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Deep models based on vision transformer (ViT) and convolutional neural network (CNN) have demonstrated remarkable performance on natural datasets. However, these models may not be similar in medical imaging, where abnormal regions cover only a small portion of the image. This challenge motivates this study to investigate the latest deep models for bladder cancer classification tasks. We propose the following to evaluate these deep models: 1) standard classification using 13 models (four CNNs and eight transormer-based models), 2) calibration analysis to examine if these models are well calibrated for bladder cancer classification, and 3) we use GradCAM++ to evaluate the interpretability of these models for clinical diagnosis. We simulate $\sim 300$ experiments on a publicly multicenter bladder cancer dataset, and the experimental results demonstrate that the ConvNext series indicate limited generalization ability to classify bladder cancer images (e.g., $\sim 60\%$ accuracy). In addition, ViTs show better calibration effects compared to ConvNext and swin transformer series. We also involve test time augmentation to improve the models interpretability. Finally, no model provides a one-size-fits-all solution for a feasible interpretable model. ConvNext series are suitable for in-distribution samples, while ViT and its variants are suitable for interpreting out-of-distribution samples.

Accurate classification of breast cancer histopathology images is pivotal for early oncological diagnosis and therapeutic intervention.However, conventional deep learning architectures often encounter performance degradation under limited annotations and suffer from a "blackbox" nature, hindering their clinical integration. To mitigate these limitations, we propose GAFRNet, a robust and interpretable Graph Attention and FuzzyRule Network specifically engineered for histopathology image classification with scarce supervision. GAFRNet constructs a similarity-driven graph representation to model intersample relationships and employs a multihead graph attention mechanism to capture complex relational features across heterogeneous tissue structures.Concurrently, a differentiable fuzzy-rule module encodes intrinsic topological descriptorsincluding node degree, clustering coefficient, and label consistencyinto explicit, human-understandable diagnostic logic. This design establishes transparent "IF-THEN" mappings that mimic the heuristic deduction process of medical experts, providing clear reasoning behind each prediction without relying on post-hoc attribution methods. Extensive evaluations on three benchmark datasets (BreakHis, Mini-DDSM, and ICIAR2018) demonstrate that GAFR-Net consistently outperforms various state-of-the-art methods across multiple magnifications and classification tasks. These results validate the superior generalization and practical utility of GAFR-Net as a reliable decision-support tool for weakly supervised medical image analysis.

Medical image analysis requires substantial labeled data for model training, yet expert annotation is expensive and time-consuming. Active learning (AL) addresses this challenge by strategically selecting the most informative samples for the annotation purpose, but traditional methods solely rely on predictive uncertainty while ignoring whether models learn from clinically meaningful features a critical requirement for clinical deployment. We propose an explainability-guided active learning framework that integrates spatial attention alignment into a sample acquisition process. Our approach advocates for a dual-criterion selection strategy combining: (i) classification uncertainty to identify informative examples, and (ii) attention misalignment with radiologist-defined regions-of-interest (ROIs) to target samples where the model focuses on incorrect features. By measuring misalignment between Grad-CAM attention maps and expert annotations using Dice similarity, our acquisition function judiciously identifies samples that enhance both predictive performance and spatial interpretability. We evaluate the framework using three expert-annotated medical imaging datasets, namely, BraTS (MRI brain tumors), VinDr-CXR (chest X-rays), and SIIM-COVID-19 (chest X-rays). Using only 570 strategically selected samples, our explainability-guided approach consistently outperforms random sampling across all the datasets, achieving 77.22% accuracy on BraTS, 52.37% on VinDr-CXR, and 52.66% on SIIM-COVID. Grad-CAM visualizations confirm that the models trained by our dual-criterion selection focus on diagnostically relevant regions, demonstrating that incorporating explanation guidance into sample acquisition yields superior data efficiency while maintaining clinical interpretability.

