Deep learning automation of MEST-C classification in IgA nephropathy.

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Abstract

Though the MEST-C classification is among the best prognostic tools in IgA nephropathy, it has a wide inter-observer variability between specialized pathologists and others. Therefore, we trained and evaluated a tool using Neural Network to automate the MEST-C grading.Biopsies of patients with IgA nephropathy were divided into three independent groups: the Training cohort (n = 42) to train the Network, the Test cohort (n = 66) to compare its pixel segmentation to that made by pathologists, and the Application cohort (n = 88) to compare the MEST-C scores computed by the Network or by pathologists.In the Test cohort, more than 73% of pixels were correctly identified by the Network as M, E, S or C. In the Application cohort, the Neural Network area under the ROC curves were 0.88, 0.91, 0.88, 0.94, 0.96, 0.96 and 0.92 to respectively predict M1, E1, S1, T1, T2, C1 and C2. The kappa coefficients between pathologists and the Network assessments were substantial for E, S, T and C scores (kappa scores respectively of 0.68, 0.79, 0.73 and 0.70) and moderate for M score (kappa score of 0.52). Network S and T scores were associated with the occurrence of the composite survival endpoint (death, dialysis, transplantation or doubling of serum creatinine) (Hazard Ratio respectively of 9.67, P = 0.006 and 7.67, P<0.001).This work highlights the possibility of automated recognition and quantification of each element of the MEST-C classification using Deep Learning methods.© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.