A Pilot Study on Automatic Diagnosis of Cancer Cells Metastasis in Frozen Section Using Convolutional Neural Network

(1)

䞿

䞿㎇὇

㔶ἓⰳ㦚㧊㣿䞲 ☯ἆ㩞䘎㦮

㞪㎎䙂

㩚

㩚㧊

㡂

㡂⿖

㧦

㧦☯㰚┾㠦

ὖ

ὖ䞲

㡞

㡞゚㡆ῂ

㩫╖㧒*, ṫ㨂ῂ*, 㩚䡲Ⰶ*, 㡺㎎㫛*, ₖ㎇㻶**, ₖ㡗Ἲ**, Ὃἓ㡓**, ㏷㧎䡲***, ⹫㏢㡆****, 㞞㑮⹒****, 㧊䡚⋮**, 㟧☯䡚**, 㥶㤦㌗***** *┾ῃ╖䞯ᾦ 䅊䜾䎆䞯ὒ, **㍲㤎㞚㌆⼧㤦, ***㍲㤎㎇⳾⼧㤦, ****⿚╏㍲㤎╖䞯ᾦ⼧㤦, *****㍶ⶎ╖䞯ᾦ 㩫⽊䐋㔶Ὃ䞯ὒ wjdeodlf0123@gmail.com, jkkang3250@gmail.com, wjsur1028@gmail.com, sejongoh@dankook.ac.kr,

sungchul7039@gmail.com, younggon2.kim@gmail.com, gygong@amc.seoul.kr, shade03@naver.com, sypmd@snu.ac.kr, suminy317@gmail.com, hyunnalee@gmail.com, donghyun.yang@gmail.com,

wyou@sunmoon.ac.kr

G

A Pilot Study on Automatic Diagnosis of Cancer Cells

Metastasis in Frozen Section Using Convolutional Neural

Network

Dae-Il Jung*, Jae-Ku Kang*, Hye-Lynn Jeon*, Se-Jong Oh*, Sungchul Kim**, Young-Gon Kim**, Gyungyub Gong**, In Hye Song***, So Yeon Park****, Soomin Ahn****, Hyunna Lee**,

Dong Hyun Yang**, Wonsang You***** *Dept. of Computer Science, Dankook University,

