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Publications

Publications by António Cunha

2021

The Role of Liquid Biopsy in Early Diagnosis of Lung Cancer

Authors
Freitas, C; Sousa, C; Machado, F; Serino, M; Santos, V; Cruz Martins, N; Teixeira, A; Cunha, A; Pereira, T; Oliveira, HP; Costa, JL; Hespanhol, V;

Publication
FRONTIERS IN ONCOLOGY

Abstract
Liquid biopsy is an emerging technology with a potential role in the screening and early detection of lung cancer. Several liquid biopsy-derived biomarkers have been identified and are currently under ongoing investigation. In this article, we review the available data on the use of circulating biomarkers for the early detection of lung cancer, focusing on the circulating tumor cells, circulating cell-free DNA, circulating micro-RNAs, tumor-derived exosomes, and tumor-educated platelets, providing an overview of future potential applicability in the clinical practice. While several biomarkers have shown exciting results, diagnostic performance and clinical applicability is still limited. The combination of different biomarkers, as well as their combination with other diagnostic tools show great promise, although further research is still required to define and validate the role of liquid biopsies in clinical practice.

2021

Sharing Biomedical Data: Strengthening AI Development in Healthcare

Authors
Pereira, T; Morgado, J; Silva, F; Pelter, MM; Dias, VR; Barros, R; Freitas, C; Negrao, E; de Lima, BF; da Silva, MC; Madureira, AJ; Ramos, I; Hespanhol, V; Costa, JL; Cunha, A; Oliveira, HP;

Publication
HEALTHCARE

Abstract
Artificial intelligence (AI)-based solutions have revolutionized our world, using extensive datasets and computational resources to create automatic tools for complex tasks that, until now, have been performed by humans. Massive data is a fundamental aspect of the most powerful AI-based algorithms. However, for AI-based healthcare solutions, there are several socioeconomic, technical/infrastructural, and most importantly, legal restrictions, which limit the large collection and access of biomedical data, especially medical imaging. To overcome this important limitation, several alternative solutions have been suggested, including transfer learning approaches, generation of artificial data, adoption of blockchain technology, and creation of an infrastructure composed of anonymous and abstract data. However, none of these strategies is currently able to completely solve this challenge. The need to build large datasets that can be used to develop healthcare solutions deserves special attention from the scientific community, clinicians, all the healthcare players, engineers, ethicists, legislators, and society in general. This paper offers an overview of the data limitation in medical predictive models; its impact on the development of healthcare solutions; benefits and barriers of sharing data; and finally, suggests future directions to overcome data limitations in the medical field and enable AI to enhance healthcare. This perspective is dedicated to the technical requirements of the learning models, and it explains the limitation that comes from poor and small datasets in the medical domain and the technical options that try or can solve the problem related to the lack of massive healthcare data.

2021

A multi-task CNN approach for lung nodule malignancy classification and characterization

Authors
Marques, S; Schiavo, F; Ferreira, CA; Pedrosa, J; Cunha, A; Campilho, A;

Publication
EXPERT SYSTEMS WITH APPLICATIONS

Abstract
Lung cancer is the type of cancer with highest mortality worldwide. Low-dose computerized tomography is the main tool used for lung cancer screening in clinical practice, allowing the visualization of lung nodules and the assessment of their malignancy. However, this evaluation is a complex task and subject to inter-observer variability, which has fueled the need for computer-aided diagnosis systems for lung nodule malignancy classification. While promising results have been obtained with automatic methods, it is often not straightforward to determine which features a given model is basing its decisions on and this lack of explainability can be a significant stumbling block in guaranteeing the adoption of automatic systems in clinical scenarios. Though visual malignancy assessment has a subjective component, radiologists strongly base their decision on nodule features such as nodule spiculation and texture, and a malignancy classification model should thus follow the same rationale. As such, this study focuses on the characterization of lung nodules as a means for the classification of nodules in terms of malignancy. For this purpose, different model architectures for nodule characterization are proposed and compared, with the final goal of malignancy classification. It is shown that models that combine direct malignancy prediction with specific branches for nodule characterization have a better performance than the remaining models, achieving an Area Under the Curve of 0.783. The most relevant features for malignancy classification according to the model were lobulation, spiculation and texture, which is found to be in line with current clinical practice.

