Automatic classification and detection of oral cancer in photographic images using deep learning algorithms

Automated classification of oral cancer lesions: Vision transformers vs radiomics

BACKGROUND AND OBJECTIVE

Early diagnosis is paramount in the effective management of oral cancer, offering numerous benefits including improved treatment outcomes, reduced morbidity and mortality, preservation of function and appearance, cost-effectiveness, and enhanced quality of life for patients. Transformer-based models, increasingly used in medical image analysis, are the focus of our study. We aim to compare a vision transformer (ViT) classification method with a fully automated radiomics approach. This involves using object detection and segmentation algorithms to effectively classify oral lesions in both cancer and control cases. A combined approach is also presented.

METHODS

The analysis included 322 patients with oral lesions, comprising 120 cancer cases and 202 controls, with standard JPG images. Pretrained transformer-based algorithms like DEtection TRansformer (DETR), Segment Anything (SAM), and Vision Transformers (ViT) were used to explore different pipelines for lesion classification. For the ViT approach, images were inputted in three configurations: the entire image, a bounding box around the lesion, and a lesion delineation. The radiomics approach involved pipelines with bounding boxes and lesion segmentations. Additionally, a ViT-Radiomics combined approach was proposed, using ViT attention maps as radiomics masks. To validate the models, a five-fold cross validation was used.

RESULTS

The combined ViT-radiomics model demonstrated superior performance for small training sets, achieving specificity = 0.97 ± 0.04, sensitivity = 0.96 ± 0.05, and accuracy = 0.97 ± 0.02 for the 100 % of the training set. When analyzed independently, the ViT approach using the entire image achieved the best results with specificity = 0.99 ± 0.02, sensitivity = 0.96 ± 0.05, and accuracy = 0.96 ± 0.02. Following closely was the pipeline using automatically obtained segmentations, while the one with bounding boxes had the least favourable outcomes. In the radiomics approach, the most effective classifier used the attention masks from the ViT classifier (derived from the entire image), achieving specificity = 0.97 ± 0.05, sensitivity = 0.95 ± 0.08, and accuracy = 0.94 ± 0.03. Manual segmentations yielded the best results for both approaches, indicating potential for performance enhancement through improved lesion segmentation.

CONCLUSIONS

The ViT classification surpassed the radiomics-based approach yet combining ViT with radiomics yielded similar results. However, the attention maps generated by ViT tend to associate oral lesions in cancer patients with regions distant from the lesions in control patients. For tasks requiring the examination and comparison of features within cancer and control oral lesions, utilizing the radiomics approach with an automatic lesion segmentation algorithm is recommended.

Artificial intelligence utilization in cancer screening program across ASEAN: a scoping review

BACKGROUND

Cancer remains a significant health challenge in the ASEAN region, highlighting the need for effective screening programs. However, approaches, target demographics, and intervals vary across ASEAN member states, necessitating a comprehensive understanding of these variations to assess program effectiveness. Additionally, while artificial intelligence (AI) holds promise as a tool for cancer screening, its utilization in the ASEAN region is unexplored.

PURPOSE

This study aims to identify and evaluate different cancer screening programs across ASEAN, with a focus on assessing the integration and impact of AI in these programs.

METHODS

A scoping review was conducted using PRISMA-ScR guidelines to provide a comprehensive overview of cancer screening programs and AI usage across ASEAN. Data were collected from government health ministries, official guidelines, literature databases, and relevant documents. The use of AI in cancer screening reviews involved searches through PubMed, Scopus, and Google Scholar with the inclusion criteria of only included studies that utilized data from the ASEAN region from January 2019 to May 2024.

RESULTS

The findings reveal diverse cancer screening approaches in ASEAN. Countries like Myanmar, Laos, Cambodia, Vietnam, Brunei, Philippines, Indonesia and Timor-Leste primarily adopt opportunistic screening, while Singapore, Malaysia, and Thailand focus on organized programs. Cervical cancer screening is widespread, using both opportunistic and organized methods. Fourteen studies were included in the scoping review, covering breast (5 studies), cervical (2 studies), colon (4 studies), hepatic (1 study), lung (1 study), and oral (1 study) cancers. Studies revealed that different stages of AI integration for cancer screening: prospective clinical evaluation (50%), silent trial (36%) and exploratory model development (14%), with promising results in enhancing cancer screening accuracy and efficiency.

CONCLUSION

Cancer screening programs in the ASEAN region require more organized approaches targeting appropriate age groups at regular intervals to meet the WHO's 2030 screening targets. Efforts to integrate AI in Singapore, Malaysia, Vietnam, Thailand, and Indonesia show promise in optimizing screening processes, reducing costs, and improving early detection. AI technology integration enhances cancer identification accuracy during screening, improving early detection and cancer management across the ASEAN region.

Artificial intelligence and the diagnosis of oral cavity cancer and oral potentially malignant disorders from clinical photographs: a narrative review

Oral cavity cancer is associated with high morbidity and mortality, particularly with advanced stage diagnosis. Oral cavity cancer, typically squamous cell carcinoma (OSCC), is often preceded by oral potentially malignant disorders (OPMDs), which comprise eleven disorders with variable risks for malignant transformation. While OPMDs are clinical diagnoses, conventional oral exam followed by biopsy and histopathological analysis is the gold standard for diagnosis of OSCC. There is vast heterogeneity in the clinical presentation of OPMDs, with possible visual similarities to early-stage OSCC or even to various benign oral mucosal abnormalities. The diagnostic challenge of OSCC/OPMDs is compounded in the non-specialist or primary care setting. There has been significant research interest in technology to assist in the diagnosis of OSCC/OPMDs. Artificial intelligence (AI), which enables machine performance of human tasks, has already shown promise in several domains of medical diagnostics. Computer vision, the field of AI dedicated to the analysis of visual data, has over the past decade been applied to clinical photographs for the diagnosis of OSCC/OPMDs. Various methodological concerns and limitations may be encountered in the literature on OSCC/OPMD image analysis. This narrative review delineates the current landscape of AI clinical photograph analysis in the diagnosis of OSCC/OPMDs and navigates the limitations, methodological issues, and clinical workflow implications of this field, providing context for future research considerations.

Detection of Architectural Dysplastic Features from Histopathological Imagery of Oral Mucosa Using Neural Networks

Oral cancer is a serious illness, but it is potentially curable if early detection can be achieved successfully. Oral epithelial dysplasia (OED), which is a precursor to oral squamous cell carcinoma (OSCC), can provide abnormal characteristics to diagnose the risk of developing oral cancer. This paper proposes a neural network architecture for detecting dysplastic features of epithelial architecture, including irregular epithelial stratification and bulbous rete ridges. The different combinations of atrous convolution, batch normalization, global pooling, and dropout are discussed regarding their effects, along with an ablation study. A signature library containing image patches was constructed and utilized to train the models. The best-performing model in the validation set attained an average accuracy of 97.52%. The results of the blind test from the receiver operating characteristic (ROC) curves show that the best model reached the best probability of detection, 0.8571, for irregular epithelial stratifications and 0.8462 for the bulbous rete ridges.

