Identifying early gastric cancer under magnifying narrow-band images via deep learning: a multicenter study.

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Abstract

Narrow-band imaging with magnifying endoscopy (ME-NBI) has shown advantages in the diagnosis of early gastric cancer (EGC). However, proficiency in diagnostic algorithms requires substantial expertise and experience. In this study, we aimed to develop a computer-aided diagnostic model, EGCM, to analyze and assist in the diagnosis of EGC under ME-NBI.
A total of 1777 ME-NBI images from 295 cases were collected from 3 centers. These cases were randomly divided into a training cohort (TC, n=170), an internal test cohort (ITC, n=73), and an external test cohort (ETC, n=52). EGCM based on VGG-19 with a single fully connected 2-classification layer was developed via fine-tuning and validated on all of the cohorts. Furthermore, we compared the model with 8 endoscopists with varying experience. Primary comparison measures included accuracy (ACC), the area under the receiver operating characteristic curve (AUC), sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV).
EGCM acquired AUCs of 0.808 in the ITC and 0.813 in the ETC. Moreover, EGCM achieved similar predictive performance to the senior endoscopists (ACC: 0.770 vs 0.755, p=0.355; Sn: 0.792 vs 0.767, p=0.183; Sp: 0.745 vs 0.742, p=0.931), but better than the junior endoscopists (ACC: 0.770 vs 0.728, p<0.05). After referring to the results of EGCM, the average diagnostic ability of the endoscopists was significantly improved in terms of accuracy, sensitivity, PPV, and NPV (p<0.05).
EGCM exhibited comparable performance to senior endoscopists in the diagnosis of EGC and showed the potential value in aiding and improving the diagnosis of EGC by endoscopists.
Copyright © 2020 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.