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Savino A, Rondonotti E, Rocchetto S, Piagnani A, Bina N, Di Domenico P, Segatta F, Radaelli F. GI genius endoscopy module: a clinical profile. Expert Rev Med Devices 2024; 21:359-372. [PMID: 38618982 DOI: 10.1080/17434440.2024.2342508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/09/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION The identification of early-stage colorectal cancers (CRC) and the resection of pre-cancerous neoplastic lesions through colonoscopy allows to decrease both CRC incidence and mortality. However, colonoscopy miss rates up to 26% for adenomas and 9% for advanced adenomas have been reported. In recent years, artificial intelligence (AI) systems have been emerging as easy-to-use tools, potentially lowering the risk of missing lesions. AREAS COVERED This review paper focuses on GI Genius device (Medtronic Co. Minneapolis, MN, U.S.A.) a computer-assisted tool designed to assist endoscopists during standard white-light colonoscopies in detecting mucosal lesions. EXPERT OPINION Randomized controlled trials (RCTs) suggest that GI Genius is a safe and effective tool for improving adenoma detection, especially in CRC screening and surveillance colonoscopies. However, its impact seems to be less significant among experienced endoscopists and in real-world clinical scenarios compared to the controlled conditions of RCTs. Furthermore, it appears that GI Genius mainly enhances the detection of non-advanced, small polyps, but does not significantly impact the identification of advanced and difficult-to-detect adenoma. When using GI Genius, no complications were documented. Only a small number of studies reported an increased in withdrawal time or the removal of non-neoplastic lesions.
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Affiliation(s)
- Alberto Savino
- Division of Gastroenterology, Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Simone Rocchetto
- Gastroenterology Unit, Valduce Hospital, Como, Italy
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Gastroenterology and Hepatology, University of Milan, Milan, Italy
| | - Alessandra Piagnani
- Gastroenterology Unit, Valduce Hospital, Como, Italy
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Gastroenterology and Hepatology, University of Milan, Milan, Italy
| | - Niccolò Bina
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | - Pasquale Di Domenico
- Gastrointestinal Unit, Department of Medicine, Surgery & Dentistry Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Francesco Segatta
- Gastroenterology Unit, Valduce Hospital, Como, Italy
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Gastroenterology and Hepatology, University of Milan, Milan, Italy
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Troya J, Sudarevic B, Krenzer A, Banck M, Brand M, Walter BM, Puppe F, Zoller WG, Meining A, Hann A. Direct comparison of multiple computer-aided polyp detection systems. Endoscopy 2024; 56:63-69. [PMID: 37532115 PMCID: PMC10736101 DOI: 10.1055/a-2147-0571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/01/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND STUDY AIMS Artificial intelligence (AI)-based systems for computer-aided detection (CADe) of polyps receive regular updates and occasionally offer customizable detection thresholds, both of which impact their performance, but little is known about these effects. This study aimed to compare the performance of different CADe systems on the same benchmark dataset. METHODS 101 colonoscopy videos were used as benchmark. Each video frame with a visible polyp was manually annotated with bounding boxes, resulting in 129 705 polyp images. The videos were then analyzed by three different CADe systems, representing five conditions: two versions of GI Genius, Endo-AID with detection Types A and B, and EndoMind, a freely available system. Evaluation included an analysis of sensitivity and false-positive rate, among other metrics. RESULTS Endo-AID detection Type A, the earlier version of GI Genius, and EndoMind detected all 93 polyps. Both the later version of GI Genius and Endo-AID Type B missed 1 polyp. The mean per-frame sensitivities were 50.63 % and 67.85 %, respectively, for the earlier and later versions of GI Genius, 65.60 % and 52.95 %, respectively, for Endo-AID Types A and B, and 60.22 % for EndoMind. CONCLUSIONS This study compares the performance of different CADe systems, different updates, and different configuration modes. This might help clinicians to select the most appropriate system for their specific needs.
