Artificial Intelligence-enabled Histological Analysis in Preclinical Respiratory Disease Models: A Scoping Review

Abstract

Histological analysis is a cornerstone of preclinical respiratory disease research, enabling assessment of pathology, therapeutic effects, and mechanisms. However, conventional approaches rely on manual scoring, which is subjective, time-consuming, and difficult to scale due to low throughput and inter-observer variability. Artificial intelligence (AI), particularly deep learning, offers potential to automate histology workflows, but its use and evaluation in preclinical respiratory models have not been synthesized. We conducted a scoping review following Joanna Briggs Institute guidelines, searching MEDLINE and Embase (inception-January 2025) for preclinical studies using AI to analyze histology in respiratory disease models. Screening, full-text review, and data extraction were performed in duplicate. Of 6271 studies screened, 29 met inclusion criteria. Most used murine models (76%) and investigated lung cancer (28%), pulmonary fibrosis (24%), or tuberculosis (17%). Hematoxylin and eosin was the most common stain (48%), with others targeting collagen or immune markers. AI tasks included image classification (n=20), segmentation (n=10), and object detection (n=4), predominantly using convolutional neural networks (69%). Preprocessing methods (e.g., stain normalization) were common, but annotation and training practices were inconsistently reported. Performance was generally high (accuracy [≥]90%; 7 studies) though validation metrics varied, and external validation was absent. Most studies used "black box" models, with minimal application of explainability techniques. Reproducibility measures, such as sharing datasets or code were rarely reported. AI tools are poised to transform histological analysis in preclinical respiratory research. By addressing gaps in validation, transparency, and standardization, the field can harness these technologies to deliver robust, efficient, and scalable workflows. Registration: Open Science Framework https://doi.org/10.17605/OSF.IO/NM94E