2021

Grapevine Variety Identification Through Grapevine Leaf Images Acquired in Natural Environment

Authors
Carneiro, GS; Pádua, L; Sousa, JJ; Peres, E; Morais, R; Cunha, A;

Publication
IEEE International Geoscience and Remote Sensing Symposium, IGARSS 2021, Brussels, Belgium, July 11-16, 2021

Abstract
In this paper we present a Deep Learning-based methodology to automatically classify 12 of the most representative grapevarieties existing in the Douro Demarked region, Portugal. The dataset used consisted of images of leaves at different stages of development, collected on their natural environment. The development of such methodologies becomes particularly important, in a scenario in which ampeleographers are disappearing, creating a gap in the task of inspection of grape varieties. Our approach was based on the transfer learning of the Xcepetion model, using Focal Loss, adaptive learning rate decay and SGD. The model obtained a F1 score of 0.93. To clearly understand the predictions of the model, and realize which regions of the image contributed the most to the classification, the LIME library was used. This way it was possible to identify the parts of the images that were considered for and against each prediction.

2021

The Impact of Interstitial Diseases Patterns on Lung CT Segmentation

Authors
Silva, F; Pereira, T; Morgado, J; Cunha, A; Oliveira, HP;

Publication
2021 43RD ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE & BIOLOGY SOCIETY (EMBC)

Abstract
Lung segmentation represents a fundamental step in the development of computer-aided decision systems for the investigation of interstitial lung diseases. In a holistic lung analysis, eliminating background areas from Computed Tomography (CT) images is essential to avoid the inclusion of noise information and spend unnecessary computational resources on non-relevant data. However, the major challenge in this segmentation task relies on the ability of the models to deal with imaging manifestations associated with severe disease. Based on U-net, a general biomedical image segmentation architecture, we proposed a light-weight and faster architecture. In this 2D approach, experiments were conducted with a combination of two publicly available databases to improve the heterogeneity of the training data. Results showed that, when compared to the original U-net, the proposed architecture maintained performance levels, achieving 0.894 +/- 0.060, 4.493 +/- 0.633 and 4.457 +/- 0.628 for DSC, HD and HD-95 metrics, respectively, when using all patients from the ILD database for testing only, while allowing a more efficient computational usage. Quantitative and qualitative evaluations on the ability to cope with high-density lung patterns associated with severe disease were conducted, supporting the idea that more representative and diverse data is necessary to build robust and reliable segmentation tools.

2021

Ensemble Strategies for EGFR Mutation Status Prediction in Lung Cancer

Authors
Malafaia, M; Pereira, T; Silva, F; Morgado, J; Cunha, A; Oliveira, HP;

Publication
2021 43RD ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE & BIOLOGY SOCIETY (EMBC)

Abstract
Lung cancer treatments that are accurate and effective are urgently needed. The diagnosis of advanced-stage patients accounts for the majority of the cases, being essential to provide a specialized course of treatment. One emerging course of treatment relies on target therapy through the testing of biomarkers, such as the Epidermal Growth Factor Receptor (EGFR) gene. Such testing can be obtained from invasive methods, namely through biopsy, which may be avoided by applying machine learning techniques to the imaging phenotypes extracted from Computerized Tomography (CT). This study aims to explore the contribution of ensemble methods when applied to the prediction of EGFR mutation status. The obtained results translate in a direct correlation between the semantic predictive model and the outcome of the combined ensemble methods, showing that the utilized features do not have a positive contribution to the predictive developed models.

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