**Asan Medical Center, ***Seoul St. Mary’s Hospital,

****Seoul National Univeristy Budang Hospital,

*****Dept. of Information and Communications Engineering, Sun Moon University 殚檃檃 ☯ἆ㩞䘎Ỗ㌂⓪ 㑮㑶ὒ 㡆Ἒ䞮㡂㞪㩚㧊㡂⿖⯒ 䕦┾䞮₆ 㥚䞲㦧 䞲⼧ⰂỖ㌂Ṗ 䞚㣪䞶 ➢ 㧊㣿♲┺. 䞿㎇὇ 㔶ἓⰳ㦖㧊⹎㰖⿚⮮㠦 ⥆㠊⋲ ㎇⓻㦚⽊㧊⓪ ❻⩂┳ ₆⻫㦒⪲ ⽎ ⏒ⶎ㠦㍲⓪ 㧊⯒ 㧊㣿䞮㡂㥶⹿㞪㩚㧊㡂⿖⯒ 㧦☯㩗㦒⪲ 㰚┾䞮⓪ ⹿⻫㦚㩲㞞䞲┺. 㔺䠮ὒ㩫㦖㩚㻮Ⰲ, 䞯㔋, 䤚㻮Ⰲ㦮 ὒ㩫㦒⪲ ῂ㎇♮㠊㧞㦒Ⳇ, 䞿㎇὇ 㔶ἓⰳ㦒⪲⓪ Resnet-18 ⳾◎㦚㌂㣿䞮㡖┺. 㔺䠮 ἆὒ 㡞䁷㩫䢫☚ ⹥ 㫛㟧㦮㾲╖ ₎㧊㩫䞿㡂⿖⯒ 㩦㑮⪲ 䢮㌆䞮㡂㟓 0.514 㦮 ἆὒ⯒ ⽊㡖┺. 1. 昢嵦 ☯ἆ㩞䘎Ỗ㌂⓪ 㥶₆㣿㩲㢖 Ṗ㡊 ❇㦮㻮Ⰲ 㠜㧊㎎䙂⌊㦮 ┾⺇㰞, 㰖㰞, Ṗ㣿㎇䟃㤦ⶒ㰞 ❇㦮㥶㿲㧊 ⋮ ㌳㫊 ⓻⩻ ㌗㔺㠜㧊㔶㏣䞮Ợ 㰚┾㧊 Ṗ⓻䞮Ⳇ 㩚㧦䡚⹎ἓ 㑮㭖㦮㥚䂮䢫㧎☚ Ṗ⓻䞲㰚┾ ⹿⻫㧊┺. 䔏䧞, 㑮㑶ὒ 㡆Ἒ䞮㡂㞪㩚㧊㡂⿖⯒ 䕦┾䞮₆ 㥚䟊㦧 䞲⼧ⰂỖ㌂Ṗ 䞚㣪䞶 ➢ 㧊㣿♲┺. 㑮㑶㭧㔲䟟♮⓪ ☯ἆ㩞䘎⼧ⰂỖ㌂⓪ 㩗㩞䞲㑮㑶⻪㥚⯒ ἆ㩫䞮⓪◆ ⰺ㤆㭧㣪䞲㡃䞶㦚䞮Ợ ♮⓪ ◆, ☯ἆ㩞䘎⼧ⰂỖ㌂㔲Ṛ㧊 ₎㠊㰞 ἓ㤆㑮㑶 ⹥ Ⱎ䀾㔲Ṛ㧊 ₎㠊㪎䢮㧦㠦Ợ 䟊⯒ ⋒䂶㑮㧞㦒Ⳇ, 䕦☛㧊㧮ⴑ♶ ἓ㤆㞪㦚㢚㩚䧞㩲Ệ䞮㰖 ⴑ䞮Ệ⋮, ⿞䞚㣪䞲㩞㩲⪲ 㧎䞲䞿⼧㯳㧊㌳₎ 㤆⩺Ṗ 㧞┺. 䔏䧞, 㥶⹿㞪䢮㧦㠦㍲㑮㑶㭧 Ṧ㔲Ⱂ䝚㩞 ☯ἆ㩞䘎Ỗ㌂⓪ 㭒㣪㞪 ▿㠊Ⰲ 㑮㑶㔲㞷㢖Ⱂ䝚㩞㩞㩲㑶㔲䟟㥶ⶊ⯒ ἆ㩫䞮₆ 㥚䞮㡂 ┺㟧䞲 ₆ὖ㠦㍲㔲䟟 ♮ἶ 㧞┺. 㧊⓪ 㩚㧊Ṗ 㧞┺ἶ 䕦┾♲ 䢮㧦✺㠦ỢⰢ 㞷㢖Ⱂ䝚㩞㩞㩲㑶㦚㔲䟟䞮㡂䞿⼧㯳㦚 ⹿㰖䞮⓪ ộ 㦒⪲ 䢮㧦㦮㌌㦮㰞㦚 ⏨㧊₆ 㥚䞾㧊┺[1]. ☯ἆ㩞䘎Ỗ㌂⓪ ザ⯎ 㔲Ṛ ⌊㠦㩫䢫䞲䕦☛㧊䞚㑮㩗㧎 ⹮Ⳋ, 㥷㞞㦒⪲ 㞪㩚㧊㡗㡃㦚䕦┾䞮₆ 㠊⪋┺. 㧊⩂䞲 ⶎ㩲⯒ 䟊ἆ䞮₆ 㥚䞮㡂, ⽎㡆ῂ㠦㍲⓪ 2019 ⎚ 12 㤪㍲㤎㞚㌆⼧㤦㧊㭒㾲䞲㦮⬢㧎Ὃ㰖⓻ Ṳ⹲ 䆮䎢㓺䔎(ڣۀڧګٻ ڞۃڼۇۇۀۉۂۀٻ ڍڋڌڔڄ㠦㍲㩲Ὃ♲ ◆㧊䎆㠦 ₆⹮䞮㡂 ❻⩂┳ 㞢ἶⰂ㯮 Ṗ㤊◆ 䞮⋮㧎䞿㎇὇ 㔶 ἓⰳ㦚㧊㣿䞮㡂 ☯ἆ㩞䘎Ỗ㌂㔲㥶⹿㞪㩚㧊㡂⿖ ⯒ 㧦☯㩗㦒⪲ 㰚┾䞮⓪ ⹿⻫㠦 ὖ䞲㡞゚㡆ῂ⯒ 㑮䟟䞮㡖┺.