Accurate compensation of brain deformation is a critical challenge for reliable image-guided neurosurgery, as surgical manipulation and tumor resection induce tissue motion that misaligns preoperative planning images with intraoperative anatomy and longitudinal studies. In this systematic review, we synthesize recent AI-driven approaches developed between January 2020 and April 2025 for modeling and correcting brain deformation. A comprehensive literature search was conducted in PubMed, IEEE Xplore, Scopus, and Web of Science, with predefined inclusion and exclusion criteria focused on computational methods applied to brain deformation compensation for neurosurgical imaging, resulting in 41 studies meeting these criteria. We provide a unified analysis of methodological strategies, including deep learning-based image registration, direct deformation field regression, synthesis-driven multimodal alignment, resection-aware architectures addressing missing correspondences, and hybrid models that integrate biomechanical priors. We also examine dataset utilization, reported evaluation metrics, validation protocols, and how uncertainty and generalization have been assessed across studies. While AI-based deformation models demonstrate promising performance and computational efficiency, current approaches exhibit limitations in out-of-distribution robustness, standardized benchmarking, interpretability, and readiness for clinical deployment. Our review highlights these gaps and outlines opportunities for future research aimed at achieving more robust, generalizable, and clinically translatable deformation compensation solutions for neurosurgical guidance. By organizing recent advances and critically evaluating evaluation practices, this work provides a comprehensive foundation for researchers and clinicians engaged in developing and applying AI-based brain deformation methods.

Recent multi-agent frameworks have broadened the ability to tackle oncology decision support tasks that require reasoning over dynamic, heterogeneous patient data. We propose Contribution-Aware Medical Multi-Agents (CoMMa), a decentralized LLM-agent framework in which specialists operate on partitioned evidence and coordinate through a game-theoretic objective for robust decision-making. In contrast to most agent architectures relying on stochastic narrative-based reasoning, CoMMa utilizes deterministic embedding projections to approximate contribution-aware credit assignment. This yields explicit evidence attribution by estimating each agent's marginal utility, producing interpretable and mathematically grounded decision pathways with improved stability. Evaluated on diverse oncology benchmarks, including a real-world multidisciplinary tumor board dataset, CoMMa achieves higher accuracy and more stable performance than data-centralized and role-based multi-agents baselines.

Colorectal cancer (CRC) remains a significant cause of cancer-related mortality, despite the widespread implementation of prophylactic initiatives aimed at detecting and removing precancerous polyps. Although screening effectively reduces incidence, a notable portion of patients initially diagnosed with low-grade adenomatous polyps will still develop CRC later in life, even without the presence of known high-risk syndromes. Identifying which low-risk patients are at higher risk of progression is a critical unmet need for tailored surveillance and preventative therapeutic strategies. Traditional histological assessment of adenomas, while fundamental, may not fully capture subtle architectural or cytological features indicative of malignant potential. Advancements in digital pathology and machine learning provide an opportunity to analyze whole-slide images (WSIs) comprehensively and objectively. This study investigates whether machine learning algorithms, specifically convolutional neural networks (CNNs), can detect subtle histological features in WSIs of low-grade tubular adenomas that are predictive of a patient's long-term risk of developing colorectal cancer.

Accurate brain tumor segmentation from MRI is limited by expensive annotations and data heterogeneity across scanners and sites. We propose a semi-supervised teacher-student framework that combines an uncertainty-aware pseudo-labeling teacher with a progressive, confidence-based curriculum for the student. The teacher produces probabilistic masks and per-pixel uncertainty; unlabeled scans are ranked by image-level confidence and introduced in stages, while a dual-loss objective trains the student to learn from high-confidence regions and unlearn low-confidence ones. Agreement-based refinement further improves pseudo-label quality. On BraTS 2021, validation DSC increased from 0.393 (10% data) to 0.872 (100%), with the largest gains in early stages, demonstrating data efficiency. The teacher reached a validation DSC of 0.922, and the student surpassed the teacher on tumor subregions (e.g., NCR/NET 0.797 and Edema 0.980); notably, the student recovered the Enhancing class (DSC 0.620) where the teacher failed. These results show that confidence-driven curricula and selective unlearning provide robust segmentation under limited supervision and noisy pseudo-labels.

