Dual-Stream Transformer with Cross-Attention on Whole-Slide Image Pyramids for Cancer Prognosis

The cancer prognosis on gigapixel Whole-Slide Images (WSIs) has always been a challenging task. Most existing approaches focus solely on single-resolution images. The multi-resolution schemes, utilizing image pyramids to enhance WSI visual representations, have not yet been paid enough attention to. In order to explore a multi-resolution solution for improving cancer prognosis accuracy, this paper proposes a dual-stream architecture to model WSIs by an image pyramid strategy. This architecture consists of two sub-streams: one for low-resolution WSIs, and the other especially for high-resolution ones. Compared to other approaches, our scheme has three highlights: (i) there exists a one-to-one relation between stream and resolution; (ii) a square pooling layer is added to align the patches from two resolution streams, largely reducing computation cost and enabling a natural stream feature fusion; (iii) a cross-attention-based method is proposed to pool high-resolution patches spatially under the guidance of low-resolution ones. We validate our scheme on three publicly-available datasets with a total number of 3,101 WSIs from 1,911 patients. Experimental results verify that (i) hierarchical dual-stream representation is more effective than single-stream ones for cancer prognosis, gaining an average C-Index rise of 5.0% and 1.8% on a single low-resolution and high-resolution stream, respectively; (ii) our dual-stream scheme could outperform current state-of-the-art ones, by an average C-Index improvement of 5.1%; (iii) the cancer diseases with observable survival differences could have different preferences for model complexity. Our scheme could serve as an alternative tool for further facilitating WSI prognosis research.