Robust automated prediction of the revised Vienna Classification in colonoscopy using deep learning: development and initial external validation.

BACKGROUND: Improved optical diagnostic technology is needed that can be used by also outside expert centers. Hence, we developed an artificial intelligence (AI) system that automatically and robustly predicts the pathological diagnosis based on the revised Vienna Classification using standard colonoscopy images. METHODS: We prepared deep learning algorithms and colonoscopy images containing pathologically proven lesions (56,872 images, 6775 lesions). Four classifications were adopted: revised Vienna Classification category 1, 3, and 4/5 and normal images. The best algorithm-ResNet152-in the independent internal validation (14,048 images, 1718 lesions) was used for external validation (255 images, 128 lesions) based on neoplastic and non-neoplastic classification. Diagnostic performance of endoscopists was compared using a computer-assisted interpreting test. RESULTS: In the internal validation, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for adenoma (category 3) of 84.6% (95% CI 83.5-85.6%), 99.7% (99.5-99.8%), 90.8% (89.9-91.7%), 89.2% (88.5-99.0%), and 89.8% (89.3-90.4%), respectively. In the external validation, ResNet152's sensitivity, specificity, PPV, NPV, and accuracy for neoplastic lesions were 88.3% (82.6-94.1%), 90.3% (83.0-97.7%), 94.6% (90.5-98.8%), 80.0% (70.6-89.4%), and 89.0% (84.5-93.6%), respectively. This diagnostic performance was superior to that of expert endoscopists. Area under the receiver-operating characteristic curve was 0.903 (0.860-0.946). CONCLUSIONS: The developed AI system can help non-expert endoscopists make differential diagnoses of colorectal neoplasia on par with expert endoscopists during colonoscopy. (229/250 words).

Detection of flat colorectal neoplasia by artificial intelligence: A systematic review.

OBJECTIVES: This study review focuses on a deep learning method for the detection of colorectal lesions in colonoscopy and AI support for detecting colorectal neoplasia, especially in flat lesions. DATA SOURCES: We performed a systematic electric search with PubMed by using "colonoscopy", "artificial intelligence", and "detection". Finally, nine articles about development and validation study and eight clinical trials met the review criteria. RESULTS: Development and validation studies showed that trained AI models had high accuracy-approximately 90% or more for detecting lesions. Performance was better in elevated lesions than in superficial lesions in the two studies. Among the eight clinical trials, all but one trial showed a significantly high adenoma detection rate in the CADe group than in the control group. Interestingly, the CADe group detected significantly high flat lesions than the control group in the seven studies. CONCLUSION: Flat colorectal neoplasia can be detected by endoscopists who use AI.

Development of a real-time endoscopic image diagnosis support system using deep learning technology in colonoscopy.

Gaps in colonoscopy skills among endoscopists, primarily due to experience, have been identified, and solutions are critically needed. Hence, the development of a real-time robust detection system for colorectal neoplasms is considered to significantly reduce the risk of missed lesions during colonoscopy. Here, we develop an artificial intelligence (AI) system that automatically detects early signs of colorectal cancer during colonoscopy; the AI system shows the sensitivity and specificity are 97.3% (95% confidence interval [CI] = 95.9%-98.4%) and 99.0% (95% CI = 98.6%-99.2%), respectively, and the area under the curve is 0.975 (95% CI = 0.964-0.986) in the validation set. Moreover, the sensitivities are 98.0% (95% CI = 96.6%-98.8%) in the polypoid subgroup and 93.7% (95% CI = 87.6%-96.9%) in the non-polypoid subgroup; To accelerate the detection, tensor metrics in the trained model was decomposed, and the system can predict cancerous regions 21.9 ms/image on average. These findings suggest that the system is sufficient to support endoscopists in the high detection against non-polypoid lesions, which are frequently missed by optical colonoscopy. This AI system can alert endoscopists in real-time to avoid missing abnormalities such as non-polypoid polyps during colonoscopy, improving the early detection of this disease.