480

-2020 온라인 춘계학술발표대회 논문집 제27권 제1호 (-2020. 5)

(2)

2. 分分崮櫶割

䞿㎇὇ 㔶ἓⰳ(Convolutional Nueral Network, 㧊䞮 CNN)㦖 ⳾◎㧊㰗㩧㧊⹎㰖, ゚❪㡺, 䎣㓺䔎 ⡦⓪ ㌂㤊✲⯒ ⿚⮮䞮⓪ 㞢ἶⰂ㯮㧊┺. CNN 㦖㧊⹎㰖㠦㍲ ṳ 㼊, 㠒Ὴ, 㧻Ⳋ㦚㧎㔳䞮₆ 㥚䟊䕾䎊㦚㺔⓪ ◆ 䔏䧞 Ⱔ㧊㌂㣿♲┺. CNN 㦖 ◆㧊䎆㠦㍲㰗㩧䞯㔋䞮Ⳇ, 䕾䎊㦚㌂㣿䞮㡂㧊⹎㰖⯒ ⿚⮮䞮ἶ 䔏㰫㦚㑮☯㦒⪲ 㿪㿲䞶䞚㣪Ṗ 㠜⓪ ộ㧊䔏㰫㧊┺.

H&E(Hematoxylin and Eosin) 㡒㌟㫆㰗㧊⹎㰖㧊㣿䞲㫆㰗䚲⽎㦚 ╖㌗㦒⪲ 㥶⹿㞪㩚㧊㡂⿖⯒ 㰚┾䞮 ⓪ ὒ㩫㠦㍲ CNN 㦚㧊㣿䞲㡆ῂ ἆὒṖ 㧞┺[2]-[4]. 䟊╏ 㡆ῂ㠦㍲⓪ 䃊䕢 Ἒ㑮(Cohen`s Kappa)⪲ 㩦㑮⯒ ₆⪳䞮㡖⓪◆, 㾲ἶ 0.8993 㦮 ⏨㦖㩦㑮⯒ ₆⪳䞮㡖┺. 䟊╏ 㡆ῂ㠦㍲⓪ CNN 㦚㧊㣿䞮㡂㫆㰗䚲⽎㦚⿚㍳䞮⓪ ộ㦒⪲ 㫡㦖 ἆὒ⯒ ⽊㧒㑮㧞㦢㦚⽊㡖┺. ⁎Ⱂ 1 㦮㣒㴓㦖 H&E 㡒㌟㫆㰗㦮㧊⹎㰖㧊Ⳇ 㡺 ⯎㴓⓪ ☯ἆ㩞䘎㦮㧊⹎㰖㧊┺. ⽎㡆ῂ㠦㍲⓪ ⚦ 㫆㰗⼧Ⰲ㦮㥶㌂㎇㦚㧊㣿䞾ὒ ☯㔲㠦㞢ἶⰂ㯮㦮 ⹲㩚㦚䐋䟊 ☯ἆ㩞䘎㦮㞪㎎䙂㩚㧊㡂⿖⯒ 㧦☯㦒⪲ 㰚 ┾䞮⓪ ⹿⻫㦚 ⳾㌟䞮ἶ㧦䞮㡖┺. ڃ⁎Ⱂٻڌڄٻڣځڠٻ㡒㌟㫆㰗ὒٻ☯ἆ㩞䘎ٻ㧊⹎㰖ٻ 3. 