Computer-aided diagnosis improves characterization of Barrett’s neoplasia by general endoscopists (with video) - 16/10/24
Doi : 10.1016/j.gie.2024.04.013
Jelmer B. Jukema, MD 1, Carolus H.J. Kusters, MS 2, Martijn R. Jong, MD 1, Kiki N. Fockens, MD, PhD 1, Tim Boers, MS 2, Joost A. van der Putten, PhD 2, Roos E. Pouw, MD, PhD 1, Lucas C. Duits, MD, PhD 1, Bas L.A.M. Weusten, MD, PhD 3, 4, Lorenza Alvarez Herrero, MD, PhD 4, Martin H.M.G. Houben, MD, PhD 5, Wouter B. Nagengast, MD, PhD 6, Jessie Westerhof, MD, PhD 6, Alaa Alkhalaf, MD, PhD 7, Rosalie Mallant-Hent, MD, PhD 8, Pieter Scholten, MD 9, Krish Ragunath, MD, PhD 10, Stefan Seewald, MD, PhD 11, Peter Elbe, MD 12, 13, Francisco Baldaque Silva, MD, PhD 12, 14, Maximilien Barret, MD, PhD 15, Jacobo Ortiz Fernández-Sordo, MD 16, Guiomar Moral Villarejo, MD 16, Oliver Pech, MD, PhD 17, Torsten Beyna, MD, PhD 18, Nahid S.M. Montazeri, PhD 19, Fons van der Sommen, PhD 2, Peter H. de With, PhD 2, A. Jeroen de Groof, MD, PhD 1, Jacques J. Bergman, MD, PhD 1, ⁎ 
on behalf of the
on behalf of the
BONS-AI consortium∗
Alaa Alkhalaf 20, Lorenza Alvarez Herrero 21, Francisco Baldaque-Silva 22, Maximilien Barret 23, Jacques J. Bergman 24, Torsten Beyna 25, Raf Bisschops 26, Tim G. Boers 27, Wouter Curvers 28, Pierre H. Deprez 29, Lucas C. Duits 30, Peter Elbe 31, Jose Miguel Esteban 32, Gary W. Falk 33, Kiki N. Fockens 34, Gregory G. Ginsberg 35, Albert J. de Groof 36, Rehan Haidry 37, Martin H. Houben 38, Anthony Infantolino 39, Prasad G. Iyer 40, Martijn Jong 41, Pieter-Jan de Jonge 42, Jelmer B. Jukema 43, Arjun Koch 44, Srinadh Komanduri 45, Vani Konda 46, Koen C. Kusters 47, Philippe Leclerq 48, Cadman L. Leggett 49, Charles J. Lightdale 50, Rosalie C. Mallant-Hent 51, Guiomar Moral Villarejo 52, Jacobo Ortiz Fernández-Sordo 53, Oliver Pech 54, Ian Penman 55, Roos E. Pouw 56, Joost A. van der Putten 57, Krish Ragunath 58, Pieter Scholten 59, Stefan Seewald 60, Amritha Sethi 61, Michael S. Smith 62, Fons van der Sommen 63, Arvind Trindade 64, Sachin Wani 65, Irving Waxman 66, Jessie Westerhof 67, Bas L. Weusten 68, Peter H. de With 69, Herbert C. Wolfsen 70
20 Isala Hospital, Zwolle, the Netherlands
21 St. Antonius Hospital, Utrecht, the Netherlands
22 Karolinska University Hospital, Stockholm, Sweden
23 Cochin Hospital, Paris, France
24 Amsterdam UMC, Amsterdam, the Netherlands
25 Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
26 University Hospitals Leuven, Leuven, Belgium
27 TU Eindhoven, Eindhoven, the Netherlands
28 Catharina Hospital, Eindhoven, the Netherlands
29 University Hospital Saint-Luc, Brussels, Belgium
30 Amsterdam UMC, Amsterdam, the Netherlands
31 Karolinska University Hospital & Karolinska Institute, Stockholm, Sweden
32 Clínico San Carlos, Madrid, Spain
33 Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
34 Amsterdam UMC, Amsterdam, the Netherlands
35 University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
36 Amsterdam UMC, Amsterdam, the Netherlands
37 Cleveland Clinic London and University College Hospitals NHS, London, United Kingdom
38 HagaZiekenhuis, The Hague, the Netherlands
39 Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
40 Mayo Clinic, Rochester, Minnesota, USA
41 Amsterdam UMC, Amsterdam, the Netherlands
42 Erasmus MC, Rotterdam, the Netherlands
43 Amsterdam UMC, Amsterdam the Netherlands
44 Erasmus MC, Rotterdam, the Netherlands
45 Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
46 Baylor University Medical Center, Dallas, Texas, USA
47 TU Eindhoven, Eindhoven, the Netherlands
48 University Hospitals Leuven, Leuven, Belgium
49 Mayo Clinic, Rochester, Minnesota, USA
50 Columbia University Medical Center, New York, New York, USA
51 Flevoziekenhuis, Almere, the Netherlands
52 Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom. V. Raman Muthusamy, UCLA Health, Los Angeles, California, USA
53 Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
54 St. John of God Hospital, Regensburg, Germany
55 Royal Infirmary Edinburgh, Edinburgh, United Kingdom
56 Amsterdam UMC, Amsterdam, the Netherlands
57 TU Eindhoven, Eindhoven, the Netherlands
58 Royal Perth Hospital, Perth, Australia
59 Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
60 Klinik Hirslanden, Zurich, Switzerland
61 Columbia University Medical Center, New York, New York, USA
62 Mount Sinai West & Mount Sinai Morningside Hospitals, New York, New York, USA
63 TU Eindhoven, Eindhoven, the Netherlands
64 Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, New York, USA
65 University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
66 Rush University Medical Center, Chicago, Illinois, USA
