Review
. 2019 May; 20(5):e253-e261.
doi: 10.1016/S1470-2045(19)30154-8.

Digital pathology and artificial intelligence

Muhammad Khalid Khan Niazi 1 Anil V Parwani 2 Metin N Gurcan 3 
Affiliations
  • PMID: 31044723
  •     85 citations

Abstract

In modern clinical practice, digital pathology has a crucial role and is increasingly a technological requirement in the scientific laboratory environment. The advent of whole-slide imaging, availability of faster networks, and cheaper storage solutions has made it easier for pathologists to manage digital slide images and share them for clinical use. In parallel, unprecedented advances in machine learning have enabled the synergy of artificial intelligence and digital pathology, which offers image-based diagnosis possibilities that were once limited only to radiology and cardiology. Integration of digital slides into the pathology workflow, advanced algorithms, and computer-aided diagnostic techniques extend the frontiers of the pathologist's view beyond a microscopic slide and enable true utilisation and integration of knowledge that is beyond human limits and boundaries, and we believe there is clear potential for artificial intelligence breakthroughs in the pathology setting. In this Review, we discuss advancements in digital slide-based image diagnosis for cancer along with some challenges and opportunities for artificial intelligence in digital pathology.

Connecting Histopathology Imaging and Proteomics in Kidney Cancer through Machine Learning.
Francisco Azuaje, Sang-Yoon Kim, Daniel Perez Hernandez, Gunnar Dittmar.
J Clin Med, 2019 Sep 29; 8(10). PMID: 31557788    Free PMC article.
Artificial intelligence in clinical and genomic diagnostics.
Raquel Dias, Ali Torkamani.
Genome Med, 2019 Nov 21; 11(1). PMID: 31744524    Free PMC article.
Review.
Recent advances in tissue imaging for cancer research.
Oscar Maiques, Mirella Georgouli, Victoria Sanz-Moreno.
F1000Res, 2019 Dec 12; 8. PMID: 31824652    Free PMC article.
Review.
A modular cGAN classification framework: Application to colorectal tumor detection.
Thomas E Tavolara, M Khalid Khan Niazi, +3 authors, Metin N Gurcan.
Sci Rep, 2019 Dec 14; 9(1). PMID: 31831792    Free PMC article.
Next generation diagnostic pathology: use of digital pathology and artificial intelligence tools to augment a pathological diagnosis.
Anil V Parwani.
Diagn Pathol, 2019 Dec 29; 14(1). PMID: 31881972    Free PMC article.
Attitudes and perceptions of UK medical students towards artificial intelligence and radiology: a multicentre survey.
Cherry Sit, Rohit Srinivasan, +4 authors, Daniel Stephen Poon.
Insights Imaging, 2020 Feb 07; 11(1). PMID: 32025951    Free PMC article.
Commentary: Automated Diagnosis and Gleason Grading of Prostate Cancer - Are Artificial Intelligence Systems Ready for Prime Time?
Anil V Parwani.
J Pathol Inform, 2020 Feb 25; 10. PMID: 32089952    Free PMC article.
Pan-cancer diagnostic consensus through searching archival histopathology images using artificial intelligence.
Shivam Kalra, H R Tizhoosh, +8 authors, Liron Pantanowitz.
NPJ Digit Med, 2020 Mar 21; 3. PMID: 32195366    Free PMC article.
Introduction to digital pathology and computer-aided pathology.
Soojeong Nam, Yosep Chong, +5 authors, Heounjeong Go.
J Pathol Transl Med, 2020 Feb 13; 54(2). PMID: 32045965    Free PMC article.
Review.
Histopathologic Evaluation and Scoring of Viral Lung Infection.
David K Meyerholz, Amanda P Beck.
Methods Mol Biol, 2019 Dec 29; 2099. PMID: 31883098    Free PMC article.
Review.
The leading role of pathology in assessing the somatic molecular alterations of cancer: Position Paper of the European Society of Pathology.
Xavier Matias-Guiu, Giorgio Stanta, +4 authors, European Society of Pathology (ESP).
Virchows Arch, 2020 Mar 04; 476(4). PMID: 32124002    Free PMC article.
Review.
Value of Public Challenges for the Development of Pathology Deep Learning Algorithms.