柪竞堆旇 ☯ἆ㩞䘎ٻ ◆㧊䎆⓪ٻ ㍲㤎㞚㌆⼧㤦ٻ 䢮㧦ٻ ڍڔڒ ⳛڇٻ ⿚ ╏ٻ㍲㤎╖䞯ᾦٻ⼧㤦ٻ䢮㧦ٻڏڑ ⳛ⪲⿖䎆ٻ䀾✳♮㠞┺ډٻ㫛㟧ٻ 㔂⧒㧊✲ٻ ڌڏڌ Ṳ㢖ڇٻ 㩫㌗ٻ 㔂⧒㧊✲ٻ ڔڐ Ṳ⪲ٻ 䞯㔋ٻ ◆㧊䎆⯒ٻῂ㎇䞮㡖㦒Ⳇڇٻ䎢㓺䔎⓪ٻڑڍ Ṳ㦮ٻ㫛㟧ٻ㔂⧒ 㧊✲㢖ٻ ڏڐ Ṳ㦮ٻ 㩫㌗ٻ 㔂⧒㧊✲⪲ٻ 㰚䟟䞮㡖┺ډٻ 㽳ٻ 㫛㟧ٻ㔂⧒㧊✲㦮ٻ㑮⓪ٻڍڋڎ Ṳ㧊Ⳇڇٻ㩫㌗ٻ㔂⧒㧊✲㦮ٻ㑮 ⓪ٻ ڌڏڋ Ṳ㡖┺ډٻ 䞯㔋ڇٻ Ỗ㯳ٻ ⹥ٻ 䎢㓺䔎⯒ٻ 㥚䟊ٻ ṗṗٻ ڌړړڇٻڏړڇٻڌڋڒ Ṳ㦮ٻ㌮䝢㧊ٻ㌂㣿♮㠞┺ډٻ ٻ 㔺䠮㠦ٻ ㌂㣿䞲ٻ ☯ἆ㩞䘎ٻ 㧊⹎㰖㦮ٻ 䔏㎇㦖ٻ 䚲ٻ ڌ 㠦ٻ 㣪㟓♮㠊ٻ㧞┺ډٻⰞ㓺䋂ٻ㧊⹎㰖㦮ٻἓ㤆ٻ㤦⽎ٻ㧊⹎㰖㦮ٻ ڌڊڌڑٻ 䋂₆⪲ٻ 㿫㏢♲ٻ 㧊⹎㰖㠦㍲ٻ 㫛㟧ٻ ⿖㥚Ṗٻ 㧚㌗㦮㠦ٻ㦮䞮㡂ٻ㩫㦮♮㠊ٻ㧊㰚䢪ٻ♲ٻ䕢㧒㦮ٻ䡫䌲⪲ٻ㩲Ὃ♮ 㠞┺ډٻ ڗ䚲ٻڌڙٻڟڼۏڼێۀۏ 㦮ٻ㧊⹎㰖ٻ䔏㎇ٻ Format “.mrxs” Resolution 93,952 x 132,352 pixels

Scanner Panoramic 250 Flash, 3DHISTECH (Hungary)

MPP (micros per pixel) 0.221 Apparent magnification 20X Image bit depth 8 bits Color channel RGBA