Limitations of panoramic radiographs in predicting mandibular wisdom tooth extraction and the potential of deep learning models to overcome them

Surgeons routinely interpret preoperative radiographic images for estimating the shape and position of the tooth prior to performing tooth extraction. In this study, we aimed to predict the difficulty of lower wisdom tooth extraction using only panoramic radiographs. Difficulty was evaluated using the modified Parant score. Two oral surgeons (a specialist and a clinical resident) predicted the difficulty level of the test data. This study also aimed to evaluate the performance of a deep learning model in predicting the necessity for tooth separation or bone removal during wisdom tooth extraction. Two convolutional neural networks (AlexNet and VGG-16) were created and trained using panoramic X-ray images. Both surgeons interpreted the same images and classified them into three groups. The accuracies for humans were 54.4% for both surgeons, 57.7% for AlexNet, and 54.4% for VGG-16. These results indicate that accurately predict the difficulty of wisdom teeth extraction using panoramic radiographs alone is challenging. However, AlexNet and VGG-16 had sensitivities of more than 90% for crown and root separation. The predictive ability of our proposed model is equivalent to that of an oral surgery specialist, and a recall value > 90% makes it suitable for screening in clinical settings.

Development of an oral cancer detection system through deep learning

OBJECTIVE

We aimed to develop an AI-based model that uses a portable electronic oral endoscope to capture intraoral images of patients for the detection of oral cancer.

SUBJECTS AND METHODS

From September 2019 to October 2023, 205 high-quality annotated images of oral cancer were collected using a portable oral electronic endoscope at the Chinese PLA General Hospital for this study. The U-Net and ResNet-34 deep learning models were employed for oral cancer detection. The performance of these models was evaluated using several metrics: Dice coefficient, Intersection over Union (IoU), Loss, Precision, Recall, and F1 Score.

RESULTS

During the algorithm model training phase, the Dice values were approximately 0.8, the Loss values were close to 0, and the IoU values were around 0.7. In the validation phase, the highest Dice values ranged between 0.4 and 0.5, while the Loss values increased, and the training loss began to decrease gradually. In the test phase, the model achieved a maximum Precision of 0.96 with a confidence threshold of 0.990. Additionally, with a confidence threshold of 0.010, the highest F1 score reached was 0.58.

CONCLUSION

This study provides an initial demonstration of the potential of deep learning models in identifying oral cancer.

Deep learning for early diagnosis of oral cancer via smartphone and DSLR image analysis: a systematic review

INTRODUCTION

Diagnosing oral cancer is crucial in healthcare, with technological advancements enhancing early detection and outcomes. This review examines the impact of handheld AI-based tools, focusing on Convolutional Neural Networks (CNNs) and their advanced architectures in oral cancer diagnosis.

METHODS

A comprehensive search across PubMed, Scopus, Google Scholar, and Web of Science identified papers on deep learning (DL) in oral cancer diagnosis using digital images. The review, registered with PROSPERO, employed PRISMA and QUADAS-2 for search and risk assessment, with data analyzed through bubble and bar charts.

RESULTS

Twenty-five papers were reviewed, highlighting classification, segmentation, and object detection as key areas. Despite challenges like limited annotated datasets and data imbalance, models such as DenseNet121, VGG19, and EfficientNet-B0 excelled in binary classification, while EfficientNet-B4, Inception-V4, and Faster R-CNN were effective for multiclass classification and object detection. Models achieved up to 100% precision, 99% specificity, and 97.5% accuracy, showcasing AI's potential to improve diagnostic accuracy. Combining datasets and leveraging transfer learning enhances detection, particularly in resource-limited settings.

CONCLUSION

Handheld AI tools are transforming oral cancer diagnosis, with ethical considerations guiding their integration into healthcare systems. DL offers explainability, builds trust in AI-driven diagnoses, and facilitates telemedicine integration.

Image-based multi-omics analysis for oral science: Recent progress and perspectives

OBJECTIVES

The diagnosis and treatment of oral and dental diseases rely heavily on various types of medical imaging. Deep learning-mediated multi-omics analysis can extract more representative features than those identified through traditional diagnostic methods. This review aims to discuss the applications and recent advances in image-based multi-omics analysis in oral science and to highlight its potential to enhance traditional diagnostic approaches for oral diseases.

STUDY SELECTION, DATA, AND SOURCES

A systematic search was conducted in the PubMed, Web of Science, and Google Scholar databases, covering all available records. This search thoroughly examined and summarized advances in image-based multi-omics analysis in oral and maxillofacial medicine.

CONCLUSIONS

This review comprehensively summarizes recent advancements in image-based multi-omics analysis for oral science, including radiomics, pathomics, and photographic-based omics analysis. It also discusses the ongoing challenges and future perspectives that could provide new insights into exploiting the potential of image-based omics analysis in the field of oral science.

CLINICAL SIGNIFICANCE

This review article presents the state of image-based multi-omics analysis in stomatology, aiming to help oral clinicians recognize the utility of combining omics analyses with imaging during diagnosis and treatment, which can improve diagnostic accuracy, shorten times to diagnosis, save medical resources, and reduce disparity in professional knowledge among clinicians.

Exploring the efficacy of various CNN architectures in diagnosing oral cancer from squamous cell carcinoma

Oral cancer can result from mutations in cells located in the lips or mouth. Diagnosing oral cavity squamous cell carcinoma (OCSCC) is particularly challenging, often occurring at advanced stages. To address this, computer-aided diagnosis methods are increasingly being used. In this work, a deep learning-based approach utilizing models such as VGG16, ResNet50, LeNet-5, MobileNetV2, and Inception V3 is presented. NEOR and OCSCC datasets were used for feature extraction, with virtual slide images divided into tiles and classified as normal or squamous cell cancer. Performance metrics like accuracy, F1-score, AUC, precision, and recall were analyzed to determine the prerequisites for optimal CNN performance. The proposed CNN approaches were effective for classifying OCSCC and oral dysplasia, with the highest accuracy of 95.41 % achieved using MobileNetV2.

Key findings

Deep learning models, particularly MobileNetV2, achieved high classification accuracy (95.41 %) for OCSCC.CNN-based methods show promise for early-stage OCSCC and oral dysplasia diagnosis. Performance parameters like precision, recall, and F1-score help optimize CNN model selection for this task.

Mapping the Use of Artificial Intelligence-Based Image Analysis for Clinical Decision-Making in Dentistry: A Scoping Review

OBJECTIVES

Artificial intelligence (AI) is an emerging field in dentistry. AI is gradually being integrated into dentistry to improve clinical dental practice. The aims of this scoping review were to investigate the application of AI in image analysis for decision-making in clinical dentistry and identify trends and research gaps in the current literature.

MATERIAL AND METHODS

This review followed the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). An electronic literature search was performed through PubMed and Scopus. After removing duplicates, a preliminary screening based on titles and abstracts was performed. A full-text review and analysis were performed according to predefined inclusion criteria, and data were extracted from eligible articles.