Douglas Joseph Hartman, Jeroen A W M Van Der Laak, Metin N Gurcan, Liron Pantanowitz.
J Pathol Inform, 2020 Apr 23; 11. PMID: 32318315    Free PMC article.
Artificial intelligence driven next-generation renal histomorphometry.
Briana A Santo, Avi Z Rosenberg, Pinaki Sarder.
Curr Opin Nephrol Hypertens, 2020 Mar 25; 29(3). PMID: 32205581    Free PMC article.
Review.
The Presence and Location of Podocytes in Glomeruli as Affected by Diabetes Mellitus.
Kathryn E Maraszek, Briana A Santo, +4 authors, Pinaki Sarder.
Proc SPIE Int Soc Opt Eng, 2020 May 05; 11320. PMID: 32362706    Free PMC article.
Artificial intelligence in oncology.
Hideyuki Shimizu, Keiichi I Nakayama.
Cancer Sci, 2020 Mar 07; 111(5). PMID: 32133724    Free PMC article.
Review.
Use of Deep Learning to Develop and Analyze Computational Hematoxylin and Eosin Staining of Prostate Core Biopsy Images for Tumor Diagnosis.
Aman Rana, Alarice Lowe, +7 authors, Pratik Shah.
JAMA Netw Open, 2020 May 21; 3(5). PMID: 32432709    Free PMC article.
OtoMatch: Content-based eardrum image retrieval using deep learning.
Seda Camalan, Muhammad Khalid Khan Niazi, +5 authors, Metin N Gurcan.
PLoS One, 2020 May 16; 15(5). PMID: 32413096    Free PMC article.
Assessment of associations between clinical and immune microenvironmental factors and tumor mutation burden in resected nonsmall cell lung cancer by applying machine learning to whole-slide images.
Akira Ono, Yukihiro Terada, +17 authors, Toshiaki Takahashi.
Cancer Med, 2020 May 14; 9(13). PMID: 32400056    Free PMC article.
What will radiation oncology look like in 2050? A look at a changing professional landscape in Europe and beyond.
Michael Baumann, Nadja Ebert, +2 authors, Jens Overgaard.
Mol Oncol, 2020 May 29; 14(7). PMID: 32463984    Free PMC article.
Review.
From Patient-Controlled Analgesia to Artificial Intelligence-Assisted Patient-Controlled Analgesia: Practices and Perspectives.
Rui Wang, Shaoshuang Wang, Na Duan, Qiang Wang.
Front Med (Lausanne), 2020 Jul 17; 7. PMID: 32671076    Free PMC article.
Semantic segmentation to identify bladder layers from H&E Images.
Muhammad Khalid Khan Niazi, Enes Yazgan, +4 authors, Metin N Gurcan.
Diagn Pathol, 2020 Jul 18; 15(1). PMID: 32677978    Free PMC article.
SCAU-Net: Spatial-Channel Attention U-Net for Gland Segmentation.
Peng Zhao, Jindi Zhang, Weijia Fang, Shuiguang Deng.
Front Bioeng Biotechnol, 2020 Jul 29; 8. PMID: 32719781    Free PMC article.
Biobanking for glomerular diseases: a study design and protocol for KOrea Renal biobank NEtwoRk System TOward NExt-generation analysis (KORNERSTONE).
Eunjeong Kang, Yaerim Kim, +24 authors, KORNERSTONE Study Group.
BMC Nephrol, 2020 Aug 28; 21(1). PMID: 32842999    Free PMC article.
Applications of Machine Learning in Cardiac Electrophysiology.
Rahul G Muthalaly, Robert M Evans.
Arrhythm Electrophysiol Rev, 2020 Sep 29; 9(2). PMID: 32983527    Free PMC article.
Review.
Artificial intelligence (AI) and big data in cancer and precision oncology.
Zodwa Dlamini, Flavia Zita Francies, Rodney Hull, Rahaba Marima.
Comput Struct Biotechnol J, 2020 Oct 01; 18. PMID: 32994889    Free PMC article.
Review.
A bird's-eye view of deep learning in bioimage analysis.
Erik Meijering.
Comput Struct Biotechnol J, 2020 Oct 01; 18. PMID: 32994890    Free PMC article.
Review.
