{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:37:51Z","timestamp":1793727471639,"version":"4.6.1"},"reference-count":51,"publisher":"Baishideng Publishing Group Inc.","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World J Gastroenterol"],"abstract":"<jats:p>BACKGROUND<\/jats:p>\n                  <jats:p>The accurate prediction of lymph node metastasis (LNM) is crucial for managing locally advanced (T3\/T4) colorectal cancer (CRC). However, both traditional histopathology and standard slide-level deep learning often fail to capture the sparse and diagnostically critical features of metastatic potential.<\/jats:p>\n                  <jats:p>AIM<\/jats:p>\n                  <jats:p>To develop and validate a case-level multiple-instance learning (MIL) framework mimicking a pathologist's comprehensive review and improve T3\/T4 CRC LNM prediction.<\/jats:p>\n                  <jats:p>METHODS<\/jats:p>\n                  <jats:p>The whole-slide images of 130 patients with T3\/T4 CRC were retrospectively collected. A case-level MIL framework utilising the CONCH v1.5 and UNI2-h deep learning models was trained on features from all haematoxylin and eosin-stained primary tumour slides for each patient. These pathological features were subsequently integrated with clinical data, and model performance was evaluated using the area under the curve (AUC).<\/jats:p>\n                  <jats:p>RESULTS<\/jats:p>\n                  <jats:p>The case-level framework demonstrated superior LNM prediction over slide-level training, with the CONCH v1.5 model achieving a mean AUC (\u00b1 SD) of 0.899 \u00b1 0.033 vs  0.814 \u00b1 0.083, respectively. Integrating pathology features with clinical data further enhanced performance, yielding a top model with a mean AUC of 0.904 \u00b1 0.047, in sharp contrast to a clinical-only model (mean AUC 0.584 \u00b1 0.084). Crucially, a pathologist\u2019s review confirmed that the model-identified high-attention regions correspond to known high-risk histopathological features.<\/jats:p>\n                  <jats:p>CONCLUSION<\/jats:p>\n                  <jats:p>A case-level MIL framework provides a superior approach for predicting LNM in advanced CRC. This method shows promise for risk stratification and therapy decisions, requiring further validation.<\/jats:p>","DOI":"10.3748\/wjg.v32.i1.112090","type":"journal-article","created":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T07:36:29Z","timestamp":1767512189000},"source":"Crossref","is-referenced-by-count":6,"title":["Predicting lymph node metastasis in colorectal cancer using case-level multiple instance learning"],"prefix":"10.3748","volume":"32","author":[{"given":"Ling-Feng","family":"Zou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan-Bing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing-Wen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Ouyang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Ying","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Long","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2060","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tranon.2021.101174"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.prp.2018.03.024"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3393\/ac.2019.06.12"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.57.3.168"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1159\/000323966"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1002\/jso.21231"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.28742"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-021-01343-4"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.7717\/peerj-cs.1031"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.media.2023.102809"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1111\/joim.13030"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1038\/s41416-020-01122-x"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2019.00185"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.tibtech.2024.02.009"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2021.08.039"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1038\/s43856-023-00282-0"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2022.05.006"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.4240\/wjgs.v8.i3.179"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1038\/s41551-020-00682-w"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-02856-4"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-02857-3"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.imu.2022.100850"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2019.00264"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-88494-z"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3390\/cancers12061677"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccell.2023.02.016"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1042\/BST20160387"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15061899"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2016.00407"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1158\/2326-6066.CIR-20-0432"},{"key":"B31","unstructured":"Komori K, Kanemitsu Y, Ishiguro S, Shimizu Y, Sano T, Ito S, Abe T, Senda Y, Misawa K, Ito Y, Uemura N, Kato T. Clinicopathological study of poorly differentiated colorectal adenocarcinomas: comparison between solid-type and non-solid-type adenocarcinomas. Anticancer Res 2011; 3463-3467"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.27745"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.21037\/jgo-22-758"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.33947"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e318184cd55"},{"key":"B36","unstructured":"Dawson H, Blank A, Zlobec I, Lugli A. Potential clinical scenarios of tumour budding in colorectal cancer. Acta Gastroenterol Belg 2019; 515-518"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.14670\/HH-11-633"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol28060447"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1093\/carcin\/bgac029"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath-2021-207485"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2018.02.027"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hyx136"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2012.163"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v31.i5.102210"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.4251\/wjgo.v12.i5.592"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.3389\/pore.2021.1609859"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.3892\/mco.2021.2260"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.3390\/cancers12061544"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v29.i24.3807"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v28.i36.5338"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1016\/j.suronc.2020.08.001"}],"container-title":["World Journal of Gastroenterology"],"original-title":[],"link":[{"URL":"https:\/\/www.wjgnet.com\/1007-9327\/full\/v32\/i1\/112090.htm","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.wjgnet.com\/1007-9327\/full\/v32\/i1\/112090.htm","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T07:36:34Z","timestamp":1767512194000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.wjgnet.com\/1007-9327\/full\/v32\/i1\/112090.htm"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,7]]},"references-count":51,"journal-issue":{"issue":"1"},"alternative-id":["112090"],"URL":"https:\/\/doi.org\/10.3748\/wjg.v32.i1.112090","relation":{},"ISSN":["1007-9327"],"issn-type":[{"value":"1007-9327","type":"print"}],"subject":[],"published":{"date-parts":[[2026,1,7]]}}}