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Affiliation(s)
- Joel Troya
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
- Bavarian Cancer Research Center, Würzburg, Germany
| | - Boban Sudarevic
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
- Department of Internal Medicine and Gastroenterology, Katharinenhospital, Stuttgart, Germany
| | - Adrian Krenzer
- Artificial Intelligence and Knowledge Systems, Institute for Computer Science, Julius-Maximilians-Universität, Würzburg, Germany
| | - Michael Banck
- Artificial Intelligence and Knowledge Systems, Institute for Computer Science, Julius-Maximilians-Universität, Würzburg, Germany
| | - Markus Brand
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Benjamin M. Walter
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - Frank Puppe
- Artificial Intelligence and Knowledge Systems, Institute for Computer Science, Julius-Maximilians-Universität, Würzburg, Germany
| | - Wolfram G. Zoller
- Department of Internal Medicine and Gastroenterology, Katharinenhospital, Stuttgart, Germany
| | - Alexander Meining
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
- Bavarian Cancer Research Center, Würzburg, Germany
| | - Alexander Hann
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
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Berzin TM, Glissen Brown J. Navigating the "Trough of Disillusionment" for CADe Polyp Detection: What Can We Learn About Negative AI Trials and the Physician-AI Hybrid? Am J Gastroenterol 2023; 118:1743-1745. [PMID: 37141122 DOI: 10.14309/ajg.0000000000002286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Tyler M Berzin
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy Glissen Brown
- Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA
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Tran TN, Adler TJ, Yamlahi A, Christodoulou E, Godau P, Reinke A, Tizabi MD, Sauer P, Persicke T, Albert JG, Maier-Hein L. Sources of performance variability in deep learning-based polyp detection. Int J Comput Assist Radiol Surg 2023:10.1007/s11548-023-02936-9. [PMID: 37266886 PMCID: PMC10329574 DOI: 10.1007/s11548-023-02936-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/24/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE Validation metrics are a key prerequisite for the reliable tracking of scientific progress and for deciding on the potential clinical translation of methods. While recent initiatives aim to develop comprehensive theoretical frameworks for understanding metric-related pitfalls in image analysis problems, there is a lack of experimental evidence on the concrete effects of common and rare pitfalls on specific applications. We address this gap in the literature in the context of colon cancer screening. METHODS Our contribution is twofold. Firstly, we present the winning solution of the Endoscopy Computer Vision Challenge on colon cancer detection, conducted in conjunction with the IEEE International Symposium on Biomedical Imaging 2022. Secondly, we demonstrate the sensitivity of commonly used metrics to a range of hyperparameters as well as the consequences of poor metric choices. RESULTS Based on comprehensive validation studies performed with patient data from six clinical centers, we found all commonly applied object detection metrics to be subject to high inter-center variability. Furthermore, our results clearly demonstrate that the adaptation of standard hyperparameters used in the computer vision community does not generally lead to the clinically most plausible results. Finally, we present localization criteria that correspond well to clinical relevance. CONCLUSION We conclude from our study that (1) performance results in polyp detection are highly sensitive to various design choices, (2) common metric configurations do not reflect the clinical need and rely on suboptimal hyperparameters and (3) comparison of performance across datasets can be largely misleading. Our work could be a first step towards reconsidering common validation strategies in deep learning-based colonoscopy and beyond.
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Affiliation(s)
- T N Tran
- Division of Intelligent Medical Systems, DKFZ, Heidelberg, Germany.