Development and interpretation of a pathomics-based model for the prediction of microsatellite instability in Colorectal Cancer.
Rui Cao, Fan Yang, +17 authors, Zhong-Yi Dong.
Theranostics, 2020 Oct 13; 10(24). PMID: 33042271    Free PMC article.
A Regulatory Science Initiative to Harmonize and Standardize Digital Pathology and Machine Learning Processes to Speed up Clinical Innovation to Patients.
Hetal Desai Marble, Richard Huang, +14 authors, Jochen K Lennerz.
J Pathol Inform, 2020 Oct 13; 11. PMID: 33042601    Free PMC article.
The Impact of IoT in Healthcare: Global Technological Change & The Roadmap to a Networked Architecture in India.
Satya Prakash Dash.
J Indian Inst Sci, 2020 Nov 10;. PMID: 33162693    Free PMC article.
Review.
PyHIST: A Histological Image Segmentation Tool.
Manuel Muñoz-Aguirre, Vasilis F Ntasis, Santiago Rojas, Roderic Guigó.
PLoS Comput Biol, 2020 Oct 20; 16(10). PMID: 33075075    Free PMC article.
Automatic discovery of clinically interpretable imaging biomarkers for Mycobacterium tuberculosis supersusceptibility using deep learning.
Thomas E Tavolara, M Khalid Khan Niazi, +4 authors, Metin N Gurcan.
EBioMedicine, 2020 Nov 10; 62. PMID: 33166789    Free PMC article.
Identification of areas of grading difficulties in prostate cancer and comparison with artificial intelligence assisted grading.
Lars Egevad, Daniela Swanberg, +23 authors, Martin Eklund.
Virchows Arch, 2020 Jun 17; 477(6). PMID: 32542445    Free PMC article.
Deep neural network models for computational histopathology: A survey.
Chetan L Srinidhi, Ozan Ciga, Anne L Martel.
Med Image Anal, 2020 Oct 14; 67. PMID: 33049577    Free PMC article.
Review.
Automated Breast Cancer Detection in Digital Mammograms of Various Densities via Deep Learning.
Yong Joon Suh, Jaewon Jung, Bum-Joo Cho.
J Pers Med, 2020 Nov 12; 10(4). PMID: 33172076    Free PMC article.
Single-Cell Spatial Analysis of Tumor and Immune Microenvironment on Whole-Slide Image Reveals Hepatocellular Carcinoma Subtypes.
Haiyue Wang, Yuming Jiang, +3 authors, Ruijiang Li.
Cancers (Basel), 2020 Dec 03; 12(12). PMID: 33260561    Free PMC article.
Fibrosis in Chronic Kidney Disease: Pathogenesis and Consequences.
Sara Panizo, Laura Martínez-Arias, +6 authors, Jorge B Cannata-Andía.
Int J Mol Sci, 2021 Jan 07; 22(1). PMID: 33401711    Free PMC article.
Review.
Artificial intelligence and computational pathology.
Miao Cui, David Y Zhang.
Lab Invest, 2021 Jan 18; 101(4). PMID: 33454724    Free PMC article.
Review.
Role of digital pathology in diagnostic histopathology in the response to COVID-19: results from a survey of experience in a UK tertiary referral hospital.
Lisa Browning, Eve Fryer, +4 authors, Clare Verrill.
J Clin Pathol, 2020 Jul 04; 74(2). PMID: 32616541    Free PMC article.
Harnessing non-destructive 3D pathology.
Jonathan T C Liu, Adam K Glaser, +4 authors, Anant Madabhushi.
Nat Biomed Eng, 2021 Feb 17; 5(3). PMID: 33589781    Free PMC article.
Review.
Deep learning powers cancer diagnosis in digital pathology.
Yunjie He, Hong Zhao, Stephen T C Wong.
Comput Med Imaging Graph, 2021 Jan 17; 88. PMID: 33453648    Free PMC article.
Review.
PathoFusion: An Open-Source AI Framework for Recognition of Pathomorphological Features and Mapping of Immunohistochemical Data.
Guoqing Bao, Xiuying Wang, +11 authors, Manuel B Graeber.
Cancers (Basel), 2021 Feb 10; 13(4). PMID: 33557152    Free PMC article.