RESULTS

Of the 1334 articles returned, 276 met the inclusion criteria (consisting of 601,122 images in total) and were included in the qualitative synthesis. Most of the included studies utilized convolutional neural networks (CNNs) on dental radiographs such as orthopantomograms (OPGs) and intraoral radiographs (bitewings and periapicals). AI was applied across all fields of dentistry - particularly oral medicine, oral surgery, and orthodontics - for direct clinical inference and segmentation. AI-based image analysis was use in several components of the clinical decision-making process, including diagnosis, detection or classification, prediction, and management.

CONCLUSIONS

A variety of machine learning and deep learning techniques are being used for dental image analysis to assist clinicians in making accurate diagnoses and choosing appropriate interventions in a timely manner.

Diagnostic performance of artificial intelligence in detecting oral potentially malignant disorders and oral cancer using medical diagnostic imaging: a systematic review and meta-analysis

Objective

Oral cancer is a widespread global health problem characterised by high mortality rates, wherein early detection is critical for better survival outcomes and quality of life. While visual examination is the primary method for detecting oral cancer, it may not be practical in remote areas. AI algorithms have shown some promise in detecting cancer from medical images, but their effectiveness in oral cancer detection remains Naïve. This systematic review aims to provide an extensive assessment of the existing evidence about the diagnostic accuracy of AI-driven approaches for detecting oral potentially malignant disorders (OPMDs) and oral cancer using medical diagnostic imaging.

Methods

Adhering to PRISMA guidelines, the review scrutinised literature from PubMed, Scopus, and IEEE databases, with a specific focus on evaluating the performance of AI architectures across diverse imaging modalities for the detection of these conditions.

Results

The performance of AI models, measured by sensitivity and specificity, was assessed using a hierarchical summary receiver operating characteristic (SROC) curve, with heterogeneity quantified through I2 statistic. To account for inter-study variability, a random effects model was utilized. We screened 296 articles, included 55 studies for qualitative synthesis, and selected 18 studies for meta-analysis. Studies evaluating the diagnostic efficacy of AI-based methods reveal a high sensitivity of 0.87 and specificity of 0.81. The diagnostic odds ratio (DOR) of 131.63 indicates a high likelihood of accurate diagnosis of oral cancer and OPMDs. The SROC curve (AUC) of 0.9758 indicates the exceptional diagnostic performance of such models. The research showed that deep learning (DL) architectures, especially CNNs (convolutional neural networks), were the best at finding OPMDs and oral cancer. Histopathological images exhibited the greatest sensitivity and specificity in these detections.

Conclusion

These findings suggest that AI algorithms have the potential to function as reliable tools for the early diagnosis of OPMDs and oral cancer, offering significant advantages, particularly in resource-constrained settings.

Systematic Review Registration

https://www.crd.york.ac.uk/, PROSPERO (CRD42023476706).

Research and Application of Deep Learning Models with Multi-Scale Feature Fusion for Lesion Segmentation in Oral Mucosal Diseases

Given the complexity of oral mucosal disease diagnosis and the limitations in the precision of traditional object detection methods, this study aims to develop a high-accuracy artificial intelligence-assisted diagnostic approach based on the SegFormer semantic segmentation model. This method is designed to automatically segment lesion areas in white-light images of oral mucosal diseases, providing objective and quantifiable evidence for clinical diagnosis. This study utilized a dataset of oral mucosal diseases provided by the Affiliated Stomatological Hospital of Zhejiang University School of Medicine, comprising 838 high-resolution images of three diseases: oral lichen planus, oral leukoplakia, and oral submucous fibrosis. These images were annotated at the pixel level by oral specialists using Labelme software (v5.5.0) to construct a semantic segmentation dataset. This study designed a SegFormer model based on the Transformer architecture, employed cross-validation to divide training and testing sets, and compared SegFormer models of different capacities with classical segmentation models such as UNet and DeepLabV3. Quantitative metrics including the Dice coefficient and mIoU were evaluated, and a qualitative visual analysis of the segmentation results was performed to comprehensively assess model performance. The SegFormer-B2 model achieved optimal performance on the test set, with a Dice coefficient of 0.710 and mIoU of 0.786, significantly outperforming other comparative algorithms. The visual results demonstrate that this model could accurately segment the lesion areas of three common oral mucosal diseases. The SegFormer model proposed in this study effectively achieves the precise automatic segmentation of three common oral mucosal diseases, providing a reliable auxiliary tool for clinical diagnosis. It shows promising prospects in improving the efficiency and accuracy of oral mucosal disease diagnosis and has potential clinical application value.

Exploring the Applications of Artificial Intelligence in Dental Image Detection: A Systematic Review

BACKGROUND

Dental care has been transformed by neural networks, introducing advanced methods for improving patient outcomes. By leveraging technological innovation, dental informatics aims to enhance treatment and diagnostic processes. Early diagnosis of dental problems is crucial, as it can substantially reduce dental disease incidence by ensuring timely and appropriate treatment. The use of artificial intelligence (AI) within dental informatics is a pivotal tool that has applications across all dental specialties. This systematic literature review aims to comprehensively summarize existing research on AI implementation in dentistry. It explores various techniques used for detecting oral features such as teeth, fillings, caries, prostheses, crowns, implants, and endodontic treatments. AI plays a vital role in the diagnosis of dental diseases by enabling precise and quick identification of issues that may be difficult to detect through traditional methods. Its ability to analyze large volumes of data enhances diagnostic accuracy and efficiency, leading to better patient outcomes.

METHODS

An extensive search was conducted across a number of databases, including Science Direct, PubMed (MEDLINE), arXiv.org, MDPI, Nature, Web of Science, Google Scholar, Scopus, and Wiley Online Library.

RESULTS

The studies included in this review employed a wide range of neural networks, showcasing their versatility in detecting the dental categories mentioned above. Additionally, the use of diverse datasets underscores the adaptability of these AI models to different clinical scenarios. This study highlights the compatibility, robustness, and heterogeneity among the reviewed studies. This indicates that AI technologies can be effectively integrated into current dental practices. The review also discusses potential challenges and future directions for AI in dentistry. It emphasizes the need for further research to optimize these technologies for broader clinical applications.

CONCLUSIONS

By providing a detailed overview of AI's role in dentistry, this review aims to inform practitioners and researchers about the current capabilities and future potential of AI-driven dental care, ultimately contributing to improved patient outcomes and more efficient dental practices.

A deep learning approach to detection of oral cancer lesions from intra oral patient images: A preliminary retrospective study

INTRODUCTION

Oral squamous cell carcinomas (OSCC) seen in the oral cavity are a category of diseases for which dentists may diagnose and even cure. This study evaluated the performance of diagnostic computer software developed to detect oral cancer lesions in intra-oral retrospective patient images.