ٻ 4. 柪竞愯憛 㔺䠮ٻ 㰚䟟⹿⻫㦖ٻ ⁎Ⱂٻ ڍ 㦒⪲ٻ 㣪㟓䞮㡂ٻ ㍺ⳛ䞲┺ډٻ 䋂Ợٻ 㩚㻮Ⰲڃګۍۀۋۍۊھۀێێۄۉۂڄڇٻ 䞯㔋ڃگۍڼۄۉۄۉۂڄڇٻ 䤚㻮 Ⰲڃګۊێۏۋۍۊھۀێێۄۉۂڄڇٻ㽳ٻ㎎ٻ┾Ἒ⪲ٻῂ⿚䞶ٻ㑮ٻ㧞┺ډٻٻ ڃ⁎Ⱂٻڍڄٻ㔺䠮ٻ㰚䟟⹿⻫ٻ㣪㟓ٻ Ⲓ㩖ٻ㧊⹎㰖ٻ㩚㻮Ⰲٻ ┾Ἒ㠦㍲⓪ٻ㎎䙂㢖ٻ⺆ἓ㦚ٻῂ ⿚䞮₆ٻ㥚䞮㡂ٻὖ㕂ٻῂ㡃ڃڭڪڤڄ㦚ٻ㧊㰚䢪䞮㡖┺ډٻ㧊✺ٻ Ṗ㤊㠦ٻ㎎䙂ٻ㡗㡃㦒⪲⿖䎆ٻڌڋڋڋ Ṳ㦮ٻ䞓㎖㦚ٻ㌮䝢Ⱇ䞲ٻ 䤚ڇٻṗٻ䞓㎖㦚ٻ㭧㕂㦒⪲ٻ䞮⓪ٻڍڐڑٻۓٻڍڐڑٻ䋂₆㦮ٻ䕾䂮 ڃۋڼۏھۃڄٻ 㧊⹎㰖⯒ٻ 㿪㿲䞮㡖┺ډٻ 㧊䤚ٻ 㫛㟧ٻ 㡂⿖㦮ٻ 㔺䁷ٻ㩫⽊ڃۂۍۊېۉڿٻۏۍېۏۃڄ⯒ٻ╊ἶٻ㧞⓪ٻⰞ㓺䋂ٻ㧊⹎㰖㢖ٻ ╖㫆䞮㡂ٻṗٻ䕾䂮㦮ٻ㫛㟧ٻ㡂⿖⯒ٻ⧒⻾Ⱇ䞮㡖┺ډٻ ٻ 䞯㔋ٻ┾Ἒ㠦㍲⓪ٻ䞿㎇὇ٻ㔶ἓⰳ㦚ٻ㧊㣿䞮㡂ٻ䞯㔋㦚ٻ 㰚䟟䞮㡖┺ډٻ◆㧊䎆ٻ䞯㔋ٻ⳾◎⪲㍲ٻڌړ Ṳ㦮ٻ⩞㧊㠊⪲ٻ ῂ㎇♲ ۍۀێۉۀۏڈڌړ 㦚ٻ 㩗㣿䞮㡖┺ډٻ ⧲►䞮Ợٻ 㽞₆䢪♲ٻ Ṗ㭧䂮⪲⿖䎆ٻ 㔲㧧䞮㡂ڇٻ 䢫⮶㩗ٻ ἓ㌂ٻ 䞮ṫ⻫ڃڮڢڟڄ㠦ٻ ➆⧒ٻڋډڋڋڋڌ 㦮ٻ䞯㔋㥾⪲ٻṖ㭧䂮⯒ٻ㾲㩗䢪䞮㡖┺ډٻ䢲㎇䢪ٻ 䞾㑮⪲㍲ٻ ڭۀڧڰڇٻ ㏦㔺ٻ 䞾㑮⪲㍲ٻ ⪲㰖㓺䕇ٻ 㧊㰚ٻ ᾦ㹾ٻ㠪䔎⪲䞒ڃڝۄۉڼۍ۔ٻھۍۊێێٻۀۉۏۍۊۋ۔ٻےۄۏۃٻۇۊۂۄۏێڄṖٻ ㌂㣿♮㠞┺ډٻڌڍ 㦮ٻڝڼۏھۃٻێۄەۀ 㢖ٻ䞾℮ڇٻڎڋ ⻞㦮ٻۀۋۊھۃ Ṗٻ 㩗㣿♮㠞┺ډٻ 䞯㔋㦖ٻ 䃊䃊㡺ٻ 䋊⧒㤆✲㦮ٻ ἶ㎇⓻ٻ ڢګڰٻ䅊䜾䕛ٻ㔲㓺䎲㠦㍲ٻ㑮䟟♮㠞┺ډٻ ٻ 䤚㻮Ⰲٻ┾Ἒ㠦㍲⓪ٻ⳾✶ٻ㎎䙂㠦ٻ╖䞮㡂ٻ㿪⪶㦚ٻ㰚䟟䞮㡂ٻ 䢫⮶ٻ 㰖☚ڃګۍۊڽڼڽۄۇۄۏ۔ٻ ۃۀڼۏۈڼۋڄ⯒ٻ ㌳㎇䞮㡖

