Pascal Birnstill | 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.

eess.IV↗

arXiv2025

Automatic Extraction of Rules for Generating Synthetic Patient Data From Real-World Population Data Using Glioblastoma as an Example

The generation of synthetic data is a promising technology to make medical data available for secondary use in a privacy-compliant manner. A popular method for creating realistic patient data is the rule-based Synthea data generator. Synthea generates data based on rules describing the lifetime of a synthetic patient. These rules typically express the probability of a condition occurring, such as a disease, depending on factors like age. Since they only contain statistical information, rules usually have no specific data protection requirements. However, creating meaningful rules can be a very complex process that requires expert knowledge and realistic sample data. In this paper, we introduce and evaluate an approach to automatically generate Synthea rules based on statistics from tabular data, which we extracted from cancer reports. As an example use case, we created a Synthea module for glioblastoma from a real-world dataset and used it to generate a synthetic dataset. Compared to the original dataset, the synthetic data reproduced known disease courses and mostly retained the statistical properties. Overall, synthetic patient data holds great potential for privacy-preserving research. The data can be used to formulate hypotheses and to develop prototypes, but medical interpretation should consider the specific limitations as with any currently available approach.

cs.LG↗