Cited by 2,930AI in cancer detectionRadiomics and Machine Learning in Medical ImagingLung Cancer Diagnosis and Treatment

Classification and mutation prediction from non–small cell lung cancer histopathology images using deep learning

Open access
Coudray, Nicolas, Ocampo, Paolo Santiago, Sakellaropoulos, Theodore, Narula, Navneet, Snuderl, Matija, Fenyö, David, Moreira, Andre L., Razavian, Narges +1 more·2018·Nature Medicine

Published version of a preprint

Abstract

Visual inspection of histopathology slides is one of the main methods used by pathologists to assess the stage, type and subtype of lung tumors. Adenocarcinoma (LUAD) and squamous cell carcinoma (LUSC) are the most prevalent subtypes of lung cancer, and their distinction requires visual inspection by an experienced pathologist. In this study, we trained a deep convolutional neural network (inception v3) on whole-slide images obtained from The Cancer Genome Atlas to accurately and automatically classify them into LUAD, LUSC or normal lung tissue. The performance of our method is comparable to that of pathologists, with an average area under the curve (AUC) of 0.97. Our model was validated on independent datasets of frozen tissues, formalin-fixed paraffin-embedded tissues and biopsies. Furthermore, we trained the network to predict the ten most commonly mutated genes in LUAD. We found that six of them-STK11, EGFR, FAT1, SETBP1, KRAS and TP53-can be predicted from pathology images, with AUCs from 0.733 to 0.856 as measured on a held-out population. These findings suggest that deep-learning models can assist pathologists in the detection of cancer subtype or gene mutations. Our approach can be applied to any cancer type, and the code is available at https://github.com/ncoudray/DeepPATH .

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Crossref · 10.1038/s41591-018-0177-5

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  • Patch-level approaches ignore up to 99% of the total tissue.

    “By design, these patch-level approaches ignore up to 99% of the total tissue, miss potentially diagnostically relevant areas, and cannot be applied to tasks that require the full context of the entire tissue sample (e.g., tumor thickness prediction).”

    From Generating dermatopathology reports from gigapixel whole slide images with HistoGPT (2025) · cites this paper as [11]

    The Results section (“A deep learning framework for the automatic analysis of histopathology images”; page unavailable) says the study divided whole-slide images into tens to thousands of non-overlapping patches per slide, rather than selecting a small fraction of tissue. The Statistical Analysis methods also describe aggregating predictions from the slide’s tiles. The paper does not report that its patch-level approach ignores up to 99% of tissue; its described approach runs contrary to that characterization. (LLM, conf=0.83)

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  • The lower WSI attribution in BRCA, COADREAD, and LUAD may result from prognostic information also being partly explained by genomics, because aberrations such as ERBB2 or KRAS mutation and microsatellite instability can be determined from histology.

    “which may result from prognostic information also partially explained via genomics as aberrations such as ERBB2 or KRAS mutation and the presence of microsatellite instability can be determined from histology (Coudray et al., 2018;Kather et al.,2019,2020;Gamble et al.,2021).”

    From Pan-cancer integrative histology-genomic analysis via multimodal deep learning (2022) · cites this paper as Coudray et al., 2018

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured
  • Patch-level approaches cannot be applied to tasks that require the full context of the entire tissue sample.

    “By design, these patch-level approaches ignore up to 99% of the total tissue, miss potentially diagnostically relevant areas, and cannot be applied to tasks that require the full context of the entire tissue sample (e.g., tumor thickness prediction).”

    From Generating dermatopathology reports from gigapixel whole slide images with HistoGPT (2025) · cites this paper as [11]

    The Results section ('A deep learning framework for the automatic analysis of histopathology images'; page not provided) says the network used 512×512-pixel tiles because whole-slide images were too large for direct input. This supports the point that an individual patch lacks whole-sample context, but the paper does not say patch-level approaches cannot be applied to tasks requiring that context, or discuss tumor-thickness prediction. (LLM, conf=0.78)

    Experimental — accuracy not yet measured
  • Patch-level approaches miss potentially diagnostically relevant areas.