481

-2020 온라인 춘계학술발표대회 논문집 제27권 제1호 (-2020. 5)

(3)

┺ډٻ㧚Ἒ㻮Ⰲڃۏۃۍۀێۃۊۇڿۄۉۂڄڇٻ䢖ٻ㺚㤖ڃۃۊۇۀٻہۄۇۇۄۉۂڄڇٻ ἓἚ㍶ٻ Ỗ㿲ٻ ⹥ٻ 㓺ⶊ❿ڃھۊۉۏۊېۍٻ ۀۓۏۍڼھۏۄۊۉٻ ڼۉڿٻ ێۈۊۊۏۃۄۉۂڄٻ₆⻫ٻ❇㦚ٻ㩗㣿䞮㡂ٻ䢫⮶㰖☚ٻ㧊⹎㰖⪲⿖䎆ٻṖ㧻ٻ䋆ٻ㞪ٻ㩚㧊ٻ㡗㡃㦚ٻ㿪㿲䞮㡖┺ډٻ㧊⪲⿖䎆ٻ䟊 ╏ٻ㧊⹎㰖㦮ٻ㫛㟧ٻ㡂⿖㢖ٻ㾲╖ٻ㞪ٻ㩚㧊ٻ㡗㡃㦮ٻ㾲㧻ٻ ₎㧊⯒ٻἚ㌆䞮㡖┺ډٻ ٻ 㫛㟧ٻ㡞䁷㦮ٻ㩫䢫☚⓪ٻ┺㦢ٻ⚦ٻṖ㰖ٻ⹿⻫㦒⪲ٻ䁷㩫䞮㡖┺ډٻ㼁ٻ⻞㱎⓪ٻ㫛㟧ٻ㡂⿖ڃڨۀۏڼێۏڼێۄێڄ⯒ٻڭڪڞ 䄺ぢ㦮ٻ ڜڰڞڃڜۍۀڼٻ ڰۉڿۀۍٻ ۏۃۀٻ ڞېۍۑۀڄ⯒ٻ ㌂㣿䞮㡂ٻ 䘟Ṗ䞮㡖 ┺ډٻ⚦ٻ⻞㱎⓪ٻ㫛㟧㦮ٻ㾲㧻ٻ₎㧊ڃڨڼۅۊۍٻڼۓۄێڄ⯒ٻ㩫╋ 㦮ٻ㡺㹾⻪㥚ڃധڐڀڄٻ⌊ٻ㩫䞿ٻ㡂⿖㠦ٻ➆⯎ٻ㩫䢫☚⪲ٻ䘟 Ṗ䞮㡖┺ډٻṗṗ㦚ٻڐڋڀ㝿ٻ⹮㡗䞮㡂ڇٻ㩫䢫☚ٻ㩦㑮⓪ٻ┺ 㦢ٻ㑮㔳ὒٻṯ㧊ٻ㩫㦮♮㠞┺ډٻ ٻ

