Bladder cancer (BC) diagnosis and prediction of prognosis are hindered by subjective pathological evaluation, which may cause misdiagnosis and under-/over-treatment. Computational pathology (CPATH) can identify clinical outcome predictors, offering an objective approach to improve prognosis. However, a systematic review of CPATH in BC literature is lacking. Therefore, we present a comprehensive overview of studies that used CPATH in BC, analyzing 33 out of 2285 identified studies. Most studies analyzed regions of interest to distinguish normal versus tumor tissue and identify tumor grade/stage and tissue types (e.g., urothelium, stroma, and muscle). The cell’s nuclear area, shape irregularity, and roundness were the most promising markers to predict recurrence and survival based on selected regions of interest, with >80% accuracy. CPATH identified molecular subtypes by detecting features, e.g., papillary structures, hyperchromatic, and pleomorphic nuclei. Combining clinicopathological and image-derived features improved recurrence and survival prediction. However, due to the lack of outcome interpretability and independent test datasets, robustness and clinical applicability could not be ensured. The current literature demonstrates that CPATH holds the potential to improve BC diagnosis and prediction of prognosis. However, more robust, interpretable, accurate models and larger datasets—representative of clinical scenarios—are needed to address artificial intelligence’s reliability, robustness, and black box challenge.
膀胱癌的诊断与预后预测受限于主观病理学评估，可能导致误诊及治疗不足或过度。计算病理学能够识别临床结局预测因子，为改善预后提供客观方法。然而，目前缺乏对膀胱癌领域计算病理学研究的系统性综述。为此，我们对膀胱癌计算病理学相关研究进行全面梳理，从2285项已识别研究中筛选出33项进行深入分析。多数研究通过分析感兴趣区域来区分正常组织与肿瘤组织，并识别肿瘤分级/分期及组织类型（如尿路上皮、间质和肌肉）。基于选定的感兴趣区域，细胞核面积、形状不规则性和圆形度成为预测复发和生存最具潜力的标志物，准确率超过80%。计算病理学通过检测乳头状结构、核深染及多形性核等特征识别分子亚型。结合临床病理学特征与图像衍生特征可提升复发和生存预测效能。然而，由于缺乏结局可解释性和独立测试数据集，其稳健性与临床适用性尚未得到充分验证。现有文献表明，计算病理学具备改善膀胱癌诊断与预后预测的潜力。但需构建更具稳健性、可解释性和准确性的模型，并获取更能代表临床场景的大规模数据集，以应对人工智能在可靠性、稳健性及“黑箱”挑战方面的问题。
Artificial Intelligence in Digital Pathology for Bladder Cancer: Hype or Hope? A Systematic Review
肿瘤(癌症)患者之家