Corpuz Kristal Dale Felimon, Kusolsuk Teera, Wongphan Benjamaporn, Chonsawat Putza, Naing Kaung Myat, Boonsang Siridech, Kittichai Veerayuth, Fan Chia-Kwung, Chuwongin Santhad, Watthanakulpanich Dorn
Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Department of Biological Sciences, College of Science, Central Luzon State University, Nueva Ecija, Philippines.
Parasit Vectors. 2025 Aug 1;18(1):322. doi: 10.1186/s13071-025-06878-w.
BACKGROUND: Human intestinal parasitic infections (IPI) pose a significant global health issue caused by parasitic helminths and protozoa, affecting around 3.5 billion people worldwide, with more than 200,000 deaths annually. Despite advancements in molecular methods with higher sensitivity and specificity, the Kato-Katz or formalin-ethyl acetate centrifugation technique (FECT) remains the gold standard and a routine diagnostic procedure suitable for its simplicity and cost-effectiveness. However, these techniques have limitations that must be addressed. Thus, this study evaluated the performance of a deep-learning-based approach for intestinal parasite identification and compared it with that of human experts. METHODS: Human experts performed FECT and Merthiolate-iodine-formalin (MIF) techniques to serve as ground truth and reference for parasite species. Subsequently, a modified direct smear was conducted to gather images for the training (80%) and testing (20%) datasets. State-of-the-art models, including YOLOv4-tiny, YOLOv7-tiny, YOLOv8-m, ResNet-50, and DINOv2 (base, small, and large), were employed and were operated using in-house CIRA CORE platform. Overall performance was evaluated using confusion matrices, the metrics of which were calculated on the basis of the one-versus-rest and micro-averaging approaches. Moreover, the receiver operating characteristic (ROC) and precision-recall (PR) curves were determined for visual comparison. Lastly, Cohen's Kappa and Bland-Altman analyses were used to statistically measure the significant differences and visualize the association levels between the human experts and the deep learning models' classification performance in intestinal parasite identification. RESULTS: Findings demonstrated the potential of a deep-learning-based approach, particularly of models DINOv2-large (accuracy: 98.93%; precision: 84.52%; sensitivity: 78.00%; specificity: 99.57%; F1 score: 81.13%; AUROC: 0.97) and YOLOv8-m (accuracy: 97.59%; precision: 62.02%; sensitivity: 46.78%; specificity: 99.13%; F1 score: 53.33%; AUROC: 0.755; AUPR: 0.556) for their high metric values in intestinal parasite identification. Class-wise prediction showed high precision, sensitivity, and F1 scores for helminthic eggs and larvae due to more distinct morphology. Moreover, all models obtained a > 0.90 k score, which indicates a strong level of agreement compared with the medical technologists. The Bland-Altman analysis also presented the best agreement between FECT performed by medical technologist A and YOLOv4-tiny, while the MIF technique performed by medical technologist B and DINOv2-small demonstrated the best bias-free agreement, with mean differences of 0.0199 and -0.0080, and standard deviation differences of 0.6012 and 0.5588, respectively. CONCLUSIONS: The results highlight the potential of integrating a deep-learning-based approach into parasite identification. The models showcased superiority in automated detection, suggesting a significant leap toward improving diagnostic procedures for IPI. This hybridization could enhance early detection and diagnosis, facilitating timely and targeted interventions to reduce the burden of IPI through more effective management and prevention strategies.
背景:人类肠道寄生虫感染(IPI)是由寄生蠕虫和原生动物引起的一个重大全球健康问题,全球约有35亿人受到影响,每年有超过20万人死亡。尽管分子方法在灵敏度和特异性方面有所进步,但加藤-厚涂片法或福尔马林-乙酸乙酯离心技术(FECT)仍然是金标准和常规诊断程序,因其简单性和成本效益而适用。然而,这些技术存在必须解决的局限性。因此,本研究评估了基于深度学习的肠道寄生虫识别方法的性能,并将其与人类专家的性能进行了比较。 方法:人类专家进行FECT和硫柳汞-碘-福尔马林(MIF)技术,作为寄生虫种类的地面真值和参考。随后,进行改良直接涂片以收集用于训练(80%)和测试(20%)数据集的图像。采用了包括YOLOv4-tiny、YOLOv7-tiny、YOLOv8-m、ResNet-50和DINOv2(基础、小型和大型)在内的先进模型,并使用内部CIRA CORE平台运行。使用混淆矩阵评估整体性能,其指标基于一对多和微平均方法计算。此外,确定了受试者工作特征(ROC)和精确召回(PR)曲线用于视觉比较。最后,使用科恩卡帕分析和布兰德-奥特曼分析来统计测量显著差异,并可视化人类专家与深度学习模型在肠道寄生虫识别中的分类性能之间的关联水平。 结果:研究结果证明了基于深度学习的方法的潜力,特别是DINOv2-large模型(准确率:98.93%;精确率:84.52%;灵敏度:78.00%;特异性:99.57%;F1分数:81.13%;AUROC:0.97)和YOLOv8-m模型(准确率:97.59%;精确率:62.02%;灵敏度:46.78%;特异性:99.13%;F1分数:53.33%;AUROC:0.755;AUPR:0.556)在肠道寄生虫识别中具有较高的指标值。按类别预测显示,由于形态更明显,蠕虫虫卵和幼虫的精确率、灵敏度和F1分数较高。此外,所有模型的kappa分数均>0.90,这表明与医学技术人员相比具有很强的一致性水平。布兰德-奥特曼分析还表明,医学技术人员A进行的FECT与YOLOv4-tiny之间的一致性最好,而医学技术人员B进行的MIF技术与DINOv2-small之间的无偏差一致性最好,平均差异分别为0.0199和-0.0080,标准差差异分别为0.6012和0.5588。 结论:结果突出了将基于深度学习的方法整合到寄生虫识别中的潜力。这些模型在自动检测方面展现出优越性,表明在改进IPI诊断程序方面迈出了重要一步。这种融合可以加强早期检测和诊断,通过更有效的管理和预防策略,促进及时和有针对性的干预,以减轻IPI的负担。
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