Boosted EfficientNet: Detection of Lymph Node Metastases in Breast Cancer Using Convolutional Neural Networks.
Jun Wang, Qianying Liu, +2 authors, Hefeng Zhou.
Cancers (Basel), 2021 Feb 11; 13(4). PMID: 33562232    Free PMC article.
Artificial intelligence assistance significantly improves Gleason grading of prostate biopsies by pathologists.
Wouter Bulten, Maschenka Balkenhol, +20 authors, Geert Litjens.
Mod Pathol, 2020 Aug 08; 34(3). PMID: 32759979    Free PMC article.
Establishment and Clinical Application of an Artificial Intelligence Diagnostic Platform for Identifying Rectal Cancer Tumor Budding.
Shanglong Liu, Yuejuan Zhang, +6 authors, Yun Lu.
Front Oncol, 2021 Mar 26; 11. PMID: 33763362    Free PMC article.
The Potential of Artificial Intelligence to Detect Lymphovascular Invasion in Testicular Cancer.
Abhisek Ghosh, Korsuk Sirinukunwattana, +8 authors, Clare Verrill.
Cancers (Basel), 2021 Apr 04; 13(6). PMID: 33809521    Free PMC article.
Computational Image Analysis Identifies Histopathological Image Features Associated With Somatic Mutations and Patient Survival in Gastric Adenocarcinoma.
Jun Cheng, Yuting Liu, +7 authors, Jie Zhang.
Front Oncol, 2021 Apr 20; 11. PMID: 33869007    Free PMC article.
Histopathological characteristics and artificial intelligence for predicting tumor mutational burden-high colorectal cancer.
Yoshifumi Shimada, Shujiro Okuda, +13 authors, Toshifumi Wakai.
J Gastroenterol, 2021 Apr 29; 56(6). PMID: 33909150
Deep Learning Model for Real-Time Prediction of Intradialytic Hypotension.
Hojun Lee, Donghwan Yun, +8 authors, Seung Seok Han.
Clin J Am Soc Nephrol, 2021 Feb 13; 16(3). PMID: 33574056    Free PMC article.
Artificial Intelligence & Tissue Biomarkers: Advantages, Risks and Perspectives for Pathology.
Cesare Lancellotti, Pierandrea Cancian, +4 authors, Luca Di Tommaso.
Cells, 2021 May 01; 10(4). PMID: 33918173    Free PMC article.
Review.
SPIE-AAPM-NCI BreastPathQ challenge: an image analysis challenge for quantitative tumor cellularity assessment in breast cancer histology images following neoadjuvant treatment.
Nicholas Petrick, Shazia Akbar, +7 authors, BreastPathQ Challenge Group.
J Med Imaging (Bellingham), 2021 May 15; 8(3). PMID: 33987451    Free PMC article.
Artificial Intelligence in Pathology: From Prototype to Product.
André Homeyer, Johannes Lotz, +5 authors, Peter Hufnagl.
J Pathol Inform, 2021 May 21; 12. PMID: 34012717    Free PMC article.
Review.
What makes AI 'intelligent' and 'caring'? Exploring affect and relationality across three sites of intelligence and care.
Giulia De Togni, Sonja Erikainen, Sarah Chan, Sarah Cunningham-Burley.
Soc Sci Med, 2021 Apr 27; 277. PMID: 33901725    Free PMC article.
Deep learning predicts gene expression as an intermediate data modality to identify susceptibility patterns in Mycobacterium tuberculosis infected Diversity Outbred mice.
Thomas E Tavolara, M K K Niazi, +3 authors, Metin N Gurcan.
EBioMedicine, 2021 May 18; 67. PMID: 34000621    Free PMC article.
AI applications in renal pathology.
Yuankai Huo, Ruining Deng, +2 authors, Haichun Yang.
Kidney Int, 2021 Feb 14; 99(6). PMID: 33581198    Free PMC article.
Review.
Prediction of False-Positive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Molecular Results in a High-Throughput Open-Platform System.
Ryan J Martinez, Nathan Pankratz, +7 authors, Andrew C Nelson.
J Mol Diagn, 2021 Jun 12; 23(9). PMID: 34116245    Free PMC article.
Requirements for implementation of artificial intelligence in the practice of gastrointestinal pathology.
Hiroshi Yoshida, Tomoharu Kiyuna.