MATERIALS AND METHODS

Oral cancer lesions were labeled with CranioCatch labeling program (CranioCatch, Eskişehir, Turkey) and polygonal type labeling method on a total of 65 anonymous retrospective intraoral patient images of oral mucosa that were diagnosed with oral cancer histopathologically by incisional biopsy from individuals in our clinic. All images have been rechecked and verified by experienced experts. This data set was divided into training (n = 53), validation (n = 6) and test (n = 6) sets. Artificial intelligence model was developed using YOLOv5 architecture, which is a deep learning approach. Model success was evaluated with confusion matrix.

RESULTS

When the success rate in estimating the images reserved for the test not used in education was evaluated, the F1, sensitivity and precision results of the artificial intelligence model obtained using the YOLOv5 architecture were found to be 0.667, 0.667 and 0.667, respectively.

CONCLUSIONS

Our study reveals that OCSCC lesions carry discriminative visual appearances, which can be identified by deep learning algorithm. Artificial intelligence shows promise in the prediagnosis of oral cancer lesions. The success rates will increase in the training models of the data set that will be formed with more images.

Profile Photograph Classification Performance of Deep Learning Algorithms Trained Using Cephalometric Measurements: A Preliminary Study

Extraoral profile photographs are crucial for orthodontic diagnosis, documentation, and treatment planning. The purpose of this study was to evaluate classifications made on extraoral patient photographs by deep learning algorithms trained using grouped patient pictures based on cephalometric measurements. Cephalometric radiographs and profile photographs of 990 patients from the archives of Kocaeli University Faculty of Dentistry Department of Orthodontics were used for the study. FH-NA, FH-NPog, FMA and N-A-Pog measurements on patient cephalometric radiographs were carried out utilizing Webceph. 3 groups for every parameter were formed according to cephalometric values. Deep learning algorithms were trained using extraoral photographs of the patients which were grouped according to respective cephalometric measurements. 14 deep learning models were trained and tested for accuracy of prediction in classifying patient images. Accuracy rates of up to 96.67% for FH-NA groups, 97.33% for FH-NPog groups, 97.67% for FMA groups and 97.00% for N-A-Pog groups were obtained. This is a pioneering study where an attempt was made to classify clinical photographs using artificial intelligence architectures that were trained according to actual cephalometric values, thus eliminating or reducing the need for cephalometric X-rays in future applications for orthodontic diagnosis.

Diagnostic accuracy of artificial intelligence assisted clinical imaging in the detection of oral potentially malignant disorders and oral cancer: a systematic review and meta-analysis

BACKGROUND

The objective of this study is to examine the application of artificial intelligence (AI) algorithms in detecting oral potentially malignant disorders (OPMD) and oral cancerous lesions, and to evaluate the accuracy variations among different imaging tools employed in these diagnostic processes.

MATERIALS AND METHODS

A systematic search was conducted in four databases: Embase, Web of Science, PubMed, and Scopus. The inclusion criteria included studies using machine learning algorithms to provide diagnostic information on specific oral lesions, prospective or retrospective design, and inclusion of OPMD. Sensitivity and specificity analyses were also required. Forest plots were generated to display overall diagnostic odds ratio (DOR), sensitivity, specificity, negative predictive values, and summary receiver operating characteristic (SROC) curves. Meta-regression analysis was conducted to examine potential differences among different imaging tools.

RESULTS

The overall DOR for AI-based screening of OPMD and oral mucosal cancerous lesions from normal mucosa was 68.438 (95% CI= [39.484-118.623], I2 =86%). The area under the SROC curve was 0.938, indicating excellent diagnostic performance. AI-assisted screening showed a sensitivity of 89.9% (95% CI= [0.866-0.925]; I2 =81%), specificity of 89.2% (95% CI= [0.851-0.922], I2 =79%), and a high negative predictive value of 89.5% (95% CI= [0.851-0.927], I2 =96%). Meta-regression analysis revealed no significant difference among the three image tools. After generating a GOSH plot, the DOR was calculated to be 49.30, and the area under the SROC curve was 0.877. Additionally, sensitivity, specificity, and negative predictive value were 90.5% (95% CI [0.873-0.929], I2 =4%), 87.0% (95% CI [0.813-0.912], I2 =49%) and 90.1% (95% CI [0.860-0.931], I2 =57%), respectively. Subgroup analysis showed that clinical photography had the highest diagnostic accuracy.

CONCLUSIONS

AI-based detection using clinical photography shows a high DOR and is easily accessible in the current era with billions of phone subscribers globally. This indicates that there is significant potential for AI to enhance the diagnostic capabilities of general practitioners to the level of specialists by utilizing clinical photographs, without the need for expensive specialized imaging equipment.

Utilizing deep learning for automated detection of oral lesions: A multicenter study

OBJECTIVES

We aim to develop a YOLOX-based convolutional neural network model for the precise detection of multiple oral lesions, including OLP, OLK, and OSCC, in patient photos.

MATERIALS AND METHODS

We collected 1419 photos for model development and evaluation, conducting both a comparative analysis to gauge the model's capabilities and a multicenter evaluation to assess its diagnostic aid, where 24 participants from 14 centers across the nation were invited. We further integrated this model into a mobile application for rapid and accurate diagnostics.

RESULTS

In the comparative analysis, our model overperformed the senior group (comprising three most experienced experts with more than 10 years of experience) in macro-average recall (85 % vs 77.5 %), precision (87.02 % vs 80.29 %), and specificity (95 % vs 92.5 %). In the multicenter model-assisted diagnosis evaluation, the dental, general, and community hospital groups showed significant improvement when aided by the model, reaching a level comparable to the senior group, with all macro-average metrics closely aligning or even surpassing with those of the latter (recall of 78.67 %, 74.72 %, 83.54 % vs 77.5 %, precision of 80.56 %, 76.42 %, 85.15 % vs 80.29 %, specificity of 92.89 %, 91.57 %, 94.51 % vs 92.5 %).

CONCLUSION

Our model exhibited a high proficiency in detection of oral lesions, surpassing the performance of highly experienced specialists. The model can also help specialists and general dentists from dental and community hospitals in diagnosing oral lesions, reaching the level of highly experienced specialists. Moreover, our model's integration into a mobile application facilitated swift and precise diagnostic procedures.

Oral mucosal lesions triage via YOLOv7 models

BACKGROUND/PURPOSE

The global incidence of lip and oral cavity cancer continues to rise, necessitating improved early detection methods. This study leverages the capabilities of computer vision and deep learning to enhance the early detection and classification of oral mucosal lesions.

METHODS

A dataset initially consisting of 6903 white-light macroscopic images collected from 2006 to 2013 was expanded to over 50,000 images to train the YOLOv7 deep learning model. Lesions were categorized into three referral grades: benign (green), potentially malignant (yellow), and malignant (red), facilitating efficient triage.

RESULTS

The YOLOv7 models, particularly the YOLOv7-E6, demonstrated high precision and recall across all lesion categories. The YOLOv7-D6 model excelled at identifying malignant lesions with notable precision, recall, and F1 scores. Enhancements, including the integration of coordinate attention in the YOLOv7-D6-CA model, significantly improved the accuracy of lesion classification.

