With the rapid advancements in cancer research, the information that is useful for characterizing disease, staging tumors, and creating treatment and survivorship plans has been changing at a pace that creates challenges when physicians try to remain current. One example involves increasing usage of biomarkers when characterizing the pathologic prognostic stage of a breast tumor. We present our semantic technology approach to support cancer characterization and demonstrate it in our end-to-end prototype system that collects the newest breast cancer staging criteria from authoritative oncology manuals to construct an ontology for breast cancer. Using a tool we developed that utilizes this ontology, physician-facing applications can be used to quickly stage a new patient to support identifying risks, treatment options, and monitoring plans based on authoritative and best practice guidelines. Physicians can also re-stage existing patients or patient populations, allowing them to find patients whose stage has changed in a given patient cohort. As new guidelines emerge, using our proposed mechanism, which is grounded by semantic technologies for ingesting new data from staging manuals, we have created an enriched cancer staging ontology that integrates relevant data from several sources with very little human intervention.
Furthermore, in addition to including classes for all cancer stages for the respective guideline, we also map the breast cancer terms to community-accepted terms from the National Cancer Institute thesaurus (NCIt) @cite_10 , and incorporate recommended tests and treatment plans from the openly reusable Clinical Interpretations of Variants in Cancer (CIViC) @cite_22 data that can be used to provide stage specific recommendations. Furthermore, our ontology includes terms that are not included in NCIt or AJCC, such as more specific subclasses of tumor characteristics (, , , , etc.) that are available in the Surveillance, Epidemiology, and End Results (SEER) dataset @cite_1 .
@cite_1 @cite_10 @cite_22
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With the advent of electronic health records, more data are continuously collected for individual patients, and more data are available for review from past patients. Despite this, it has not yet been possible to successfully use this data to systematically build clinical decision support systems that can produce personalized clinical recommendations to assist clinicians in providing individualized healthcare. In this paper, we present a novel approach, discovery engine (DE), that discovers which patient characteristics are most relevant for predicting the correct diagnosis and or recommending the best treatment regimen for each patient. We demonstrate the performance of DE in two clinical settings: diagnosis of breast cancer as well as a personalized recommendation for a specific chemotherapy regimen for breast cancer patients. For each distinct clinical recommendation, different patient features are relevant; DE can discover these different relevant features and use them to recommend personalized clinical decisions. The DE approach achieves a 16.6 improvement over existing state-of-the-art recommendation algorithms regarding kappa coefficients for recommending the personalized chemotherapy regimens. For diagnostic predictions, the DE approach achieves a 2.18 and 4.20 improvement over existing state-of-the-art prediction algorithms regarding prediction error rate and false positive rate, respectively. We also demonstrate that the performance of our approach is robust against missing information and that the relevant features discovered by DE are confirmed by clinical references. Radiology reports contain vital diagnostic information that characterizes patient disease progression. However, information from reports is represented in free text, which is difficult to query against for secondary use. Automatic extraction of important information, such as tumor events using natural language processing, offers possibilities in improved clinical decision support, cohort identification, and retrospective evidence-based research for cancer patients. The goal of this work was to classify tumor event attributes: negation, temporality, and malignancy, using biomedical ontology and linguistically enriched features. We report our results on an annotated corpus of 101 hepatocellular carcinoma patient radiology reports, and show that the improved classification improves overall template structuring. Classification performances for negation identification, past temporality classification, and malignancy classification were at 0.94, 0.62, and 0.77 F1, respectively. Incorporating the attributes into full templates led to an improvement of 0.72 F1 for tumor-related events over a baseline of 0.65 F1. Improvement of negation, malignancy, and temporality classifications led to significant improvements in template extraction for the majority of categories. We present our machine-learning approach to identifying these several tumor event attributes from radiology reports, as well as highlight challenges and areas for improvement. The inability to interpret the model prediction in semantically and visually meaningful ways is a well-known shortcoming of most existing computer-aided diagnosis methods. In this paper, we propose MDNet to establish a direct multimodal mapping between medical images and diagnostic reports that can read images, generate diagnostic reports, retrieve images by symptom descriptions, and visualize attention, to provide justifications of the network diagnosis process. MDNet includes an image model and a language model. The image model is proposed to enhance multi-scale feature ensembles and utilization efficiency. The language model, integrated with our improved attention mechanism, aims to read and explore discriminative image feature descriptions from reports to learn a direct mapping from sentence words to image pixels. The overall network is trained end-to-end by using our developed optimization strategy. Based on a pathology bladder cancer images and its diagnostic reports (BCIDR) dataset, we conduct sufficient experiments to demonstrate that MDNet outperforms comparative baselines. The proposed image model obtains state-of-the-art performance on two CIFAR datasets as well. The inability to interpret the model prediction in semantically and visually meaningful ways is a well-known shortcoming of most existing computer-aided diagnosis methods. In this paper, we propose MDNet to establish a direct multimodal mapping between medical images and diagnostic reports that can read images, generate diagnostic reports, retrieve images by symptom descriptions, and visualize attention, to provide justifications of the network diagnosis process. MDNet includes an image model and a language model. The image model is proposed to enhance multi-scale feature ensembles and utilization efficiency. The language model, integrated with our improved attention mechanism, aims to read and explore discriminative image feature descriptions from reports to learn a direct mapping from sentence words to image pixels. The overall network is trained end-to-end by using our developed optimization strategy. Based on a pathology bladder cancer images and its diagnostic reports (BCIDR) dataset, we conduct sufficient experiments to demonstrate that MDNet outperforms comparative baselines. The proposed image model obtains state-of-the-art performance on two CIFAR datasets as well.