World J Gastroenterol, 2021 Jun 18; 27(21). PMID: 34135556    Free PMC article.
Review.
Multiplex Immunofluorescence and Multispectral Imaging: Forming the Basis of a Clinical Test Platform for Immuno-Oncology.
Clifford C Hoyt.
Front Mol Biosci, 2021 Jun 22; 8. PMID: 34150850    Free PMC article.
Review.
Artificial intelligence in oncology: Path to implementation.
Isaac S Chua, Michal Gaziel-Yablowitz, +6 authors, Michael Hassett.
Cancer Med, 2021 May 08; 10(12). PMID: 33960708    Free PMC article.
Review.
Translational Applications of Artificial Intelligence and Machine Learning for Diagnostic Pathology in Lymphoid Neoplasms: A Comprehensive and Evolutive Analysis.
Julia Moran-Sanchez, Antonio Santisteban-Espejo, +2 authors, Marcial Garcia-Rojo.
Biomolecules, 2021 Jun 03; 11(6). PMID: 34070632    Free PMC article.
Diagnostic digital pathology implementation: Learning from the digital health experience.
Samar Betmouni.
Digit Health, 2021 Jul 03; 7. PMID: 34211723    Free PMC article.
A Calibrated Multiexit Neural Network for Detecting Urothelial Cancer Cells.
L Lilli, E Giarnieri, S Scardapane.
Comput Math Methods Med, 2021 Jul 09; 2021. PMID: 34234839    Free PMC article.
Digital pathology and artificial intelligence will be key to supporting clinical and academic cellular pathology through COVID-19 and future crises: the PathLAKE consortium perspective.
Lisa Browning, Richard Colling, +6 authors, Clare Verrill.
J Clin Pathol, 2020 Jul 06; 74(7). PMID: 32620678    Free PMC article.
Review.
Transpathology: molecular imaging-based pathology.
Mei Tian, Xuexin He, +8 authors, Hong Zhang.
Eur J Nucl Med Mol Imaging, 2021 Feb 16; 48(8). PMID: 33585964    Free PMC article.
Review.
The Immune Subtypes and Landscape of Gastric Cancer and to Predict Based on the Whole-Slide Images Using Deep Learning.
Yan Chen, Zepang Sun, +9 authors, Zhongqing Xu.
Front Immunol, 2021 Jul 16; 12. PMID: 34262565    Free PMC article.
Integrated imaging and molecular analysis to decipher tumor microenvironment in the era of immunotherapy.
Jia Wu, Aaron T Mayer, Ruijiang Li.
Semin Cancer Biol, 2020 Dec 09;. PMID: 33290844    Free PMC article.
A Deep-Learning Model With the Attention Mechanism Could Rigorously Predict Survivals in Neuroblastoma.
Chenzhao Feng, Tianyu Xiang, +7 authors, Jiexiong Feng.
Front Oncol, 2021 Aug 03; 11. PMID: 34336652    Free PMC article.
An independent assessment of an artificial intelligence system for prostate cancer detection shows strong diagnostic accuracy.
Sudhir Perincheri, Angelique Wolf Levi, +7 authors, John Sinard.
Mod Pathol, 2021 Mar 31; 34(8). PMID: 33782551    Free PMC article.
Artificial Intelligence in Digital Pathology: What Is the Future? Part 1: From the Digital Slide Onwards.
Maria Rosaria Giovagnoli, Daniele Giansanti.
Healthcare (Basel), 2021 Aug 07; 9(7). PMID: 34356236    Free PMC article.
A Spatial Quantitative Systems Pharmacology Platform spQSP-IO for Simulations of Tumor-Immune Interactions and Effects of Checkpoint Inhibitor Immunotherapy.
Chang Gong, Alvaro Ruiz-Martinez, Holly Kimko, Aleksander S Popel.
Cancers (Basel), 2021 Aug 08; 13(15). PMID: 34359653    Free PMC article.
Integrated digital pathology at scale: A solution for clinical diagnostics and cancer research at a large academic medical center.
Peter J Schüffler, Luke Geneslaw, +29 authors, Thomas J Fuchs.
J Am Med Inform Assoc, 2021 Jul 15; 28(9). PMID: 34260720    Free PMC article.