CONCLUSION

The study underscores the robust comparison of various YOLOv7 model configurations in the classification to triage oral lesions. The overall results highlight the potential of deep learning models to contribute to the early detection of oral cancers, offering valuable tools for both clinical settings and remote screening applications.

Oral cancer diagnosis based on gated recurrent unit networks optimized by an improved version of Northern Goshawk optimization algorithm

Oral cancer early diagnosis is a critical task in the field of medical science, and one of the most necessary things is to develop sound and effective strategies for early detection. The current research investigates a new strategy to diagnose an oral cancer based upon combination of effective learning and medical imaging. The current research investigates a new strategy to diagnose an oral cancer using Gated Recurrent Unit (GRU) networks optimized by an improved model of the NGO (Northern Goshawk Optimization) algorithm. The proposed approach has several advantages over existing methods, including its ability to analyze large and complex datasets, its high accuracy, as well as its capacity to detect oral cancer at the very beginning stage. The improved NGO algorithm is utilized to improve the GRU network that helps to improve the performance of the network and increase the accuracy of the diagnosis. The paper describes the proposed approach and evaluates its performance using a dataset of oral cancer patients. The findings of the study demonstrate the efficiency of the suggested approach in accurately diagnosing oral cancer.

Convolutional neural network misclassification analysis in oral lesions: an error evaluation criterion by image characteristics

OBJECTIVE

This retrospective study analyzed the errors generated by a convolutional neural network (CNN) when performing automated classification of oral lesions according to their clinical characteristics, seeking to identify patterns in systemic errors in the intermediate layers of the CNN.

STUDY DESIGN

A cross-sectional analysis nested in a previous trial in which automated classification by a CNN model of elementary lesions from clinical images of oral lesions was performed. The resulting CNN classification errors formed the dataset for this study. A total of 116 real outputs were identified that diverged from the estimated outputs, representing 7.6% of the total images analyzed by the CNN.

RESULTS

The discrepancies between the real and estimated outputs were associated with problems relating to image sharpness, resolution, and focus; human errors; and the impact of data augmentation.

CONCLUSIONS

From qualitative analysis of errors in the process of automated classification of clinical images, it was possible to confirm the impact of image quality, as well as identify the strong impact of the data augmentation process. Knowledge of the factors that models evaluate to make decisions can increase confidence in the high classification potential of CNNs.

Deep learning in oral cancer- a systematic review

BACKGROUND

Oral cancer is a life-threatening malignancy, which affects the survival rate and quality of life of patients. The aim of this systematic review was to review deep learning (DL) studies in the diagnosis and prognostic prediction of oral cancer.

METHODS

This systematic review was conducted following the PRISMA guidelines. Databases (Medline via PubMed, Google Scholar, Scopus) were searched for relevant studies, from January 2000 to June 2023.

RESULTS

Fifty-four qualified for inclusion, including diagnostic (n = 51), and prognostic prediction (n = 3). Thirteen studies showed a low risk of biases in all domains, and 40 studies low risk for concerns regarding applicability. The performance of DL models was reported of the accuracy of 85.0-100%, F1-score of 79.31 - 89.0%, Dice coefficient index of 76.0 - 96.3% and Concordance index of 0.78-0.95 for classification, object detection, segmentation, and prognostic prediction, respectively. The pooled diagnostic odds ratios were 2549.08 (95% CI 410.77-4687.39) for classification studies.

CONCLUSIONS

The number of DL studies in oral cancer is increasing, with a diverse type of architectures. The reported accuracy showed promising DL performance in studies of oral cancer and appeared to have potential utility in improving informed clinical decision-making of oral cancer.

Artificial intelligence for classification and detection of oral mucosa lesions on photographs: a systematic review and meta-analysis

OBJECTIVE

This study aimed to review and synthesize studies using artificial intelligence (AI) for classifying, detecting, or segmenting oral mucosal lesions on photographs.

MATERIALS AND METHOD

Inclusion criteria were (1) studies employing AI to (2) classify, detect, or segment oral mucosa lesions, (3) on oral photographs of human subjects. Included studies were assessed for risk of bias using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). A PubMed, Scopus, Embase, Web of Science, IEEE, arXiv, medRxiv, and grey literature (Google Scholar) search was conducted until June 2023, without language limitation.

RESULTS

After initial searching, 36 eligible studies (from 8734 identified records) were included. Based on QUADAS-2, only 7% of studies were at low risk of bias for all domains. Studies employed different AI models and reported a wide range of outcomes and metrics. The accuracy of AI for detecting oral mucosal lesions ranged from 74 to 100%, while that for clinicians un-aided by AI ranged from 61 to 98%. Pooled diagnostic odds ratio for studies which evaluated AI for diagnosing or discriminating potentially malignant lesions was 155 (95% confidence interval 23-1019), while that for cancerous lesions was 114 (59-221).

CONCLUSIONS

AI may assist in oral mucosa lesion screening while the expected accuracy gains or further health benefits remain unclear so far.

CLINICAL RELEVANCE

Artificial intelligence assists oral mucosa lesion screening and may foster more targeted testing and referral in the hands of non-specialist providers, for example. So far, it remains unclear if accuracy gains compared with specialized can be realized.

Artificial intelligence-powered dentistry: Probing the potential, challenges, and ethicality of artificial intelligence in dentistry

Introduction

Healthcare amelioration is exponential to technological advancement. In the recent era of automation, the consolidation of artificial intelligence (AI) in dentistry has rendered transformation in oral healthcare from a hardware-centric approach to a software-centric approach, leading to enhanced efficiency and improved educational and clinical outcomes.

Objectives

The aim of this narrative overview is to extend the succinct of the major events and innovations that led to the creation of modern-day AI and dentistry and the applicability of the former in dentistry. This article also prompts oral healthcare workers to endeavor a liable and optimal approach for effective incorporation of AI technology into their practice to promote oral health by exploring the potentials, constraints, and ethical considerations of AI in dentistry.

Methods

A comprehensive approach for searching the white and grey literature was carried out to collect and assess the data on AI, its use in dentistry, and the associated challenges and ethical concerns.

Results

AI in dentistry is still in its evolving phase with paramount applicabilities relevant to risk prediction, diagnosis, decision-making, prognosis, tailored treatment plans, patient management, and academia as well as the associated challenges and ethical concerns in its implementation.

Conclusion

The upsurging advancements in AI have resulted in transformations and promising outcomes across all domains of dentistry. In futurity, AI may be capable of executing a multitude of tasks in the domain of oral healthcare, at the level of or surpassing the ability of mankind. However, AI could be of significant benefit to oral health only if it is utilized under responsibility, ethicality and universality.

[Oral cavity cancer: A distinct entity]

Oral Squamous cell carcinoma represent the 17th most frequent cancer in the world. The main risk factors are alcohol and tobacco consumption but dietary, familial, genetic, or oral diseases may be involved in oral carcinogenesis. Diagnosis is made on biopsy, but detection remains late, leading to a poor prognosis. New technologies could reduce these delays, notably Artificial Intelligence and the quantitative evaluation of salivary biological markers. Currently, management of oral cancer consists in surgery, which can be mutilating despite possible reconstructions. In the future, immunotherapies could become a therapeutic alternative and the immune microenvironment could constitute a source of prognostic markers.

