Combining CNN-based histologic whole slide image analysis and patient data to improve skin cancer classification

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Julia Höhn - , German Cancer Research Center (DKFZ) (Author)
  • Eva Krieghoff-Henning - , German Cancer Research Center (DKFZ) (Author)
  • Tanja B. Jutzi - , German Cancer Research Center (DKFZ) (Author)
  • Christof von Kalle - , Berlin Institute of Health at Charité (Author)
  • Jochen S. Utikal - , Heidelberg University , German Cancer Research Center (DKFZ) (Author)
  • Friedegund Meier - , Department of Dermatology, Skin Tumor Center, National Center for Tumor Diseases Dresden, University Cancer Centre Dresden (Author)
  • Frank F. Gellrich - , Department of Dermatology, Skin Tumor Center, National Center for Tumor Diseases Dresden, University Cancer Centre Dresden (Author)
  • Sarah Hobelsberger - , Department of Dermatology, Skin Tumor Center, National Center for Tumor Diseases Dresden, University Cancer Centre Dresden (Author)
  • Axel Hauschild - , University Hospital Schleswig-Holstein Campus Kiel (Author)
  • Justin G. Schlager - , Ludwig Maximilian University of Munich (Author)
  • Lars French - , Ludwig Maximilian University of Munich (Author)
  • Lucie Heinzerling - , Ludwig Maximilian University of Munich (Author)
  • Max Schlaak - , Charité – Universitätsmedizin Berlin (Author)
  • Kamran Ghoreschi - , Charité – Universitätsmedizin Berlin (Author)
  • Franz J. Hilke - , Charité – Universitätsmedizin Berlin (Author)
  • Gabriela Poch - , Charité – Universitätsmedizin Berlin (Author)
  • Heinz Kutzner - , Medical care center Dermapathology Friedrichshafen/Lake Constance PartG (Author)
  • Markus V. Heppt - , Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • Sebastian Haferkamp - , University of Regensburg (Author)
  • Wiebke Sondermann - , University of Duisburg-Essen (Author)
  • Dirk Schadendorf - , University of Duisburg-Essen (Author)
  • Bastian Schilling - , University of Würzburg (Author)
  • Matthias Goebeler - , University of Würzburg (Author)
  • Achim Hekler - , German Cancer Research Center (DKFZ) (Author)
  • Stefan Fröhling - , German Cancer Research Center (DKFZ) (Author)
  • Daniel B. Lipka - , German Cancer Research Center (DKFZ) (Author)
  • Jakob N. Kather - , RWTH Aachen University (Author)
  • Dieter Krahl - , Private Laboratory of Dermatohistopathology (Author)
  • Gerardo Ferrara - , Macerata General Hospital (Author)
  • Sarah Haggenmüller - , German Cancer Research Center (DKFZ) (Author)
  • Titus J. Brinker - , German Cancer Research Center (DKFZ) (Author)

Abstract

Background: Clinicians and pathologists traditionally use patient data in addition to clinical examination to support their diagnoses. Objectives: We investigated whether a combination of histologic whole slides image (WSI) analysis based on convolutional neural networks (CNNs) and commonly available patient data (age, sex and anatomical site of the lesion) in a binary melanoma/nevus classification task could increase the performance compared with CNNs alone. Methods: We used 431 WSIs from two different laboratories and analysed the performance of classifiers that used the image or patient data individually or three common fusion techniques. Furthermore, we tested a naive combination of patient data and an image classifier: for cases interpreted as ‘uncertain’ (CNN output score <0.7), the decision of the CNN was replaced by the decision of the patient data classifier. Results: The CNN on its own achieved the best performance (mean ± standard deviation of five individual runs) with AUROC of 92.30% ± 0.23% and balanced accuracy of 83.17% ± 0.38%. While the classification performance was not significantly improved in general by any of the tested fusions, naive strategy of replacing the image classifier with the patient data classifier on slides with low output scores improved balanced accuracy to 86.72% ± 0.36%. Conclusion: In most cases, the CNN on its own was so accurate that patient data integration did not provide any benefit. However, incorporating patient data for lesions that were classified by the CNN with low ‘confidence’ improved balanced accuracy.

Details

Original languageEnglish
Pages (from-to)94-101
Number of pages8
JournalEuropean journal of cancer
Volume149
Publication statusPublished - May 2021
Peer-reviewedYes

External IDs

ORCID /0000-0002-2164-4644/work/148607193
Scopus 85103699179
PubMed 33838393
ORCID /0000-0003-4340-9706/work/159608223

Keywords

Sustainable Development Goals

Keywords

  • Convolutional neural networks, Data fusion, Histologic whole slide images, Patient data, Skin cancer classification