Mitosis domain generalization in histopathology images — The MIDOG challenge

Marc Aubreville*, Nikolas Stathonikos, Christof A. Bertram, Robert Klopfleisch, Natalie ter Hoeve, Francesco Ciompi, Frauke Wilm, Christian Marzahl, Taryn A. Donovan, Andreas Maier, Jack Breen, Nishant Ravikumar, Youjin Chung, Jinah Park, Ramin Nateghi, Fattaneh Pourakpour, Rutger H.J. Fick, Saima Ben Hadj, Mostafa Jahanifar, Adam ShephardJakob Dexl, Thomas Wittenberg, Satoshi Kondo, Maxime W. Lafarge, Viktor H. Koelzer, Jingtang Liang, Yubo Wang, Xi Long, Jingxin Liu, Salar Razavi, April Khademi, Sen Yang, Xiyue Wang, Ramona Erber, Andrea Klang, Karoline Lipnik, Pompei Bolfa, Michael J. Dark, Gabriel Wasinger, Mitko Veta, Katharina Breininger

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

44 Citations (Scopus)


The density of mitotic figures (MF) within tumor tissue is known to be highly correlated with tumor proliferation and thus is an important marker in tumor grading. Recognition of MF by pathologists is subject to a strong inter-rater bias, limiting its prognostic value. State-of-the-art deep learning methods can support experts but have been observed to strongly deteriorate when applied in a different clinical environment. The variability caused by using different whole slide scanners has been identified as one decisive component in the underlying domain shift. The goal of the MICCAI MIDOG 2021 challenge was the creation of scanner-agnostic MF detection algorithms. The challenge used a training set of 200 cases, split across four scanning systems. As test set, an additional 100 cases split across four scanning systems, including two previously unseen scanners, were provided. In this paper, we evaluate and compare the approaches that were submitted to the challenge and identify methodological factors contributing to better performance. The winning algorithm yielded an F1 score of 0.748 (CI95: 0.704-0.781), exceeding the performance of six experts on the same task.

Original languageEnglish
Article number102699
JournalMedical Image Analysis
Publication statusE-pub ahead of print - Feb 2023


  • Challenge
  • Deep Learning
  • Domain generalization
  • Histopathology
  • Mitosis


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