Deep learning algorithms for classification and detection of recurrent aphthous ulcerations using oral clinical photographic images

Background/purpose

The application of artificial intelligence diagnosis based on deep learning in the medical field has been widely accepted. We aimed to evaluate convolutional neural networks (CNNs) for automated classification and detection of recurrent aphthous ulcerations (RAU), normal oral mucosa, and other common oral mucosal diseases in clinical oral photographs.

Materials and methods

The study included 785 clinical oral photographs, which was divided into 251 images of RAU, 271 images of the normal oral mucosa, and 263 images of other common oral mucosal diseases. Four and three CNN models were used for the classification and detection tasks, respectively. 628 images were randomly selected as training data. In addition, 78 and 79 images were assigned as validating and testing data. Main outcome measures included precision, recall, F1, specificity, sensitivity and area under the receiver operating characteristics curve (AUC).

Results

In the classification task, the Pretrained ResNet50 model had the best performance with a precision of 92.86%, a recall of 91.84%, an F1 score of 92.24%, a specificity of 96.41%, a sensitivity of 91.84% and an AUC of 98.95%. In the detection task, the Pretrained YOLOV5 model had the best performance with a precision of 98.70%, a recall of 79.51%, an F1 score of 88.07% and an AUC of Precision-Recall curve 90.89%.

Conclusion

The Pretrained ResNet50 and the Pretrained YOLOV5 algorithms were shown to have superior performance and acceptable potential in the classification and detection of RAU lesions based on non-invasive oral images, which may prove useful in clinical practice.

A Deep Learning Framework with an Intermediate Layer Using the Swarm Intelligence Optimizer for Diagnosing Oral Squamous Cell Carcinoma

One of the most prevalent cancers is oral squamous cell carcinoma, and preventing mortality from this disease primarily depends on early detection. Clinicians will greatly benefit from automated diagnostic techniques that analyze a patient's histopathology images to identify abnormal oral lesions. A deep learning framework was designed with an intermediate layer between feature extraction layers and classification layers for classifying the histopathological images into two categories, namely, normal and oral squamous cell carcinoma. The intermediate layer is constructed using the proposed swarm intelligence technique called the Modified Gorilla Troops Optimizer. While there are many optimization algorithms used in the literature for feature selection, weight updating, and optimal parameter identification in deep learning models, this work focuses on using optimization algorithms as an intermediate layer to convert extracted features into features that are better suited for classification. Three datasets comprising 2784 normal and 3632 oral squamous cell carcinoma subjects are considered in this work. Three popular CNN architectures, namely, InceptionV2, MobileNetV3, and EfficientNetB3, are investigated as feature extraction layers. Two fully connected Neural Network layers, batch normalization, and dropout are used as classification layers. With the best accuracy of 0.89 among the examined feature extraction models, MobileNetV3 exhibits good performance. This accuracy is increased to 0.95 when the suggested Modified Gorilla Troops Optimizer is used as an intermediary layer.

Benign and Malignant Oral Lesion Image Classification Using Fine-Tuned Transfer Learning Techniques

Oral lesions are a prevalent manifestation of oral disease, and the timely identification of oral lesions is imperative for effective intervention. Fortunately, deep learning algorithms have shown great potential for automated lesion detection. The primary aim of this study was to employ deep learning-based image classification algorithms to identify oral lesions. We used three deep learning models, namely VGG19, DeIT, and MobileNet, to assess the efficacy of various categorization methods. To evaluate the accuracy and reliability of the models, we employed a dataset consisting of oral pictures encompassing two distinct categories: benign and malignant lesions. The experimental findings indicate that VGG19 and MobileNet attained an almost perfect accuracy rate of 100%, while DeIT achieved a slightly lower accuracy rate of 98.73%. The results of this study indicate that deep learning algorithms for picture classification demonstrate a high level of effectiveness in detecting oral lesions by achieving 100% for VGG19 and MobileNet and 98.73% for DeIT. Specifically, the VGG19 and MobileNet models exhibit notable suitability for this particular task.

Artificial Intelligence-Based Diagnosis of Oral Lichen Planus Using Deep Convolutional Neural Networks

OBJECTIVE

 The aim of this study was to employ artificial intelligence (AI) via convolutional neural network (CNN) for the separation of oral lichen planus (OLP) and non-OLP in biopsy-proven clinical cases of OLP and non-OLP.

MATERIALS AND METHODS

 Data comprised of clinical photographs of 609 OLP and 480 non-OLP which diagnosis has been confirmed histopathologically. Fifty-five photographs from the OLP and non-OLP groups were randomly selected for use as the test dataset, while the remaining were used as training and validation datasets. Data augmentation was performed on the training dataset to increase the number and variation of photographs. Performance metrics for the CNN model performance included accuracy, positive predictive value, negative predictive value, sensitivity, specificity, and F1-score. Gradient-weighted class activation mapping was also used to visualize the important regions associated with discriminative clinical features on which the model relies.

RESULTS

 All the selected CNN models were able to diagnose OLP and non-OLP lesions using photographs. The performance of the Xception model was significantly higher than that of the other models in terms of overall accuracy and F1-score.

CONCLUSIONS

 Our demonstration shows that CNN models can achieve an accuracy of 82 to 88%. Xception model performed the best in terms of both accuracy and F1-score.

AI-Assisted Screening of Oral Potentially Malignant Disorders Using Smartphone-Based Photographic Images

The prevalence of oral potentially malignant disorders (OPMDs) and oral cancer is surging in low- and middle-income countries. A lack of resources for population screening in remote locations delays the detection of these lesions in the early stages and contributes to higher mortality and a poor quality of life. Digital imaging and artificial intelligence (AI) are promising tools for cancer screening. This study aimed to evaluate the utility of AI-based techniques for detecting OPMDs in the Indian population using photographic images of oral cavities captured using a smartphone. A dataset comprising 1120 suspicious and 1058 non-suspicious oral cavity photographic images taken by trained front-line healthcare workers (FHWs) was used for evaluating the performance of different deep learning models based on convolution (DenseNets) and Transformer (Swin) architectures. The best-performing model was also tested on an additional independent test set comprising 440 photographic images taken by untrained FHWs (set I). DenseNet201 and Swin Transformer (base) models show high classification performance with an F1-score of 0.84 (CI 0.79-0.89) and 0.83 (CI 0.78-0.88) on the internal test set, respectively. However, the performance of models decreases on test set I, which has considerable variation in the image quality, with the best F1-score of 0.73 (CI 0.67-0.78) obtained using DenseNet201. The proposed AI model has the potential to identify suspicious and non-suspicious oral lesions using photographic images. This simplified image-based AI solution can assist in screening, early detection, and prompt referral for OPMDs.