| | - T J Adler
- Division of Intelligent Medical Systems, DKFZ, Heidelberg, Germany
| | - A Yamlahi
- Division of Intelligent Medical Systems, DKFZ, Heidelberg, Germany
| | - E Christodoulou
- Division of Intelligent Medical Systems, DKFZ, Heidelberg, Germany
| | - P Godau
- Division of Intelligent Medical Systems, DKFZ, Heidelberg, Germany
- Faculty of Mathematics and Computer Science, University of Heidelberg, Heidelberg, Germany
| | - A Reinke
- Division of Intelligent Medical Systems, DKFZ, Heidelberg, Germany
| | - M D Tizabi
- Division of Intelligent Medical Systems, DKFZ, Heidelberg, Germany
| | - P Sauer
- Interdisciplinary Endoscopy Center (IEZ), University Hospital Heidelberg, Heidelberg, Germany
| | - T Persicke
- Department of Gastroenterology, Hepatology and Endocrinology, Robert-Bosch Hospital (RBK), Stuttgart, Germany
| | - J G Albert
- Department of Gastroenterology, Hepatology and Endocrinology, Robert-Bosch Hospital (RBK), Stuttgart, Germany
- Clinic for General Internal Medicine, Gastroenterology, Hepatology and Infectiology, Pneumology, Klinikum Stuttgart, Stuttgart, Germany
| | - L Maier-Hein
- Division of Intelligent Medical Systems, DKFZ, Heidelberg, Germany
- Faculty of Mathematics and Computer Science, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a Partnership Between DKFZ and University Medical Center Heidelberg, Heidelberg, Germany
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Krenzer A, Banck M, Makowski K, Hekalo A, Fitting D, Troya J, Sudarevic B, Zoller WG, Hann A, Puppe F. A Real-Time Polyp-Detection System with Clinical Application in Colonoscopy Using Deep Convolutional Neural Networks. J Imaging 2023; 9:jimaging9020026. [PMID: 36826945 PMCID: PMC9967208 DOI: 10.3390/jimaging9020026] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide. The best method to prevent CRC is with a colonoscopy. During this procedure, the gastroenterologist searches for polyps. However, there is a potential risk of polyps being missed by the gastroenterologist. Automated detection of polyps helps to assist the gastroenterologist during a colonoscopy. There are already publications examining the problem of polyp detection in the literature. Nevertheless, most of these systems are only used in the research context and are not implemented for clinical application. Therefore, we introduce the first fully open-source automated polyp-detection system scoring best on current benchmark data and implementing it ready for clinical application. To create the polyp-detection system (ENDOMIND-Advanced), we combined our own collected data from different hospitals and practices in Germany with open-source datasets to create a dataset with over 500,000 annotated images. ENDOMIND-Advanced leverages a post-processing technique based on video detection to work in real-time with a stream of images. It is integrated into a prototype ready for application in clinical interventions. We achieve better performance compared to the best system in the literature and score a F1-score of 90.24% on the open-source CVC-VideoClinicDB benchmark.
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Affiliation(s)
- Adrian Krenzer
- Department of Artificial Intelligence and Knowledge Systems, Julius-Maximilians University of Würzburg, Sanderring 2, 97070 Würzburg, Germany
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Michael Banck
- Department of Artificial Intelligence and Knowledge Systems, Julius-Maximilians University of Würzburg, Sanderring 2, 97070 Würzburg, Germany
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Kevin Makowski
- Department of Artificial Intelligence and Knowledge Systems, Julius-Maximilians University of Würzburg, Sanderring 2, 97070 Würzburg, Germany
| | - Amar Hekalo
- Department of Artificial Intelligence and Knowledge Systems, Julius-Maximilians University of Würzburg, Sanderring 2, 97070 Würzburg, Germany
| | - Daniel Fitting
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Joel Troya
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Boban Sudarevic
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
- Department of Internal Medicine and Gastroenterology, Katharinenhospital, Kriegsbergstrasse 60, 70174 Stuttgart, Germany
| | - Wolfgang G Zoller
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
- Department of Internal Medicine and Gastroenterology, Katharinenhospital, Kriegsbergstrasse 60, 70174 Stuttgart, Germany
| | - Alexander Hann
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Frank Puppe
- Department of Artificial Intelligence and Knowledge Systems, Julius-Maximilians University of Würzburg, Sanderring 2, 97070 Würzburg, Germany
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ELKarazle K, Raman V, Then P, Chua C. Detection of Colorectal Polyps from Colonoscopy Using Machine Learning: A Survey on Modern Techniques. SENSORS (BASEL, SWITZERLAND) 2023; 23:1225. [PMID: 36772263 PMCID: PMC9953705 DOI: 10.3390/s23031225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/08/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Given the increased interest in utilizing artificial intelligence as an assistive tool in the medical sector, colorectal polyp detection and classification using deep learning techniques has been an active area of research in recent years. The motivation for researching this topic is that physicians miss polyps from time to time due to fatigue and lack of experience carrying out the procedure. Unidentified polyps can cause further complications and ultimately lead to colorectal cancer (CRC), one of the leading causes of cancer mortality. Although various techniques have been presented recently, several key issues, such as the lack of enough training data, white light reflection, and blur affect the performance of such methods. This paper presents a survey on recently proposed methods for detecting polyps from colonoscopy. The survey covers benchmark dataset analysis, evaluation metrics, common challenges, standard methods of building polyp detectors and a review of the latest work in the literature. We conclude this paper by providing a precise analysis of the gaps and trends discovered in the reviewed literature for future work.
