wildtype GISTs were 0.920, 0.958, and 0.776, respectively, while slide-level AUCs for these respective groups were 0.714, 0.922, and 0.886, respectively. Our model showed comparable or better prediction of actual response to TKI than sequencing-based screening (accuracy 0.9286 versus 0.8929; DL model versus sequencing), while predictions of nonresponse to imatinib/avapritinib showed markedly higher accuracy than sequencing (0.7143 versus 0.4286). These results demonstrate the potential of a DL model to improve predictions of treatment response to TKI therapy from histology in GIST patients. © 2025 The Pathological Society of Great Britain and Ireland.

Traditional histopathology, characterized by manual quantifications and assessments, faces challenges such as low-throughput and inter-observer variability that hinder the introduction of precision medicine in pathology diagnostics and research. The advent of digital pathology allowed the introduction of computational pathology, a discipline that leverages computational methods, especially based on deep learning (DL) techniques, to analyze histopathology specimens. A growing body of research shows impressive performances of DL-based models in pathology for a multitude of tasks, such as mutation prediction, large-scale pathomics analyses, or prognosis prediction. New approaches integrate multimodal data sources and increasingly rely on multi-purpose foundation models. This review provides an introductory overview of advancements in computational pathology and discusses their implications for the future of histopathology in research and diagnostics.

Predicting disease-related molecular traits from histomorphology brings great opportunities for precision medicine. Despite the rich information present in histopathological images, extracting fine-grained molecular features from standard whole slide images (WSI) is non-trivial. The task is further complicated by the lack of annotations for subtyping and contextual histomorphological features that might span multiple scales. This work proposes a novel multiple-instance learning (MIL) framework capable of WSI-based cancer morpho-molecular subtyping by fusion of different-scale features. Our method, debuting as Inter-MIL, follows a weakly-supervised scheme. It enables the training of the patch-level encoder for WSI in a task-aware optimisation procedure, a step normally not modelled in most existing MIL-based WSI analysis frameworks. We demonstrate that optimising the patch-level encoder is crucial to achieving high-quality fine-grained and tissue-level subtyping results and offers a significant improvement over task-agnostic encoders. Our approach deploys a pseudo-label propagation strategy to update the patch encoder iteratively, allowing discriminative subtype features to be learned. This mechanism also empowers extracting fine-grained attention within image tiles (the small patches), a task largely ignored in most existing weakly supervised-based frameworks. With Inter-MIL, we carried out four challenging cancer molecular subtyping tasks in the context of ovarian, colorectal, lung, and breast cancer. Extensive evaluation results show that Inter-MIL is a robust framework for cancer morpho-molecular subtyping with superior performance compared to several recently proposed methods, in small dataset scenarios where the number of available training slides is less than 100. The iterative optimisation mechanism of Inter-MIL significantly improves the quality of the image features learned by the patch embedded and generally directs the attention map to areas that better align with experts' interpretation, leading to the identification of more reliable histopathology biomarkers. Moreover, an external validation cohort is used to verify the robustness of Inter-MIL on molecular trait prediction.

The College of American Pathologists (CAP) accreditation requirements for clinical laboratory testing help ensure laboratories implement and maintain systems and processes that are associated with quality. Machine learning (ML)-based models share some features of conventional laboratory testing methods. Accreditation requirements that specifically address clinical laboratories' use of ML remain in the early stages of development.

To identify relevant CAP accreditation requirements that may be applied to the clinical adoption of ML-based molecular oncology assays, and to provide examples of current and emerging ML applications in molecular oncology testing.

CAP accreditation checklists related to molecular pathology and general laboratory practices (Molecular Pathology, All Common and Laboratory General) were reviewed. Examples of checklist requirements that are generally applicable to validation, revalidation, quality management, infrastructure, and analytical procedures of ML-based molecular oncology assays were summarized. Instances of ML use in molecular oncology testing were assessed from literature review.

Components of the general CAP accreditation framework that exist for traditional molecular oncology assay validation and maintenance are also relevant for implementing ML-based tests in a clinical laboratory. Current and emerging applications of ML in molecular oncology testing include DNA methylation profiling for central nervous system tumor classification, variant calling, microsatellite instability testing, mutational signature analysis, and variant prediction from histopathology images.

