{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:59:32Z","timestamp":1792789172032,"version":"4.5.0"},"reference-count":58,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U54CA268083"],"award-info":[{"award-number":["U54CA268083"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"award":["U54CA268083"],"award-info":[{"award-number":["U54CA268083"]}],"id":[{"id":"https:\/\/ror.org\/040gcmg81","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Lustgarten Foundation-AACR Career Development Award for Pancreatic Cancer Research, in Honor of Ruth Bader Ginsburg","id":[{"id":"https:\/\/ror.org\/02xjhr934","id-type":"ROR","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/02xjhr934","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Rolfe Pancreatic Cancer Foundation","id":[{"id":"https:\/\/ror.org\/02p524v68","id-type":"ROR","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/02p524v68","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Fight Cancer Stay Positive"},{"name":"Susan Wojcicki and Denis Troper"},{"name":"The Joseph C. Monastra Foundation for Pancreatic Cancer Research","id":[{"id":"https:\/\/ror.org\/04nj9rw71","id-type":"ROR","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/04nj9rw71","id-type":"ROR","asserted-by":"publisher"}]},{"name":"The Carl and Carol Nale Fund for Pancreatic Cancer Research"},{"name":"The Stringer Foundation"},{"name":"Doug and Julie Ostrover"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: The training of diagnostic pancreatic pathologists is largely limited by the diversity of available pathology images, especially those of rare diseases or conditions. Methods: Using a cohort of seven pancreatic neoplasms, we developed an iterative, pathologist-in-the-loop workflow integrating scalable tile pruning, generative-model optimization, and postprocessing truncation. Two pathologists evaluated synthetic-image quality and subtype representation on a 0\u20133 scale; the independent pathologist was blinded to image source and truncation condition and also rated curated real training tiles. Results: Untruncated images had lower class-balanced FID than per-class-truncated images (6.64 versus 29.08) and higher recall and coverage, whereas truncation increased precision. The independent pathologist rated per-class-truncated images higher than matched non-truncated images (mean difference 0.80, bootstrap 95% CI 0.57\u20131.03). Quadratic-weighted Cohen\u2019s \u03ba was 0.599 (95% CI 0.489\u20130.691); after grouping ratings as 0\u20131 versus 2\u20133, raw agreement was 80.7% (95% CI 75.0\u201386.4%). Conclusions: Per-class truncation improved independently rated image quality and subtype representation. Successful synthetic histology generation requires careful data curation, domain-specific oversight, and independent validation; clinical utility requires separate task-based evaluation.<\/jats:p>","DOI":"10.3390\/cancers18183004","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T13:50:27Z","timestamp":1789566627000},"page":"3004","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An Iterative, Pathologist-in-the-Loop Workflow for Generation of Clinical-Grade Synthetic Pathology Images in a Diverse Cohort of Pancreatic Tumors"],"prefix":"10.3390","volume":"18","author":[{"given":"Yixi","family":"Xu","sequence":"first","affiliation":[{"name":"AI for Good Lab, Microsoft, Redmond, WA 98052, 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Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4799-7488","authenticated-orcid":false,"given":"Tiane","family":"Chen","sequence":"additional","affiliation":[{"name":"The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins University, Baltimore, MD 21218, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4554-5672","authenticated-orcid":false,"given":"Ralph H.","family":"Hruban","sequence":"additional","affiliation":[{"name":"The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins University, Baltimore, MD 21218, USA"},{"name":"Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"}]},{"given":"William B.","family":"Weeks","sequence":"additional","affiliation":[{"name":"AI for Good Lab, Microsoft, Redmond, WA 98052, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Rahul","family":"Dodhia","sequence":"additional","affiliation":[{"name":"AI for Good Lab, Microsoft, Redmond, WA 98052, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Juan Lavista","family":"Ferres","sequence":"additional","affiliation":[{"name":"AI for Good Lab, Microsoft, Redmond, WA 98052, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Ashley L.","family":"Kiemen","sequence":"additional","affiliation":[{"name":"Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA"},{"name":"The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins University, Baltimore, MD 21218, USA"},{"name":"Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA"},{"name":"Department of Anatomy and Functional Evolution, The Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1145\/1007730.1007735","article-title":"A study of the behavior of several methods for balancing machine learning training 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