Artificial intelligence (AI) has shown promise for diagnosing prostate cancer in biopsies. However, results have been limited to individual studies, lacking validation in multinational settings. Competitions have been shown to be accelerators for medical imaging innovations, but their impact is hindered by lack of reproducibility and independent validation. With this in mind, we organized the PANDA challenge—the largest histopathology competition to date, joined by 1,290 developers—to catalyze development of reproducible AI algorithms for Gleason grading using 10,616 digitized prostate biopsies. We validated that a diverse set of submitted algorithms reached pathologist-level performance on independent cross-continental cohorts, fully blinded to the algorithm developers. On United States and European external validation sets, the algorithms achieved agreements of 0.862 (quadratically weighted κ, 95% confidence interval (CI), 0.840–0.884) and 0.868 (95% CI, 0.835–0.900) with expert uropathologists. Successful generalization across different patient populations, laboratories and reference standards, achieved by a variety of algorithmic approaches, warrants evaluating AI-based Gleason grading in prospective clinical trials.
Transformers have shown superior performance on various vision tasks. Their large receptive field endows Transformer models with higher representation power than their CNN counterparts. Nevertheless, simply enlarging the receptive field also raises several concerns. On the one hand, using dense attention in ViT leads to excessive memory and computational cost, and features can be influenced by irrelevant parts that are beyond the region of interests. On the other hand, the handcrafted attention adopted in PVT or Swin Transformer is data agnostic and may limit the ability to model long-range relations. To solve this dilemma, we propose a novel deformable multi-head attention module, where the positions of key and value pairs in self-attention are adaptively allocated in a data-dependent way. This flexible scheme enables the proposed deformable attention to dynamically focus on relevant regions while maintains the representation power of global attention. On this basis, we present Deformable Attention Transformer (DAT), a general vision backbone efficient and effective for visual recognition. We further build an enhanced version DAT++. Extensive experiments show that our DAT++ achieves state-of-the-art results on various visual recognition benchmarks, with 85.9% ImageNet accuracy, 54.5 and 47.0 MS-COCO instance segmentation mAP, and 51.5 ADE20K semantic segmentation mIoU.
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