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Mitosis is a critical criterion for meningioma grading. However, pathologists’ assessment of mitoses is subject to significant inter-observer variation due to challenges in locating mitosis hotspots and accurately detecting mitotic figures. To address this issue, we leverage digital pathology and propose a computational strategy to enhance pathologists’ mitosis assessment. The strategy has two components: (1) A depth-first search algorithm that quantifies the mathematically maximum mitotic count in 10 consecutive high-power fields, which can enhance the preciseness, especially in cases with borderline mitotic count. (2) Implementing a collaborative sphere to group a set of pathologists to detect mitoses under each high-power field, which can mitigate subjective random errors in mitosis detection originating from individual detection errors. By depth-first search algorithm (1) , we analyzed 19 meningioma slides and discovered that the proposed algorithm upgraded two borderline cases verified at consensus conferences. This improvement is attributed to the algorithm’s ability to quantify the mitotic count more comprehensively compared to other conventional methods of counting mitoses. In implementing a collaborative sphere (2) , we evaluated the correctness of mitosis detection from grouped pathologists and/or pathology residents, where each member of the group annotated a set of 48 high-power field images for mitotic figures independently. We report that groups with sizes of three can achieve an average precision of 0.897 and sensitivity of 0.699 in mitosis detection, which is higher than an average pathologist in this study (precision: 0.750, sensitivity: 0.667). The proposed computational strategy can be integrated with artificial intelligence workflow, which envisions the future of achieving a rapid and robust mitosis assessment by interactive assisting algorithms that can ultimately benefit patient management.

 

Recent developments in AI have provided assisting tools to support pathologists’ diagnoses. However, it remains challenging to incorporate such tools into pathologists’ practice; one main concern is AI’s insufficient workflow integration with medical decisions. We observed pathologists’ examination and discovered that the main hindering factor to integrate AI is its incompatibility with pathologists’ workflow. To bridge the gap between pathologists and AI, we developed a human-AI collaborative diagnosis tool — xPath — that shares a similar examination process to that of pathologists, which can improve AI’s integration into their routine examination. The viability of xPath  is confirmed by a technical evaluation and work sessions with twelve medical professionals in pathology. This work identifies and addresses the challenge of incorporating AI models into pathology, which can offer first-hand knowledge about how HCI researchers can work with medical professionals side-by-side to bring technological advances to medical tasks towards practical applications.