Clinical Feasibility of Low-Magnification Fluorescence Imaging for Breast Cancer Margin Detection Using Texture Analysis and Deep Learning

Breast cancer diagnosis demands rapid and precise tools, yet traditional histopathological methods often fall short in intra-operative settings. Deep Ultraviolet (DUV) fluorescence imaging emerges as a transformative approach, offering high-contrast, label-free visualization of whole-slide images (WSIs) with unprecedented detail, surpassing conventional hematoxylin and eosin (H&E) staining in speed and resolution. However, existing deep learning methods for breast cancer classification, predominantly patch-based, fragment spatial context and incur significant preprocessing overhead, limiting their clinical utility. Moreover, standard attention mechanisms, such as Spatial, Squeeze-and-Excitation, Global Context and Guided Context Gating, fail to fully exploit the rich, multi-scale regional relationships inherent in DUV-WSI data, often prioritizing generic feature recalibration over diagnostic specificity. This study introduces a novel Region-Affinity Attention mechanism tailored for DUV-WSI breast cancer classification, processing entire slides without patching to preserve spatial integrity. By modeling local neighbor distances and constructing a full affinity matrix, our method dynamically highlights diagnostically relevant regions, augmented by a contrastive loss to enhance feature discriminability. Evaluated on a dataset of 136 DUV-WSI samples, our approach achieves an accuracy of 92.67 +/- 0.73% and an AUC of 95.97%, outperforming existing attention methods.

Vision Transformers $(\texttt{ViT})$ have become the architecture of choice for many computer vision tasks, yet their performance in computer-aided diagnostics remains limited. Focusing on breast cancer detection from mammograms, we identify two main causes for this shortfall. First, medical images are high-resolution with small abnormalities, leading to an excessive number of tokens and making it difficult for the softmax-based attention to localize and attend to relevant regions. Second, medical image classification is inherently fine-grained, with low inter-class and high intra-class variability, where standard cross-entropy training is insufficient. To overcome these challenges, we propose a framework with three key components: (1) Region of interest $(\texttt{RoI})$ based token reduction using an object detection model to guide attention; (2) contrastive learning between selected $\texttt{RoI}$ to enhance fine-grained discrimination through hard-negative based training; and (3) a $\texttt{DINOv2}$ pretrained $\texttt{ViT}$ that captures localization-aware, fine-grained features instead of global $\texttt{CLIP}$ representations. Experiments on public mammography datasets demonstrate that our method achieves superior performance over existing baselines, establishing its effectiveness and potential clinical utility for large-scale breast cancer screening. Our code is available for reproducibility here: https://aih-iitd.github.io/publications/attend-what-matters

Hyperspectral Imaging (HSI) is a promising modality for intraoperative assessment of resection margins in Breast-Conserving Surgery (BCS), but its clinical translation requires aligning the inherently 2D spectral information onto the 3D shape of the excised tissue so that suspicious regions can be precisely localized for targeted follow-up. We present a fully automated, calibration-free pipeline that produces a 3D hyperspectral point cloud of an ex-vivo lumpectomy specimen from a set of consumer-camera RGB images and a single top-down HSI acquisition. The 3D geometry is reconstructed with a deep-learning Structure-from-Motion backbone, stabilized in a metric reference frame by a custom bundle adjustment that enforces consistency on the corners of four ArUco markers placed around the specimen. The HSI cube is then registered to the reconstruction without recovering the HSI camera pose: the markers, visible in both modalities, define 16 corner correspondences that drive a planar homography, and 3D coordinates are recovered by lookup on an orthographically rendered depth map. Evaluated on two ex-vivo lumpectomy specimens, the pipeline achieves a median 3D registration error below 1~mm and a 2D reprojection error below 0.02 mm, with a total per-specimen processing time under 4 minutes on accelerated hardware. These results support the feasibility of integrating HSI-guided spatial localization into intraoperative margin assessment workflows for breast-conserving surgery.