Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China.
Gastrointest Endosc. 2021 Sep;94(3):540-548.e4. doi: 10.1016/j.gie.2021.03.013. Epub 2021 Mar 17.
Gastric precancerous conditions, including gastric atrophy (GA) and intestinal metaplasia (IM), play an important role in the development of gastric cancer. Image-enhanced endoscopy (IEE) shows great potential in diagnosing gastric precancerous conditions and adenocarcinoma. In this study, a deep convolutional neural network system, named ENDOANGEL, was constructed to detect gastric precancerous conditions by IEE.
Endoscopic images were retrospectively obtained from 5 hospitals in China for the development, validation, and internal and external test of the system. Prospective consecutive patients receiving IEE were enrolled from January 13, 2020 to October 29, 2020 in Renmin Hospital of Wuhan University to assess in real time the applicability of the proposed computer-aided detection (CADe) system in clinical practice, and the performance of CADe was compared with that of endoscopists.
Six thousand two hundred fifty endoscopic images from 760 patients and 98 video clips from 77 individuals undergoing IEE were enrolled in this study. The diagnostic accuracy of GA was .901 (95% confidence interval [CI], .883-.917) in the internal test set, .864 (95% CI, .842-.884) in the multicenter external test set, and .878 (95% CI, .796-.935) in the prospective video test set. The diagnostic accuracy of IM was .908 (95% CI, .889-.924) in the internal test set, .859 (95% CI, .837-.880) in the multicenter external test set, and .898 (95% CI, .820-.950) in the prospective video test set. CADe achieved similar diagnostic accuracy to that of the experts for detecting GA (.869 [95% CI, .790-.927] vs .846 [95% CI, .808-.879], P = .396) and IM (.888 [95% CI, .812-.941] vs .820 [95% CI, .780-.855], P = .117) and was superior to that of nonexperts for GA (.750 [95% CI, .711-.786], P = .008) and IM (.736 [95% CI, .697-.773], P = .028).
CADe achieved high diagnostic accuracy in gastric precancerous conditions, which was similar to that of experts and superior to that of nonexperts. Thus, CADe provides possibilities for a wide application in assisting in the diagnosis of gastric precancerous conditions.
胃前病变，包括胃萎缩（GA）和肠上皮化生（IM），在胃癌的发生发展中起着重要作用。增强内镜（IEE）在诊断胃前病变和腺癌方面显示出巨大的潜力。本研究构建了一个名为 ENDOANGEL 的深度卷积神经网络系统，用于通过 IEE 检测胃前病变。
本研究回顾性地从中国的 5 家医院获得内镜图像，用于系统的开发、验证以及内部和外部测试。2020 年 1 月 13 日至 2020 年 10 月 29 日，从武汉大学人民医院连续前瞻性纳入接受 IEE 的患者，以评估所提出的计算机辅助检测（CADe）系统在临床实践中的适用性，并比较 CADe 的性能与内镜医生的表现。
本研究纳入了 760 例患者的 6250 张内镜图像和 77 名患者的 98 段 IEE 视频，用于内部测试集、多中心外部测试集和前瞻性视频测试集。GA 的内部测试集诊断准确率为 0.901（95%置信区间[CI]：0.8830.917），多中心外部测试集为 0.864（95%CI：0.8420.884），前瞻性视频测试集为 0.878（95%CI：0.7960.935）。IM 的内部测试集诊断准确率为 0.908（95%CI：0.8890.924），多中心外部测试集为 0.859（95%CI：0.8370.880），前瞻性视频测试集为 0.898（95%CI：0.8200.950）。CADe 在检测 GA（0.869 [95%CI：0.7900.927] vs. 0.846 [95%CI：0.8080.879]，P = 0.396）和 IM（0.888 [95%CI：0.8120.941] vs. 0.820 [95%CI：0.7800.855]，P = 0.117）方面与专家的诊断准确率相当，并且在 GA（0.750 [95%CI：0.7110.786]，P = 0.008）和 IM（0.736 [95%CI：0.6970.773]，P = 0.028）方面优于非专家。
CADe 在胃前病变的诊断中具有较高的准确性，与专家相当，优于非专家。因此，CADe 为辅助诊断胃前病变提供了广泛应用的可能性。
