# A Fully Automated and Explainable Algorithm for the Prediction of Malignant Transformation in Oral Epithelial Dysplasia

arXiv: https://arxiv.org/abs/2307.03757 · HTML: https://mlsanity.com/paper/2307.03757/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Builds on 20 of its 53 references that are in the map.
- First posted on arXiv 6 Jul 2023.

## Builds on (most cited first, 20 of 20)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Domain-Adversarial Training of Neural Networks](https://mlsanity.com/paper/1505.07818/) (2015)
- [A Survey on Deep Learning in Medical Image Analysis](https://mlsanity.com/paper/1702.05747/) (2017)
- [Attention-based Deep Multiple Instance Learning](https://mlsanity.com/paper/1802.04712/) (2018)
- [Data Efficient and Weakly Supervised Computational Pathology on Whole Slide Images](https://mlsanity.com/paper/2004.09666/) (2020)
- [Symmetric Cross Entropy for Robust Learning with Noisy Labels](https://mlsanity.com/paper/1908.06112/) (2019)
- [Deep Learning for Medical Image Analysis](https://mlsanity.com/paper/1708.08987/) (2017)
- [HoVer-Net: Simultaneous Segmentation and Classification of Nuclei in Multi-Tissue Histology Images](https://mlsanity.com/paper/1812.06499/) (2018)
- [Mitosis domain generalization in histopathology images -- The MIDOG challenge](https://mlsanity.com/paper/2204.03742/) (2022)
- [CGC-Net: Cell Graph Convolutional Network for Grading of Colorectal Cancer Histology Images](https://mlsanity.com/paper/1909.01068/) (2019)
- [Micro-Net: A unified model for segmentation of various objects in microscopy images](https://mlsanity.com/paper/1804.08145/) (2018)
- [NuClick: A Deep Learning Framework for Interactive Segmentation of Microscopy Images](https://mlsanity.com/paper/2005.14511/) (2020)
- [One Model is All You Need: Multi-Task Learning Enables Simultaneous Histology Image Segmentation and Classification](https://mlsanity.com/paper/2203.00077/) (2022)
- [SlideGraph+: Whole Slide Image Level Graphs to Predict HER2Status in Breast Cancer](https://mlsanity.com/paper/2110.06042/) (2021)
- [Epithelium segmentation using deep learning in H&E-stained prostate specimens with immunohistochemistry as reference standard](https://mlsanity.com/paper/1808.05883/) (2018)
- [An Aggregation of Aggregation Methods in Computational Pathology](https://mlsanity.com/paper/2211.01256/) (2022)
- [Stain-Robust Mitotic Figure Detection for the Mitosis Domain Generalization Challenge](https://mlsanity.com/paper/2109.00853/) (2021)
- [Location Sensitive Deep Convolutional Neural Networks for Segmentation of White Matter Hyperintensities](https://mlsanity.com/paper/1610.04834/) (2016)
- [Simultaneous Nuclear Instance and Layer Segmentation in Oral Epithelial Dysplasia](https://mlsanity.com/paper/2108.13904/) (2021)
- [NuClick: From Clicks in the Nuclei to Nuclear Boundaries](https://mlsanity.com/paper/1909.03253/) (2019)

## Built on by (most cited first, 3 of 3)

- [Domain Generalization in Computational Pathology: Survey and Guidelines](https://mlsanity.com/paper/2310.19656/) (2023)
- [An Automated Pipeline for Tumour-Infiltrating Lymphocyte Scoring in Breast Cancer](https://mlsanity.com/paper/2311.06185/) (2023)
- [An Attention Based Pipeline for Identifying Pre-Cancer Lesions in Head and Neck Clinical Images](https://mlsanity.com/paper/2405.01937/) (2024)

## Abstract (arXiv)

Oral epithelial dysplasia (OED) is a premalignant histopathological diagnosis given to lesions of the oral cavity. Its grading suffers from significant inter-/intra- observer variability, and does not reliably predict malignancy progression, potentially leading to suboptimal treatment decisions. To address this, we developed a novel artificial intelligence algorithm that can assign an Oral Malignant Transformation (OMT) risk score, based on histological patterns in the in Haematoxylin and Eosin stained whole slide images, to quantify the risk of OED progression. The algorithm is based on the detection and segmentation of nuclei within (and around) the epithelium using an in-house segmentation model. We then employed a shallow neural network fed with interpretable morphological/spatial features, emulating histological markers. We conducted internal cross-validation on our development cohort (Sheffield; n = 193 cases) followed by independent validation on two external cohorts (Birmingham and Belfast; n = 92 cases). The proposed OMTscore yields an AUROC = 0.74 in predicting whether an OED progresses to malignancy or not. Survival analyses showed the prognostic value of our OMTscore for predicting malignancy transformation, when compared to the manually-assigned WHO and binary grades. Analysis of the correctly predicted cases elucidated the presence of peri-epithelial and epithelium-infiltrating lymphocytes in the most predictive patches of cases that transformed (p < 0.0001). This is the first study to propose a completely automated algorithm for predicting OED transformation based on interpretable nuclear features, whilst being validated on external datasets. The algorithm shows better-than-human-level performance for prediction of OED malignant transformation and offers a promising solution to the challenges of grading OED in routine clinical practice.