Detection of Abnormal Changes on the Dorsal Tongue Surface Using Deep Learning

Background and Objective: The tongue mucosa often changes due to various local and systemic diseases or conditions. This study aimed to investigate whether deep learning can help detect abnormal regions on the dorsal tongue surface in patients and healthy adults. Materials and Methods: The study collected 175 clinical photographic images of the dorsal tongue surface, which were divided into 7782 cropped images classified into normal, abnormal, and non-tongue regions and trained using the VGG16 deep learning model. The 80 photographic images of the entire dorsal tongue surface were used for the segmentation of abnormal regions using point mapping segmentation. Results: The F1-scores of the abnormal and normal classes were 0.960 (precision: 0.935, recall: 0.986) and 0.968 (precision: 0.987, recall: 0.950), respectively, in the prediction of the VGG16 model. As a result of evaluation using point mapping segmentation, the average F1-scores were 0.727 (precision: 0.717, recall: 0.737) and 0.645 (precision: 0.650, recall: 0.641), the average intersection of union was 0.695 and 0.590, and the average precision was 0.940 and 0.890, respectively, for abnormal and normal classes. Conclusions: The deep learning algorithm used in this study can accurately determine abnormal areas on the dorsal tongue surface, which can assist in diagnosing specific diseases or conditions of the tongue mucosa.

Use of Deep Neural Networks in the Detection and Automated Classification of Lesions Using Clinical Images in Ophthalmology, Dermatology, and Oral Medicine-A Systematic Review

Artificial neural networks (ANN) are artificial intelligence (AI) techniques used in the automated recognition and classification of pathological changes from clinical images in areas such as ophthalmology, dermatology, and oral medicine. The combination of enterprise imaging and AI is gaining notoriety for its potential benefits in healthcare areas such as cardiology, dermatology, ophthalmology, pathology, physiatry, radiation oncology, radiology, and endoscopic. The present study aimed to analyze, through a systematic literature review, the application of performance of ANN and deep learning in the recognition and automated classification of lesions from clinical images, when comparing to the human performance. The PRISMA 2020 approach (Preferred Reporting Items for Systematic Reviews and Meta-analyses) was used by searching four databases of studies that reference the use of IA to define the diagnosis of lesions in ophthalmology, dermatology, and oral medicine areas. A quantitative and qualitative analyses of the articles that met the inclusion criteria were performed. The search yielded the inclusion of 60 studies. It was found that the interest in the topic has increased, especially in the last 3 years. We observed that the performance of IA models is promising, with high accuracy, sensitivity, and specificity, most of them had outcomes equivalent to human comparators. The reproducibility of the performance of models in real-life practice has been reported as a critical point. Study designs and results have been progressively improved. IA resources have the potential to contribute to several areas of health. In the coming years, it is likely to be incorporated into everyday life, contributing to the precision and reducing the time required by the diagnostic process.

Data-centric artificial intelligence in oncology: a systematic review assessing data quality in machine learning models for head and neck cancer

Machine learning models have been increasingly considered to model head and neck cancer outcomes for improved screening, diagnosis, treatment, and prognostication of the disease. As the concept of data-centric artificial intelligence is still incipient in healthcare systems, little is known about the data quality of the models proposed for clinical utility. This is important as it supports the generalizability of the models and data standardization. Therefore, this study overviews the quality of structured and unstructured data used for machine learning model construction in head and neck cancer. Relevant studies reporting on the use of machine learning models based on structured and unstructured custom datasets between January 2016 and June 2022 were sourced from PubMed, EMBASE, Scopus, and Web of Science electronic databases. Prediction model Risk of Bias Assessment (PROBAST) tool was used to assess the quality of individual studies before comprehensive data quality parameters were assessed according to the type of dataset used for model construction. A total of 159 studies were included in the review; 106 utilized structured datasets while 53 utilized unstructured datasets. Data quality assessments were deliberately performed for 14.2% of structured datasets and 11.3% of unstructured datasets before model construction. Class imbalance and data fairness were the most common limitations in data quality for both types of datasets while outlier detection and lack of representative outcome classes were common in structured and unstructured datasets respectively. Furthermore, this review found that class imbalance reduced the discriminatory performance for models based on structured datasets while higher image resolution and good class overlap resulted in better model performance using unstructured datasets during internal validation. Overall, data quality was infrequently assessed before the construction of ML models in head and neck cancer irrespective of the use of structured or unstructured datasets. To improve model generalizability, the assessments discussed in this study should be introduced during model construction to achieve data-centric intelligent systems for head and neck cancer management.

Interpretable and Reliable Oral Cancer Classifier with Attention Mechanism and Expert Knowledge Embedding via Attention Map

Convolutional neural networks have demonstrated excellent performance in oral cancer detection and classification. However, the end-to-end learning strategy makes CNNs hard to interpret, and it can be challenging to fully understand the decision-making procedure. Additionally, reliability is also a significant challenge for CNN based approaches. In this study, we proposed a neural network called the attention branch network (ABN), which combines the visual explanation and attention mechanisms to improve the recognition performance and interpret the decision-making simultaneously. We also embedded expert knowledge into the network by having human experts manually edit the attention maps for the attention mechanism. Our experiments have shown that ABN performs better than the original baseline network. By introducing the Squeeze-and-Excitation (SE) blocks to the network, the cross-validation accuracy increased further. Furthermore, we observed that some previously misclassified cases were correctly recognized after updating by manually editing the attention maps. The cross-validation accuracy increased from 0.846 to 0.875 with the ABN (Resnet18 as baseline), 0.877 with SE-ABN, and 0.903 after embedding expert knowledge. The proposed method provides an accurate, interpretable, and reliable oral cancer computer-aided diagnosis system through visual explanation, attention mechanisms, and expert knowledge embedding.

Clinical Decision Support System for Geriatric Dental Treatment Using a Bayesian Network and a Convolutional Neural Network

OBJECTIVES

The aim of this study was to evaluate the performance of a clinical decision support system (CDSS) for therapeutic plans in geriatric dentistry. The information that needs to be considered in a therapeutic plan includes not only the patient's oral health status obtained from an oral examination, but also other related factors such as underlying diseases, socioeconomic characteristics, and functional dependency.

METHODS

A Bayesian network (BN) was used as a framework to construct a model of contributing factors and their causal relationships based on clinical knowledge and data. The faster R-CNN (regional convolutional neural network) algorithm was used to detect oral health status, which was part of the BN structure. The study was conducted using retrospective data from 400 patients receiving geriatric dental care at a university hospital between January 2020 and June 2021.

RESULTS

The model showed an F1-score of 89.31%, precision of 86.69%, and recall of 82.14% for the detection of periodontally compromised teeth. A receiver operating characteristic curve analysis showed that the BN model was highly accurate for recommending therapeutic plans (area under the curve = 0.902). The model performance was compared to that of experts in geriatric dentistry, and the experts and the system strongly agreed on the recommended therapeutic plans (kappa value = 0.905).

