Detection of prostate cancer in 3D pathology datasets via generative immunolabeling

Recent advancements in nondestructive 3D pathology offer a complement to standard histology by enabling comprehensive volumetric analyses of intact clinical specimens (e.g. biopsies). Prior studies have demonstrated the added prognostic value of 3D pathology for prostate cancer risk stratification by correlating 3D microarchitectural features with long-term patient outcomes. However, these analyses relied on coarse manual annotations of cancer-enriched regions for downstream analysis without fine-grained delineation between often-intermixed cancerous and benign glands. To address these limitations, we have developed a 3D computational pipeline: Synthetic Immunolabeling for Generative Heatmaps of Tumor (SIGHT). SIGHT relies on deep learning-based 3D image translation models, trained in a fully supervised fashion, to convert H&E-analog 3D pathology datasets into multiplexed 3D immunofluorescence datasets that facilitate tumor detection. Our implementation of SIGHT synthetically labels two cytokeratin markers that are differentially expressed in cancerous and benign prostate glands, which are used to generate explainable 3D heatmaps of cancer-enriched regions in prostate tissues. Validation of SIGHT against ground-truth annotations from a panel of genitourinary pathologists yields an average F1 score of 0.88 which is comparable to the average inter-pathologist agreement F1 score of 0.90. To demonstrate the value of SIGHT, we developed machine classifiers of recurrence risk based on 3D glandular histomorphometric features from 75 patients. Volumetric glandular analysis in SIGHT-identified cancer-enriched regions vs. all tissue regions yields an average Kaplan-Meier hazard ratio of 3.57 (1.6 - 7.9 CI) vs. 0.92 (0.45 - 1.89 CI).