Multi-Beholder: Biomarker Prediction for Low-Grade Glioma With Multiple Instance Learning and One-Class...

Biomarker detection is an indispensable part of the diagnosis and treatment of low-grade glioma (LGG). However, current LGG biomarker detection methods rely on expensive and complex molecular genetic testing, for which professionals are required to analyze the results, and intra-rater variability is often reported. To overcome these challenges, we propose an interpretable deep learning pipeline, named Multi-Biomarker Histomorphology Discoverer (Multi-Beholder), to predict the status of five biomarkers in LGG using only hematoxylin and eosin-stained whole slide images. Specifically, Multi-Beholder incorporates one-class classification into the multiple instance learning framework to achieve accurate instance-level pseudo-labeling, thereby complementing slide-level labels and improving prediction performance. Multi-Beholder demonstrates high performance on two LGG cohorts with diverse races and scanning protocols, with area under the receiver operating characteristic curve up to 0.973 on the internal-validated TCGA-LGG dataset and 0.820 on the external-validated Xiangya cohort. Moreover, the interpretability of Multi-Beholder allows for discovering quantitative and qualitative correlations between biomarker status and histomorphology characteristics. Our pipeline not only provides a novel approach for biomarker prediction, enhancing the applicability of molecular treatments for LGG patients but also facilitates the discovery of new mechanisms in molecular functionality and LGG progression.