SlideGraph+: Whole slide image level graphs to predict HER2 status in breast cancer.

Human epidermal growth factor receptor 2 (HER2) is an important prognostic and predictive factor which is overexpressed in 15-20% of breast cancer (BCa). The determination of its status is a key clinical decision making step for selection of treatment regimen and prognostication. HER2 status is evaluated using transcriptomics or immunohistochemistry (IHC) through in-situ hybridisation (ISH) which incurs additional costs and tissue burden and is prone to analytical variabilities in terms of manual observational biases in scoring. In this study, we propose a novel graph neural network (GNN) based model (SlideGraph+) to predict HER2 status directly from whole-slide images of routine Haematoxylin and Eosin (H&E) stained slides. The network was trained and tested on slides from The Cancer Genome Atlas (TCGA) in addition to two independent test datasets. We demonstrate that the proposed model outperforms the state-of-the-art methods with area under the ROC curve (AUC) values > 0.75 on TCGA and 0.80 on independent test sets. Our experiments show that the proposed approach can be utilised for case triaging as well as pre-ordering diagnostic tests in a diagnostic setting. It can also be used for other weakly supervised prediction problems in computational pathology. The SlideGraph+ code repository is available at https://github.com/wenqi006/SlideGraph along with an IPython notebook showing an end-to-end use case at https://github.com/TissueImageAnalytics/tiatoolbox/blob/develop/examples/full-pipelines/slide-graph.ipynb.