Christoph Buck | Searcharxiv

arXiv2026

Explainable histomorphology-based survival prediction of glioblastoma, IDH-wildtype

Glioblastoma, IDH-wildtype (GBM-IDHwt) is the most common malignant brain tumor. While histomorphology is a crucial component of GBM-IDHwt diagnosis, it is not further considered for prognosis. Here, we present an explainable artificial intelligence (AI) framework to identify and interpret histomorphological features associated with patient survival. The framework combines an explainable multiple instance learning (MIL) architecture that directly identifies prognostically relevant image tiles with a sparse autoencoder (SAE) that maps these tiles to interpretable visual patterns. The MIL model was trained and evaluated on a new real-world dataset of 720 GBM-IDHwt cases from three hospitals and four cancer registries across Germany. The SAE was trained on 1,878 whole-slide images from five independent public glioblastoma collections. Despite the many factors influencing survival time, our method showed some ability to discriminate between patients living less than 180 days or more than 360 days solely based on histomorphology (AUC: 0.67; 95% CI: 0.63-0.72). Cox proportional hazards regression confirmed a significant survival difference between predicted groups after adjustment for established prognostic factors (hazard ratio: 1.47; 95% CI: 1.26-1.72). Three neuropathologists categorized the identified visual patterns into seven distinct histomorphological groups, revealing both established prognostic features and unexpected associations, the latter being potentially attributable to surgery-related confounders. The presented explainable AI framework facilitates prognostic biomarker discovery in GBM-IDHwt and beyond, highlighting promising histomorphological features for further analysis and exposing potential confounders that would be hidden in black-box models.

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arXiv2024

Applications of artificial intelligence in the analysis of histopathology images of gliomas: a review

In recent years, the diagnosis of gliomas has become increasingly complex. Analysis of glioma histopathology images using artificial intelligence (AI) offers new opportunities to support diagnosis and outcome prediction. To give an overview of the current state of research, this review examines 83 publicly available research studies that have proposed AI-based methods for whole-slide histopathology images of human gliomas, covering the diagnostic tasks of subtyping (23/83), grading (27/83), molecular marker prediction (20/83), and survival prediction (29/83). All studies were reviewed with regard to methodological aspects as well as clinical applicability. It was found that the focus of current research is the assessment of hematoxylin and eosin-stained tissue sections of adult-type diffuse gliomas. The majority of studies (52/83) are based on the publicly available glioblastoma and low-grade glioma datasets from The Cancer Genome Atlas (TCGA) and only a few studies employed other datasets in isolation (16/83) or in addition to the TCGA datasets (15/83). Current approaches mostly rely on convolutional neural networks (63/83) for analyzing tissue at 20x magnification (35/83). A new field of research is the integration of clinical data, omics data, or magnetic resonance imaging (29/83). So far, AI-based methods have achieved promising results, but are not yet used in real clinical settings. Future work should focus on the independent validation of methods on larger, multi-site datasets with high-quality and up-to-date clinical and molecular pathology annotations to demonstrate routine applicability.

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