Score = 0.5 x AUC of Metastasis + 0.5 x Acc of Major axisٻ ٻ ٻ 5. 柪柪竞冶刂㡂⩂ٻ 㹾⪖㦮ٻ 㔺䠮ٻ ἆὒٻ Ṗ㧻ٻ ⏨㦖ٻ 㩫䢫☚ٻ 㩦㑮⓪ٻ ڋډڐڌڏ 㡖┺ډٻ㫛㟧ٻ㡂⿖㦮ٻ㩫䢫☚⓪ٻ䢫⮶㰖☚⪲⿖䎆ٻ㾲 ╖ٻ㞪ٻ㩚㧊ٻ㡗㡃㦚ٻ㿪㿲䞮⓪ٻ䤚㻮Ⰲٻὒ㩫㦮ٻ㎎⿖ٻ㍺㩫㠦ٻ➆⧒ٻ䋂Ợٻ╂⧒㰖⓪ٻ㟧㌗㦚ٻ⽊㡖┺ډٻ䔏䧞ڇٻ䞯㔋ٻ ◆㧊䎆ٻṖ㤊◆ٻṖ㧻ٻ㧧㦖ٻ㫛㟧㦮ٻ㾲㧻ٻ₎㧊⓪ٻڎڋډڑ 㧊㠞⓪◆ڇٻ䤚㻮Ⰲٻὒ㩫㠦㍲ٻ㫛㟧㦮ٻ㾲㧻ٻ₎㧊㦮ٻ㧚Ἒ㩦㦚ٻ ⌄Ợٻ ㍺㩫䞶ٻ ἓ㤆ٻ 㫛㟧ٻ 䕦⼚㦮ٻ 㩫䢫☚Ṗٻ 䡚㩖䧞ٻ 㩖䞮♮⓪ٻἆὒ⯒ٻ⽊㡖┺ډٻ ٻٻ 6. 冶嵦 ⽎ٻ⏒ⶎ㠦㍲⓪ٻ☯ἆ㩞䘎Ỗ㌂㠦㍲ٻ㞪㎎䙂ٻ㩚㧊ٻ㡂⿖ ⯒ٻ 㧦☯㦒⪲ٻ 㰚┾䞮₆ٻ 㥚䞲ٻ ❻⩂┳ٻ 㞢ἶⰂ㯮㦒⪲㍲ٻ 䞿㎇὇ٻ㔶ἓⰳ㧎ٻۍۀێۉۀۏڈڌړ 㦮ٻ㎇⓻㦚ٻ䘟Ṗ䞮㡖┺ډٻ ٻ 䆮䎢㓺䔎ٻ 㺎Ṗ㦮ٻ 䡫㔳㦒⪲ٻ 㩲䞲♲ٻ 㔲Ṛ㠦ٻ 㔺䠮㧊ٻ 㧊⬾㠊㪎ٻ Ⱒ㫇䞶ٻ Ⱒ䞲ٻ 㑮㭖㦮ٻ ἆὒ⯒ٻ 㠑㰖⓪ٻ ⴑ䞮㡖㰖Ⱒڇٻ ㌂㩚䞯㔋ٻ ⳾◎㦮ٻ 㩗㣿ڇٻ 㩚㧊䞯㔋ڃۏۍڼۉێہۀۍٻ ۇۀڼۍۉۄۉۂڄڇٻ 䞮㧊䗒䕢⧒⹎䎆ٻ 㾲㩗䢪ڇٻ 㿪Ṗ㩗ٻ ◆㧊䎆ٻ ⼖㫆ڃڿڼۏڼٻ ڼېۂۈۀۉۏڼۏۄۊۉڄٻ ₆⻫㦮ٻ 㩗㣿ٻ ❇㦚ٻ 䙂䞾䞲ٻ 䤚㏣ٻ㡆ῂ⯒ٻ䐋䞮㡂ٻ㞪ٻ㩚㧊ٻ㡞䁷㦮ٻ㩫䢫☚⯒ٻ䟻㌗㔲䌂ٻ㑮ٻ㧞㦚ٻộ㦒⪲ٻ₆╖♲┺ډٻ ٻ 㧊⻞ٻ㔺䠮㦮ٻἆὒ⓪ٻ 㧎Ὃ㰖⓻ٻ₆㑶㦚ٻ㌂㣿䞲ٻ 㥶⹿ 㞪ٻ 㧦☯㰚┾ٻ ₆㑶㦮ٻ 㧶㨂㩗ٻ 䣾㣿㎇ὒٻ ⹲㩚ٻ Ṗ⓻㎇㦚ٻ ⽊㡂㭖┺ډٻ ٻ Acknowledgement ⽎ٻ ⏒ⶎ㦖ٻ ڍڋڍڋ ⎚☚ٻ 㩫⿖ڃὒ䞯₆㑶㩫⽊䐋㔶⿖ڄ㦮ٻ 㨂㤦㦒⪲ٻ 㩫⽊䐋㔶₆䣣䘟Ṗ㤦㦮ٻ 㰖㤦㦚ٻ ⹱㞚ٻ 㑮䟟♲ٻ 㡆ῂ㧚ٻڃڍڋڌړڈڋڈڋڋڍڏڍډٻ゛◆㧊䎆ٻ₆⹮ٻ㧎Ὃ㰖⓻ٻ㞞ὒٻ 㰚┾₆㑶ٻ⹥ٻ㓺Ⱎ䔎ٻ㰚⬢ٻ䝢⨁䙒ٻṲ⹲ڄٻ 焾処怾竒

