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Predicting TNM stage is the major determinant of breast cancer prognosis and treatment. The essential part of TNM stage classification is whether the cancer has metastasized to the regional lymph nodes (N-stage). Pathologic N-stage (pN-stage) is commonly performed by pathologists detecting metastasis in histological slides. However, this diagnostic procedure is prone to misinterpretation and would normally require extensive time by pathologists because of the sheer volume of data that needs a thorough review. Automated detection of lymph node metastasis and pN-stage prediction has a great potential to reduce their workload and help the pathologist. Recent advances in convolutional neural networks (CNN) have shown significant improvements in histological slide analysis, but accuracy is not optimized because of the difficulty in the handling of gigapixel images. In this paper, we propose a robust method for metastasis detection and pN-stage classification in breast cancer from multiple gigapixel pathology images in an effective way. pN-stage is predicted by combining patch-level CNN based metastasis detector and slide-level lymph node classifier. The proposed framework achieves a state-of-the-art quadratic weighted kappa score of 0.9203 on the Camelyon17 dataset, outperforming the previous winning method of the Camelyon17 challenge.

A Robust and Effective Approach Towards Accurate Metastasis Detection and pN-stage Classification in Breast Cancer