MiThyCA: A Computational Pathology Pipeline for the Identification of Microscopic Foci of Papillary Thyroid Carcinoma-Like Nuclear Features with AI in Whole-Slide Histological Images.

The histological identification of papillary thyroid carcinoma (PTC) is straightforward for experienced endocrine pathologists. The increase in radical thyroidectomies led to a raise in the rate of postoperative incidental subcentimeter PTC foci and the recent introduction of the Non-Invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP) as a less aggressive mimicker of PTC, which significantly complicated the histology screening of thyroid histology specimens. Artificial Intelligence (AI) applied to Whole Slide Images (WSI) can speed up these processes, aiding pathologists to improve diagnostic accuracy and turnaround times. Here we present a computational pathology pipeline for the identification of Microscopic foci of papillary Thyroid Carcinoma-like nuclear features using Artificial intelligence (MiThyCA). This algorithm relies on a tandem architecture consisting of a Convolutional Neural Network (CNN) designed to identify neoplastic areas within thyroid specimens, and a Vision Transformer (TinyViT) focused on detecting PTC-like areas within the neoplastic regions identified by the first model. The study was conducted on a multi-institutional cohort of 73 WSIs from 67 patients with normal thyroid tissue (n = 22 patients, 33