[1] Langer I, Guller U, Berclaz G, Koechli OR, Schaer G, Fehr MK, et al. Morbidity of sentinel lymph node biopsy (SLN) alone versus SLN and completion axillary lymph node dissection after breast cancer surgery: a prospective Swiss multicenter study on 659 patients. Ann Surg 2007;245:452-61.

[2] Bándi, P., Geessink, O., Manson, Q., Dijk, M., Balkenhol, M., Hermsen, M., Bejnordi, B., Lee, B., Paeng, K., Zhong, A., Li, Q., Zanjani, F., Zinger, S., Fukuta, K., Komura, D., Ovtcharov, V., Cheng, S., Zeng, S., Thagaard, J., Dahl, A., Lin, H., Chen, H., Jacobsson, L., Hedlund, M., Çetin, M., Halıcı, E., Jackson, H., Chen, R., Both, F., Franke, J., Küsters-Vandevelde, H., Vreuls, W., Bult, P., Ginneken, B., Laak, J., Litjens, G. (2019). From Detection of Individual Metastases to Classification of Lymph Node Status at the Patient Level: The CAMELYON17 Challenge IEEE Transactions on Medical Imaging 38(2), 550-560. [3] Litjens, G., Bandi, P., Bejnordi, B., Geessink, O.,

Balkenhol, M., Bult, P., Halilovic, A., Hermsen, M., Loo, R., Vogels, R., Manson, Q., Stathonikos, N., Baidoshvili, A., Diest, P., Wauters, C., Dijk, M., Laak, J. (2018). 1399 H&E-stained sentinel lymph node sections of breast cancer patients: the CAMELYON dataset. GigaScience 7(6), giy065.

[4] Bejnordi, B., Veta, M., Diest, P., Ginneken, B., Karssemeijer, N., Litjens, G., Laak, J., Consortium, a., Hermsen, M., Manson, Q., Balkenhol, M., Geessink, O., Stathonikos, N., Dijk, M., Bult, P., Beca, F., Beck, A., Wang, D., Khosla, A., Gargeya, R., Irshad, H., Zhong, A., Dou, Q., Li, Q., Chen, H., Lin, H., Heng, P., Haß, C., Bruni, E., Wong, Q., Halici, U., Öner, M., Cetin-Atalay, R., Berseth, M., Khvatkov, V., Vylegzhanin, A., Kraus, O., Shaban, M., Rajpoot, N., Awan, R., Sirinukunwattana, K., Qaiser, T., Tsang, Y., Tellez, D., Annuscheit, J., Hufnagl, P., Valkonen, M., Kartasalo, K., Latonen, L., Ruusuvuori, P., Liimatainen, K., Albarqouni, S., Mungal, B., George, A., Demirci, S., Navab, N., Watanabe, S., Seno, S., Takenaka, Y., Matsuda, H., Phoulady, H., Kovalev, V., Kalinovsky, A., Liauchuk, V., Bueno, G., Fernandez-Carrobles, M., Serrano, I., Deniz, O., Racoceanu, D., Venâncio, R. (2017). Diagnostic Assessment of Deep Learning Algorithms for Detection of Lymph Node Metastases in Women With Breast Cancer JAMA 318(22), 2199.