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Affiliation(s)
- Khaled ELKarazle
- School of Information and Communication Technologies, Swinburne University of Technology, Sarawak Campus, Kuching 93350, Malaysia
| | - Valliappan Raman
- Department of Artificial Intelligence and Data Science, Coimbatore Institute of Technology, Coimbatore 641014, India
| | - Patrick Then
- School of Information and Communication Technologies, Swinburne University of Technology, Sarawak Campus, Kuching 93350, Malaysia
| | - Caslon Chua
- Department of Computer Science and Software Engineering, Swinburne University of Technology, Melbourne 3122, Australia
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Zhao Q, Jia Q, Chi T. Deep learning as a novel method for endoscopic diagnosis of chronic atrophic gastritis: a prospective nested case-control study. BMC Gastroenterol 2022; 22:352. [PMID: 35879649 PMCID: PMC9310473 DOI: 10.1186/s12876-022-02427-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/15/2022] [Indexed: 11/28/2022] Open
Abstract
Background and aims Chronic atrophic gastritis (CAG) is a precancerous disease that often leads to the development of gastric cancer (GC) and is positively correlated with GC morbidity. However, the sensitivity of the endoscopic diagnosis of CAG is only 42%. Therefore, we developed a real-time video monitoring model for endoscopic diagnosis of CAG based on U-Net deep learning (DL) and conducted a prospective nested case–control study to evaluate the diagnostic evaluation indices of the model and its consistency with pathological diagnosis.
Methods Our cohort consisted of 1539 patients undergoing gastroscopy from December 1, 2020, to July 1, 2021. Based on pathological diagnosis, patients in the cohort were divided into the CAG group or the chronic nonatrophic gastritis (CNAG) group, and we assessed the diagnostic evaluation indices of this model and its consistency with pathological diagnosis after propensity score matching (PSM) to minimize selection bias in the study. Results After matching, the diagnostic evaluation indices and consistency evaluation of the model were better than those of endoscopists [sensitivity (84.02% vs. 62.72%), specificity (97.04% vs. 81.95%), positive predictive value (96.60% vs. 77.66%), negative predictive value (85.86% vs. 68.73%), accuracy rate (90.53% vs. 72.34%), Youden index (81.06% vs. 44.67%), odd product (172.5 vs. 7.64), positive likelihood ratio (28.39 vs. 3.47), negative likelihood ratio (0.16 vs. 0.45), AUC (95% CI) [0.909 (0.884–0.934) vs. 0.740 (0.702–0.778)] and Kappa (0.852 vs. 0.558)]. Conclusions Our prospective nested case–control study proved that the diagnostic evaluation indices and consistency evaluation of the real-time video monitoring model for endoscopic diagnosis of CAG based on U-Net DL were superior to those of endoscopists. Trial registrationChiCTR2100044458, 18/03/2020.
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Affiliation(s)
- Quchuan Zhao
- Department of Gastroenterology, Xuanwu Hospital of Capital Medical University, 45 Chang-chun Street, Beijing, 100053, China
| | - Qing Jia
- Department of Anesthesiology, Guang'anmen Hospital China Academy of Chinese Medical Sciences, 5 North Court Street, Beijing, 100053, China.
| | - Tianyu Chi
- Department of Gastroenterology, Xuanwu Hospital of Capital Medical University, 45 Chang-chun Street, Beijing, 100053, China.
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