    “By design, these patch-level approaches ignore up to 99% of the total tissue, miss potentially diagnostically relevant areas, and cannot be applied to tasks that require the full context of the entire tissue sample (e.g., tumor thickness prediction).”

    From Generating dermatopathology reports from gigapixel whole slide images with HistoGPT (2025) · cites this paper as [11]

    The Results section (‘A deep learning framework’; page unavailable) describes dividing whole-slide images into non-overlapping patches and producing tens to thousands of tiles per slide. The Online Methods (‘Tests on independent cohorts’; page unavailable) describe restricting some tests to pathologist-selected regions, but neither passage says patch-level approaches miss diagnostically relevant areas. I searched for missed diagnostic areas and tissue excluded by patch selection. (LLM, conf=0.74)

    Experimental — accuracy not yet measured
  • Studies have shown that morphological features captured by a hematoxylin and eosin stain are predictive of molecular biomarkers utilized in theragnosis.

    “Studies have even shown that morphological features captured by a hematoxylin and eosin (H&E) stain are predictive of molecular biomarkers utilized in theragnosis 85,89 .”

    From Deep learning-enabled medical computer vision (2021) · cites this paper as [85]

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Research works printed but not linked: 5

  1. [18]Qaiser T, Tsang Y-W, Epstein D & RajpootEma N in Medical Image Understanding and Analysis: 21st Annual Conference on Medical Image Understanding and Analysis. (ed Springer International Publishing).
  2. [21]de Bel T in Medical Imaging 2018: Digital Pathology Vol. 10581 (ed International Society for Optics and Photonics.) 1058112 (2018).
  3. [26]Ertosun MG & Rubin DL in AMIA Annual Symposium Proceedings. (ed American Medical Informatics Association).
  4. [28]Mishra R, Daescu O, Leavey P, Rakheja D & Sengupta A in International Symposium on Bioinformatics Research and Applications. (ed Springer) 12– 23.
  5. [42]Zeiler MD & Fergus R in European Conference on Computer Vision. 818– 833.

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Authors
Coudray, N., Ocampo, P. S., Sakellaropoulos, T., Narula, N., Snuderl, M., Fenyö, D., Moreira, A. L., Razavian, N., & Tsirigos, A.
Affiliations
  • New York University (US)
  • National Technical University of Athens (GR)
  • NYU Langone Health (US)
Corresponding author
  • Razavian, Narges
  • Tsirigos, Aristotelis
Venue
Nature Medicine
Published
2018-09-17
Volume
24
Issue
10
Pages
1559-1567
ISSN
  • 1078-8956 (ISSN-L)
  • 1546-170X
OpenAlex
W2760946358
Cited by
2,930
References
71
Citations by year
2026: 349 · 2025: 380 · 2024: 380 · 2023: 436 · 2022: 452 · 2021: 415 · 2020: 319 · 2019: 183 · 2018: 10 · 2017: 1 · 2014: 1
FWCI
130.74
Type
journal article
Language
en
Open access
Locations
  • Nature Medicine (publishedVersion)
  • bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • NYU Langone Medical Center
  • School of Medicine, New York University
  • National Cancer Institute (P30CA016087)
Topics
  • Physical Sciences › Computer Science › Artificial Intelligence › AI in cancer detection
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiomics and Machine Learning in Medical Imaging
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
Keywords
non-small cell lung cancer, lung adenocarcinoma, squamous cell carcinoma, histopathological image classification, whole slide images, gene mutation prediction, STK11, EGFR, FAT1, SETBP1, KRAS, TP53, computer-aided diagnosis, frozen tissue, formalin-fixed paraffin-embedded tissue, biopsy
MeSH terms
Deep Learning, Adenocarcinoma, Carcinoma, Non-Small-Cell Lung, Carcinoma, Squamous Cell, Humans, Mutation, Neoplasm Proteins, Gene Expression Regulation, Neoplastic, Neural Networks, Computer

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