Accurate annotation of fixation type is a critical step in slide preparation for pathology laboratories. However, this manual process is prone to errors, impacting downstream analyses and diagnostic accuracy. Existing methods for verifying formalin-fixed, paraffin-embedded (FFPE), and frozen section (FS) fixation types typically require full-resolution whole-slide images (WSIs), limiting scalability for high-throughput quality control. We propose a deep-learning model to predict fixation types using low-resolution, pre-scan thumbnail images. The model was trained on WSIs from the TUM Institute of Pathology (n=1,200, Leica GT450DX) and evaluated on a class-balanced subset of The Cancer Genome Atlas dataset (TCGA, n=8,800, Leica AT2), as well as on class-balanced datasets from Augsburg (n=695 [392 FFPE, 303 FS], Philips UFS) and Regensburg (n=202, 3DHISTECH P1000). Our model achieves an AUROC of 0.88 on TCGA, outperforming comparable pre-scan methods by 4.8%. It also achieves AUROCs of 0.72 on Regensburg and Augsburg slides, underscoring challenges related to scanner-induced domain shifts. Furthermore, the model processes each slide in 21 ms, $400\times$ faster than existing high-magnification, full-resolution methods, enabling rapid, high-throughput processing. This approach provides an efficient solution for detecting labelling errors without relying on high-magnification scans, offering a valuable tool for quality control in high-throughput pathology workflows. Future work will improve and evaluate the model's generalisation to additional scanner types. Our findings suggest that this method can increase accuracy and efficiency in digital pathology workflows and may be extended to other low-resolution slide annotations.

Retrieving wrist radiographs with analogous fracture patterns is challenging because clinically important cues are subtle, highly localized and often obscured by overlapping anatomy or variable imaging views. Progress is further limited by the scarcity of large, well-annotated datasets for case-based medical image retrieval. We introduce WristMIR, a region-aware pediatric wrist radiograph retrieval framework that leverages dense radiology reports and bone-specific localization to learn fine-grained, clinically meaningful image representations without any manual image-level annotations. Using MedGemma-based structured report mining to generate both global and region-level captions, together with pre-processed wrist images and bone-specific crops of the distal radius, distal ulna, and ulnar styloid, WristMIR jointly trains global and local contrastive encoders and performs a two-stage retrieval process: (1) coarse global matching to identify candidate exams, followed by (2) region-conditioned reranking aligned to a predefined anatomical bone region. WristMIR improves retrieval performance over strong vision-language baselines, raising image-to-text Recall@5 from 0.82% to 9.35%. Its embeddings also yield stronger fracture classification (AUROC 0.949, AUPRC 0.953). In region-aware evaluation, the two-stage design markedly improves retrieval-based fracture diagnosis, increasing mean $F_1$ from 0.568 to 0.753, and radiologists rate its retrieved cases as more clinically relevant, with mean scores rising from 3.36 to 4.35. These findings highlight the potential of anatomically guided retrieval to enhance diagnostic reasoning and support clinical decision-making in pediatric musculoskeletal imaging. The source code is publicly available at https://github.com/quin-med-harvard-edu/WristMIR.

Metastatic Progression remains the leading cause of cancer-related mortality, yet predicting whether a primary tumor will metastasize and where it will disseminate directly from histopathology remains a fundamental challenge. Although whole-slide images (WSIs) provide rich morphological information, prior computational pathology approaches typically address metastatic status or site prediction as isolated tasks, and do not explicitly model the clinically sequential decision process of metastatic risk assessment followed by downstream site-specific evaluation. To address this research gap, we present a decision-aware, concept-aligned MIL framework, HistoMet, for prognostic metastatic outcome prediction from primary tumor WSIs. Our proposed framework adopts a two-module prediction pipeline in which the likelihood of metastatic progression from the primary tumor is first estimated, followed by conditional prediction of metastatic site for high-risk cases. To guide representation learning and improve clinical interpretability, our framework integrates linguistically defined and data-adaptive metastatic concepts through a pretrained pathology vision-language model. We evaluate HistoMet on a multi-institutional pan-cancer cohort of 6504 patients with metastasis follow-up and site annotations. Under clinically relevant high-sensitivity screening settings (95 percent sensitivity), HistoMet significantly reduces downstream workload while maintaining high metastatic risk recall. Conditional on metastatic cases, HistoMet achieves a macro F1 of 74.6 with a standard deviation of 1.3 and a macro one-vs-rest AUC of 92.1. These results demonstrate that explicitly modeling clinical decision structure enables robust and deployable prognostic prediction of metastatic progression and site tropism directly from primary tumor histopathology.