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Title: Development of Training Materials for Pathologists to Provide Machine Learning Validation Data of Tumor-Infiltrating Lymphocytes in Breast Cancer

Journal Article · · Cancers (Basel)

The High Throughput Truthing project aims to develop a dataset for validating artificial intelligence and machine learning models (AI/ML) fit for regulatory purposes. The context of this AI/ML validation dataset is the reporting of stromal tumor-infiltrating lymphocytes (sTILs) density evaluations in hematoxylin and eosin-stained invasive breast cancer biopsy specimens. After completing the pilot study, we found notable variability in the sTILs estimates as well as inconsistencies and gaps in the provided training to pathologists. Using the pilot study data and an expert panel, we created custom training materials to improve pathologist annotation quality for the pivotal study. We categorized regions of interest (ROIs) based on their mean sTILs density and selected ROIs with the highest and lowest sTILs variability. In a series of eight one-hour sessions, the expert panel reviewed each ROI and provided verbal density estimates and comments on features that confounded the sTILs evaluation. We aggregated and shaped the comments to identify pitfalls and instructions to improve our training materials. From these selected ROIs, we created a training set and proficiency test set to improve pathologist training with the goal to improve data collection for the pivotal study. We are not exploring AI/ML performance in this paper. Instead, we are creating materials that will train crowd-sourced pathologists to be the reference standard in a pivotal study to create an AI/ML model validation dataset. The issues discussed here are also important for clinicians to understand about the evaluation of sTILs in clinical practice and can provide insight to developers of AI/ML models.

Research Organization:
Oak Ridge Inst. for Science and Education (ORISE), Oak Ridge, TN (United States)
Sponsoring Organization:
US Food and Drug Administration; USDOE; USDOE Office of Science (SC)
Grant/Contract Number:
SC0014664
OSTI ID:
1868129
Journal Information:
Cancers (Basel), Journal Name: Cancers (Basel) Journal Issue: 10 Vol. 14; ISSN CANCCT; ISSN 2072-6694
Publisher:
MDPI AGCopyright Statement
Country of Publication:
Switzerland
Language:
English

References (30)

A Mathematical Theory of Communication journal July 1948
Tumour-infiltrating lymphocytes and prognosis in different subtypes of breast cancer: a pooled analysis of 3771 patients treated with neoadjuvant therapy journal January 2018
Analyzing productive learning behaviors for students using immediate corrective feedback in a blended learning environment journal February 2018
A Computational Tumor-Infiltrating Lymphocyte Assessment Method Comparable with Visual Reporting Guidelines for Triple-Negative Breast Cancer journal August 2021
Clinical relevance of host immunity in breast cancer: from TILs to the clinic journal December 2015
Report on computational assessment of Tumor Infiltrating Lymphocytes from the International Immuno-Oncology Biomarker Working Group journal May 2020
Pitfalls in assessing stromal tumor infiltrating lymphocytes (sTILs) in breast cancer journal May 2020
A tribute to Claude Shannon (1916-2001) and a plea for more rigorous use of species richness, species diversity and the ‘Shannon-Wiener’ Index journal April 2003
The evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer: recommendations by an International TILs Working Group 2014 journal February 2015
Prognostic implications of residual disease tumor-infiltrating lymphocytes and residual cancer burden in triple-negative breast cancer patients after neoadjuvant chemotherapy journal February 2019
Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up journal August 2019
Prognostic value of tumor-infiltrating lymphocytes in patients with early-stage triple-negative breast cancers (TNBC) who did not receive adjuvant chemotherapy journal December 2019
Assessing Tumor-infiltrating Lymphocytes in Solid Tumors: A Practical Review for Pathologists and Proposal for a Standardized Method From the International Immunooncology Biomarkers Working Group: Part 1: Assessing the Host Immune Response, TILs in Invasive Breast Carcinoma and Ductal Carcinoma In Situ, Metastatic Tumor Deposits and Areas for Further Research journal January 2017
Comparison of tumor-infiltrating lymphocytes between primary and metastatic tumors in breast cancer patients journal December 2016
Evaluation environment for digital and analog pathology: a platform for validation studies journal October 2014
A Containerized Software System for Generation, Management, and Exploration of Features from Whole Slide Tissue Images journal October 2017
St. Gallen/Vienna 2019: A Brief Summary of the Consensus Discussion on the Optimal Primary Breast Cancer Treatment journal January 2019
Clinical significance of tumor-infiltrating lymphocytes in breast cancer journal October 2016
Tumor-Infiltrating Lymphocytes and Prognosis: A Pooled Individual Patient Analysis of Early-Stage Triple-Negative Breast Cancers journal March 2019
Tumor-Infiltrating Lymphocytes and Response to Neoadjuvant Chemotherapy With or Without Carboplatin in Human Epidermal Growth Factor Receptor 2–Positive and Triple-Negative Primary Breast Cancers journal March 2015
Interobserver Agreement Between Pathologists Assessing Tumor-Infiltrating Lymphocytes (TILs) in Breast Cancer Using Methodology Proposed by the International TILs Working Group journal March 2016
The Prognostic Value of Tumor-Infiltrating Lymphocytes in Breast Cancer: A Systematic Review and Meta-Analysis journal April 2016
Consensus methods: characteristics and guidelines for use. journal September 1984
Highlights of the 16th St Gallen International Breast Cancer Conference, Vienna, Austria, 20–23 March 2019: personalised treatments for patients with early breast cancer journal April 2019
Clinical Validity and Utility of Tumor-Infiltrating Lymphocytes in Routine Clinical Practice for Breast Cancer Patients: Current and Future Directions journal August 2017
Automated Quantification of sTIL Density with H&E-Based Digital Image Analysis Has Prognostic Potential in Triple-Negative Breast Cancers journal June 2021
Interobserver Agreement of PD-L1/SP142 Immunohistochemistry and Tumor-Infiltrating Lymphocytes (TILs) in Distant Metastases of Triple-Negative Breast Cancer: A Proof-of-Concept Study. A Report on Behalf of the International Immuno-Oncology Biomarker Working Group journal September 2021
Spatial Characterization of Tumor-Infiltrating Lymphocytes and Breast Cancer Progression journal April 2022
Prognostic Role and Clinical Significance of Tumor-Infiltrating Lymphocyte (TIL) and Programmed Death Ligand 1 (PD-L1) Expression in Triple-Negative Breast Cancer (TNBC): A Systematic Review and Meta-Analysis Study journal September 2020
A Pathologist-Annotated Dataset for Validating Artificial Intelligence: A Project Description and Pilot Study journal January 2021