67 UMC Groningen, Groningen, the Netherlands
68 UMC Utrecht & St. Antonius Hospital, Utrecht, the Netherlands
69 TU Eindhoven, Eindhoven, the Netherlands
70 Mayo Clinic, Jacksonville, Florida, USA
1 Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
2 Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
3 Department of Gastroenterology and Hepatology, UMC Utrecht, University of Utrecht, Utrecht, the Netherlands
4 Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, the Netherlands
5 Department of Gastroenterology and Hepatology, HagaZiekenhuis Den Haag, Den Haag, the Netherlands
6 Department of Gastroenterology and Hepatology, UMC Groningen, University of Groningen, Groningen, the Netherlands
7 Department of Gastroenterology and Hepatology, Isala Hospital Zwolle, Zwolle, the Netherlands
8 Department of Gastroenterology and Hepatology, Flevoziekenhuis Almere, Almere, the Netherlands
9 Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
10 Department of Gastroenterology and Hepatology, Royal Perth Hospital, Curtin University, Perth, WA, Australia
11 Department of Gastroenterology and Hepatology, Hirslanden Klinik, Zurich, Switzerland
12 Department of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
13 Division of Surgery, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
14 Center for Advanced Endoscopy Carlos Moreira da Silva, Gastroenterology Department, Pedro Hispano Hospital, ULSM Matosinhos, Portugal
15 Department of Gastroenterology and Hepatology, Cochin Hospital Paris, Paris, France
16 Department of Gastroenterology and Hepatology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
17 Department of Gastroenterology and Hepatology, St. John of God Hospital, Regensburg, Germany
18 Department of Gastroenterology and Hepatology, Evangalisches Krankenhaus Düsseldorf, Düsseldorf, Germany
19 Biostatistics Unit, Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
∗Reprint requests: Jacques J. Bergman, MD, PhD, Amsterdam UMC, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.Amsterdam UMCDe Boelelaan 1117Amsterdam1081 HVthe Netherlands
Abstract |
Background and Aims |
Characterization of visible abnormalities in patients with Barrett’s esophagus (BE) can be challenging, especially for inexperienced endoscopists. This results in suboptimal diagnostic accuracy and poor interobserver agreement. Computer-aided diagnosis (CADx) systems may assist endoscopists. We aimed to develop, validate, and benchmark a CADx system for BE neoplasia.
Methods |
The CADx system received pretraining with ImageNet and then consecutive domain-specific pretraining with GastroNet, which includes 5 million endoscopic images. It was subsequently trained and internally validated using 1758 narrow-band imaging (NBI) images of early BE neoplasia (352 patients) and 1838 NBI images of nondysplastic BE (173 patients) from 8 international centers. CADx was tested prospectively on corresponding image and video test sets with 30 cases (20 patients) of BE neoplasia and 60 cases (31 patients) of nondysplastic BE. The test set was benchmarked by 44 general endoscopists in 2 phases (phase 1, no CADx assistance; phase 2, with CADx assistance). Ten international BE experts provided additional benchmark performance.
Results |
Stand-alone sensitivity and specificity of the CADx system were 100% and 98% for images and 93% and 96% for videos, respectively. CADx outperformed general endoscopists without CADx assistance in terms of sensitivity (P = .04). Sensitivity and specificity of general endoscopists increased from 84% to 96% and 90% to 98% with CAD assistance (P < .001). CADx assistance increased endoscopists’ confidence in characterization (P < .001). CADx performance was similar to that of the BE experts.
Conclusions |
CADx assistance significantly increased characterization performance of BE neoplasia by general endoscopists to the level of expert endoscopists. The use of this CADx system may thereby improve daily Barrett surveillance.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : BE, CADe, CADx, NBI, NDBE, WLE
Mappa
| DIVERSITY, EQUITY, AND INCLUSION: One or more of the authors of this paper self-identifies as an under-represented gender minority in science. One or more of the authors of this paper self-identifies as an under-represented ethnic minority in science. The author list of this paper includes contributors from the location where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. |
© 2024
American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
Vol 100 - N° 4
P. 616 - ottobre 2024 Ritorno al numero
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