Looking for a perfect match: multimodal combinations of Raman spectroscopy for biomedical applications.
Iwan Schie, Clara Stiebing, Jürgen Popp.
J Biomed Opt, 2021 Aug 14; 26(8). PMID: 34387049    Free PMC article.
Review.
Evolving Trends in Surgical Management of Breast Cancer: An Analysis of 30 Years of Practice Changing Papers.
Stephen Keelan, Michael Flanagan, Arnold D K Hill.
Front Oncol, 2021 Aug 24; 11. PMID: 34422626    Free PMC article.
Review.
Uncovering Spatiotemporal Heterogeneity of High-Grade Gliomas: From Disease Biology to Therapeutic Implications.
Andrea Comba, Syed M Faisal, +7 authors, Pedro R Lowenstein.
Front Oncol, 2021 Aug 24; 11. PMID: 34422657    Free PMC article.
Review.
Effectiveness of a Cloud-Based Telepathology System in China: Large-Sample Observational Study.
Xianying He, Linlin Wang, +7 authors, Jie Zhao.
J Med Internet Res, 2021 Jul 31; 23(7). PMID: 34326037    Free PMC article.
Artificial intelligence for advance requesting of immunohistochemistry in diagnostically uncertain prostate biopsies.
Andrea Chatrian, Richard T Colling, +11 authors, Clare Verrill.
Mod Pathol, 2021 May 22; 34(9). PMID: 34017063    Free PMC article.
PTEN and DNA Ploidy Status by Machine Learning in Prostate Cancer.
Karolina Cyll, Andreas Kleppe, +11 authors, Håvard E Danielsen.
Cancers (Basel), 2021 Sep 11; 13(17). PMID: 34503100    Free PMC article.
Predicting primary site of secondary liver cancer with a neural estimator of metastatic origin.
Geoffrey F Schau, Erik A Burlingame, +5 authors, Young H Chang.
J Med Imaging (Bellingham), 2020 Jan 01; 7(1). PMID: 34541020    Free PMC article.
Integrating digital pathology into clinical practice.
Matthew G Hanna, Orly Ardon, +3 authors, Meera R Hameed.
Mod Pathol, 2021 Oct 03;. PMID: 34599281
Review.
Application of Artificial Intelligence in Community-Based Primary Health Care: Systematic Scoping Review and Critical Appraisal.
Samira Abbasgholizadeh Rahimi, France Légaré, +10 authors, Jean Légaré.
J Med Internet Res, 2021 Sep 04; 23(9). PMID: 34477556    Free PMC article.
Systematic Review.
The Lancet Commission on diagnostics: transforming access to diagnostics.
Kenneth A Fleming, Susan Horton, +29 authors, Kamini Walia.
Lancet, 2021 Oct 10;. PMID: 34626542    Free PMC article.
Review.
Ethics of AI in Pathology: Current Paradigms and Emerging Issues.
Chhavi Chauhan, Rama R Gullapalli.
Am J Pathol, 2021 Jul 13; 191(10). PMID: 34252382    Free PMC article.
Review.
Multi-Task Learning-Based Immunofluorescence Classification of Kidney Disease.
Sai Pan, Yibing Fu, +13 authors, Xiangmei Chen.
Int J Environ Res Public Health, 2021 Oct 24; 18(20). PMID: 34682567    Free PMC article.
Artificial Intelligence in Digital Pathology: What Is the Future? Part 2: An Investigation on the Insiders.
Maria Rosaria Giovagnoli, Sara Ciucciarelli, Livia Castrichella, Daniele Giansanti.
Healthcare (Basel), 2021 Oct 24; 9(10). PMID: 34683027    Free PMC article.
Qualitative Histopathological Classification of Primary Bone Tumors Using Deep Learning: A Pilot Study.
Yuzhang Tao, Xiao Huang, +16 authors, Jian Zhang.
Front Oncol, 2021 Oct 26; 11. PMID: 34692509    Free PMC article.
Histopathological Images and Multi-Omics Integration Predict Molecular Characteristics and Survival in Lung Adenocarcinoma.
Linyan Chen, Hao Zeng, +3 authors, Xuelei Ma.
Front Cell Dev Biol, 2021 Oct 29; 9. PMID: 34708036    Free PMC article.