AI slipping on tiles: data leakage in digital pathology

Abstract: Reproducibility of AI models on biomedical data still stays as a major concern for their acceptance into the clinical practice. Initiatives for reproducibility in the development of predictive biomarkers as the MAQC Consortium already underlined the importance of appropriate Data Analysis Plans (DAPs) to control for different types of bias, including data leakage from the training to the test set. In the context of digital pathology, the leakage typically lurks in weakly designed experiments not accounting for the subjects in their data partitioning schemes. This issue is then exacerbated when fractions or subregions of slides (i.e. "tiles") are considered. Despite this aspect is largely recognized by the community, we argue that it is often overlooked. In this study, we assess the impact of data leakage on the performance of machine learning models trained and validated on multiple histology data collection. We prove that, even with a properly designed DAP (10x5 repeated cross-validation), predictive scores can be inflated up to 41% when tiles from the same subject are used both in training and validation sets by deep learning models. We replicate the experiments for $4$ classification tasks on 3 histopathological datasets, for a total of 374 subjects, 556 slides and more than 27,000 tiles. Also, we discuss the effects of data leakage on transfer learning strategies with models pre-trained on general-purpose datasets or off-task digital pathology collections. Finally, we propose a solution that automates the creation of leakage-free deep learning pipelines for digital pathology based on histolab, a novel Python package for histology data preprocessing. We validate the solution on two public datasets (TCGA and GTEx).