Weakly supervised pathological differentiation of primary central nervous system lymphoma and glioblastoma on multi-site whole slide images.

Purpose: Differentiating primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM) is crucial because their prognosis and treatment differ substantially. Manual examination of their histological characteristics is considered the golden standard in clinical diagnosis. However, this process is tedious and time-consuming and might lead to misdiagnosis caused by morphological similarity between their histology and tumor heterogeneity. Existing research focuses on radiological differentiation, which mostly uses multi-parametric magnetic resonance imaging. By contrast, we investigate the pathological differentiation between the two types of tumors using whole slide images (WSIs) of postoperative formalin-fixed paraffin-embedded samples. Approach: To learn the specific and intrinsic histological feature representations from the WSI patches, a self-supervised feature extractor is trained. Then, the patch representations are fused by feeding into a weakly supervised multiple-instance learning model for the WSI classification. We validate our approach on 134 PCNSL and 526 GBM cases collected from three hospitals. We also investigate the effect of feature extraction on the final prediction by comparing the performance of applying the feature extractors trained on the PCNSL/GBM slides from specific institutions, multi-site PCNSL/GBM slides, and large-scale histopathological images. Results: Different feature extractors perform comparably with the overall area under the receiver operating characteristic curve value exceeding 85% for each dataset and close to 95% for the combined multi-site dataset. Using the institution-specific feature extractors generally obtains the best overall prediction with both of the PCNSL and GBM classification accuracies reaching 80% for each dataset. Conclusions: The excellent classification performance suggests that our approach can be used as an assistant tool to reduce the pathologists' workload by providing an accurate and objective second diagnosis. Moreover, the discriminant regions indicated by the generated attention heatmap improve the model interpretability and provide additional diagnostic information.