Currently, much of the ML activity in molecular oncology is within early clinical implementation. Despite specific considerations that apply to the adoption of ML-based methods, existing CAP requirements can serve as general guidelines for the clinical implementation of ML-based assays in molecular oncology testing.

Image-based survival prediction through deep learning techniques represents a burgeoning frontier aimed at augmenting the diagnostic capabilities of pathologists. However, directly applying existing deep learning models to survival prediction may not be a panacea due to the inherent complexity and sophistication of whole slide images (WSIs). The intricate nature of high-resolution WSIs, characterized by sophisticated patterns and inherent noise, presents significant challenges in terms of effectiveness and trustworthiness. In this paper, we propose CTUSurv, a novel survival prediction model designed to simultaneously capture cell-to-cell and cell-to-microenvironment interactions, complemented by a region-based uncertainty estimation framework to assess the reliability of survival predictions. Our approach incorporates an innovative region sampling strategy to extract task-relevant, informative regions from high-resolution WSIs. To address the challenges posed by sophisticated biological patterns, a cell-aware encoding module is integrated to model the interactions among biological entities. Furthermore, CTUSurv includes a novel aleatoric uncertainty estimation module to provide fine-grained uncertainty scores at the region level. Extensive evaluations across four datasets demonstrate the superiority of our proposed approach in terms of both predictive accuracy and reliability.

Ensuring trustworthiness is fundamental to the development of artificial intelligence (AI) that is considered societally responsible, particularly in cancer diagnostics, where a misdiagnosis can have dire consequences. Current digital pathology AI models lack systematic solutions to address trustworthiness concerns arising from model limitations and data discrepancies between model deployment and development environments. To address this issue, we developed TRUECAM, a framework designed to ensure both data and model trustworthiness in non-small cell lung cancer subtyping with whole-slide images. TRUECAM integrates 1) a spectral-normalized neural Gaussian process for identifying out-of-scope inputs and 2) an ambiguity-guided elimination of tiles to filter out highly ambiguous regions, addressing data trustworthiness, as well as 3) conformal prediction to ensure controlled error rates. We systematically evaluated the framework across multiple large-scale cancer datasets, leveraging both task-specific and foundation models, illustrate that an AI model wrapped with TRUECAM significantly outperforms models that lack such guidance, in terms of classification accuracy, robustness, interpretability, and data efficiency, while also achieving improvements in fairness. These findings highlight TRUECAM as a versatile wrapper framework for digital pathology AI models with diverse architectural designs, promoting their responsible and effective applications in real-world settings.

The role of tumor microenvironment in invasive breast cancer prognosis and treatment is highly appreciated. With the advent of immunotherapy, immunophenotypic characterization in primary tumors is gaining attention as it can improve patient stratification. Here, we discuss the benefits of spatial analysis employing double and multiplex immunostaining, allowing the simultaneous detection of more than one protein on the same tissue section, which in turn helps us provide functional insight into infiltrating immune cells within tumors. We focus on studies demonstrating the prognostic and predictive impact of distinct tumor-infiltrating lymphocyte subpopulations including different CD8(+) T subsets as well as CD4(+) T cells and tumor-associated macrophages in invasive breast carcinoma. The clinical value of immune cell topography is also appreciated. We further refer to how the integration of digital pathology and artificial intelligence in routine practice could enhance the accuracy of multiplex immunostainings evaluation within the tumor microenvironment, maximizing our perception of host immune response, improving in turn decision-making towards more precise immune-associated therapies.

Large language models have shown efficacy across multiple medical tasks. However, their value in the assessment of longitudinal follow-up computed tomography (CT) images of patients with lung nodules is unclear. In this study, we evaluate the ability of the latest generative pre-trained transformer (GPT)-4o model to assess changes in malignancy probability, size, and features of lung nodules on longitudinal CT scans from 647 patients (547 from two local centers and 100 from a public dataset). GPT-4o achieves an average accuracy of 0.88 in predicting lung nodule malignancy compared to pathological results and an average intraclass correlation coefficient of 0.91 in measuring nodule size compared with manual measurements by radiologists. Six radiologists' evaluations demonstrate GPT-4o's ability to capture changes in nodule features with a median Likert score of 4.17 (out of 5.00). In summary, GPT-4o could capture dynamic changes in lung nodules across longitudinal follow-up CT images, thus providing high-quality radiological evidence to assist in clinical management.