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Triage-driven diagnosis of Barrett's esophagus for early detection of esophageal adenocarcinoma using deep learning.

Accepted version
Peer-reviewed

Type

Article

Change log

Authors

Crispin-Ortuzar, Mireia  ORCID logo  https://orcid.org/0000-0002-4351-3709
Berman, Adam G 
O'Donovan, Maria 
Fitzgerald, Rebecca C 

Abstract

Deep learning methods have been shown to achieve excellent performance on diagnostic tasks, but how to optimally combine them with expert knowledge and existing clinical decision pathways is still an open challenge. This question is particularly important for the early detection of cancer, where high-volume workflows may benefit from (semi-)automated analysis. Here we present a deep learning framework to analyze samples of the Cytosponge-TFF3 test, a minimally invasive alternative to endoscopy, for detecting Barrett's esophagus, which is the main precursor of esophageal adenocarcinoma. We trained and independently validated the framework on data from two clinical trials, analyzing a combined total of 4,662 pathology slides from 2,331 patients. Our approach exploits decision patterns of gastrointestinal pathologists to define eight triage classes of varying priority for manual expert review. By substituting manual review with automated review in low-priority classes, we can reduce pathologist workload by 57% while matching the diagnostic performance of experienced pathologists.

Description

Keywords

Adenocarcinoma, Barrett Esophagus, Case-Control Studies, Decision Support Systems, Clinical, Deep Learning, Early Detection of Cancer, Esophageal Neoplasms, Esophagus, Humans, Triage

Journal Title

Nat Med

Conference Name

Journal ISSN

1078-8956
1546-170X

Volume Title

27

Publisher

Springer Science and Business Media LLC
Sponsorship
Cancer Research UK (C14478/A12088)
MRC (unknown)
National Institute for Health and Care Research (IS-BRC-1215-20014)
MRC (MR/W014122/1)
Medical Research Council (MC_UU_12022/2)
Cancer Research UK (28290)
Cancer Research UK (21047)
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