Evaluation of Virtual Stain Multiplexed CD68 for Macrophage Detection in NSCLC PD-L1 Slides

Elad Arbel, Oded Ben-David, Itay Remer, Amir Ben-Dor, Daniela Rabkin, Sarit Aviel-Ronen, Frederik Aidt, Tine Hagedorn-Olsen, Lars Jacobsen, Kristopher Kersch, Jim Christian, Quyen Nguyen, Anya Tsalenko

Keywords: Immunohistochemistry, Virtual Stain, Multiplexing, Deep Learning, Macrophages, NSCLC, PD-L1, AI, Agreement, Pathology

TL;DR: Evaluation of Virtual Stain Multiplexing, demonstrating improved agreement and performance of VSM CD68 assisted pathologiststs detecting macrophages in PD-L1 IHC stained slides

Abstract:

Manual reading of tissue slides by pathologists serves both as a foundation for clinical decision-making and as a source of ground truth for training artificial intelligence (AI) models. However, challenges such as inter-observer variability, limited tissue availability, and complex annotation tasks often compromise reliability and scalability. This study exemplifies a broader trend in pathology: leveraging virtual staining and other AI-based methodologies to address these challenges. We applied virtual stain multiplexing to a challenging annotation task - macrophage identification in non-small cell lung cancer tissue PD-L1 IHC stains, demonstrating its ability to improve pathologist performance and inter-observer agreement. In six challenging regions selected from 49 curated whole slide images, virtual staining significantly increased macrophage detection consistency, with Fleiss' kappa improving from -0.1 to 0.62, and enhanced overall accuracy, with the F1 score increasing from 0.13 to 0.65. These results highlight the potential use of AI-based virtual staining to assist pathologists reading slides, thereby improving consistency, enhancing accuracy, and alleviating the dependence on additional costly staining. Virtual stain multiplexing demonstrates a generalizable approach to improving pathologist performance through measurement-based AI tools, addressing broader needs for reproducibility and efficiency in diagnostic pathology.

Primary Subject Area: Application: Histopathology

Secondary Subject Area: Image Synthesis

Paper Type: Validation or Application

Registration Requirement: Yes

Visa & Travel: Yes

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Submission Number: 103