CONCLUSIONS

This research was the first phase of the development of a CDSS to recommend geriatric dental treatment. The proposed system, when integrated into the clinical workflow, is expected to provide general practitioners with expert-level decision support in geriatric dental care.

AI-based analysis of oral lesions using novel deep convolutional neural networks for early detection of oral cancer

Artificial intelligence (AI) applications in oncology have been developed rapidly with reported successes in recent years. This work aims to evaluate the performance of deep convolutional neural network (CNN) algorithms for the classification and detection of oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma (OSCC) in oral photographic images. A dataset comprising 980 oral photographic images was divided into 365 images of OSCC, 315 images of OPMDs and 300 images of non-pathological images. Multiclass image classification models were created by using DenseNet-169, ResNet-101, SqueezeNet and Swin-S. Multiclass object detection models were fabricated by using faster R-CNN, YOLOv5, RetinaNet and CenterNet2. The AUC of multiclass image classification of the best CNN models, DenseNet-196, was 1.00 and 0.98 on OSCC and OPMDs, respectively. The AUC of the best multiclass CNN-base object detection models, Faster R-CNN, was 0.88 and 0.64 on OSCC and OPMDs, respectively. In comparison, DenseNet-196 yielded the best multiclass image classification performance with AUC of 1.00 and 0.98 on OSCC and OPMD, respectively. These values were inline with the performance of experts and superior to those of general practictioners (GPs). In conclusion, CNN-based models have potential for the identification of OSCC and OPMDs in oral photographic images and are expected to be a diagnostic tool to assist GPs for the early detection of oral cancer.

Machine learning in point-of-care automated classification of oral potentially malignant and malignant disorders: a systematic review and meta-analysis

Machine learning (ML) algorithms are becoming increasingly pervasive in the domains of medical diagnostics and prognostication, afforded by complex deep learning architectures that overcome the limitations of manual feature extraction. In this systematic review and meta-analysis, we provide an update on current progress of ML algorithms in point-of-care (POC) automated diagnostic classification systems for lesions of the oral cavity. Studies reporting performance metrics on ML algorithms used in automatic classification of oral regions of interest were identified and screened by 2 independent reviewers from 4 databases. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. 35 studies were suitable for qualitative synthesis, and 31 for quantitative analysis. Outcomes were assessed using a bivariate random-effects model following an assessment of bias and heterogeneity. 4 distinct methodologies were identified for POC diagnosis: (1) clinical photography; (2) optical imaging; (3) thermal imaging; (4) analysis of volatile organic compounds. Estimated AUROC across all studies was 0.935, and no difference in performance was identified between methodologies. We discuss the various classical and modern approaches to ML employed within identified studies, and highlight issues that will need to be addressed for implementation of automated classification systems in screening and early detection.

Accuracy of artificial intelligence-assisted detection of Oral Squamous Cell Carcinoma: A systematic review and meta-analysis

Oral Squamous Cell Carcinoma (OSCC) is an aggressive tumor with a poor prognosis. Accurate and timely diagnosis is therefore essential for reducing the burden of advanced disease and improving outcomes. In this meta-analysis, we evaluated the accuracy of artificial intelligence (AI)-assisted technologies in detecting OSCC. We included studies that validated any diagnostic modality that used AI to detect OSCC. A search was performed in six databases: PubMed, Embase, Scopus, Cochrane Library, ProQuest, and Web of Science up to 15 Mar 2022. The Quality Assessment Tool for Diagnostic Accuracy Studies was used to evaluate the included studies' quality, while the Split Component Synthesis method was utilized to quantitatively synthesize the pooled diagnostic efficacy estimates. We considered 16 out of the 566 yielded studies, which included twelve different AI models with a total of 6606 samples. The summary sensitivity, summary specificity, positive and negative likelihood ratios as well as the pooled diagnostic odds ratio were 92.0 % (95 % confidence interval [CI] 86.7-95.4 %), 91.9 % (95 % CI 86.5-95.3 %), 11.4 (95 % CI 6.74-19.2), 0.087 (95 % CI 0.051-0.146) and 132 (95 % CI 62.6-277), respectively. Our findings support the capability of AI-assisted systems to detect OSCC with high accuracy, potentially aiding the histopathological examination in early diagnosis, yet more prospective studies are needed to justify their use in the real population.

Review of the Use of Artificial Intelligence in Early Diagnosis and Prevention of Oral Cancer

The global occurrence of oral cancer (OC) has increased in recent years. OC that is diagnosed in its advanced stages results in morbidity and mortality. The use of technology may be beneficial for early detection and diagnosis and thus help the clinician with better patient management. The advent of artificial intelligence (AI) has the potential to improve OC screening. AI can precisely analyze an enormous dataset from various imaging modalities and provide assistance in the field of oncology. This review focused on the applications of AI in the early diagnosis and prevention of OC. A literature search was conducted in the PubMed and Scopus databases using the search terminology “oral cancer” and “artificial intelligence.” Further information regarding the topic was collected by scrutinizing the reference lists of selected articles. Based on the information obtained, this article reviews and discusses the applications and advantages of AI in OC screening, early diagnosis, disease prediction, treatment planning, and prognosis. Limitations and the future scope of AI in OC research are also highlighted.

Efficacy of Artificial Intelligence-Assisted Discrimination of Oral Cancerous Lesions from Normal Mucosa Based on the Oral Mucosal Image: A Systematic Review and Meta-Analysis

Simple Summary

Early detection of oral cancer is important to increase the survival rate and reduce morbidity. For the past few years, the early detection of oral cancer using artificial intelligence (AI) technology based on autofluorescence imaging, photographic imaging, and optical coherence tomography imaging has been an important research area. In this study, diagnostic values including sensitivity and specificity data were comprehensively confirmed in various studies that performed AI analysis of images. The diagnostic sensitivity of AI-assisted screening was 0.92. In subgroup analysis, there was no statistically significant difference in the diagnostic rate according to each image tool. AI shows good diagnostic performance with high sensitivity for oral cancer. Image analysis using AI is expected to be used as a clinical tool for early detection and evaluation of treatment efficacy for oral cancer.

Abstract

The accuracy of artificial intelligence (AI)-assisted discrimination of oral cancerous lesions from normal mucosa based on mucosal images was evaluated. Two authors independently reviewed the database until June 2022. Oral mucosal disorder, as recorded by photographic images, autofluorescence, and optical coherence tomography (OCT), was compared with the reference results by histology findings. True-positive, true-negative, false-positive, and false-negative data were extracted. Seven studies were included for discriminating oral cancerous lesions from normal mucosa. The diagnostic odds ratio (DOR) of AI-assisted screening was 121.66 (95% confidence interval [CI], 29.60; 500.05). Twelve studies were included for discriminating all oral precancerous lesions from normal mucosa. The DOR of screening was 63.02 (95% CI, 40.32; 98.49). Subgroup analysis showed that OCT was more diagnostically accurate (324.33 vs. 66.81 and 27.63) and more negatively predictive (0.94 vs. 0.93 and 0.84) than photographic images and autofluorescence on the screening for all oral precancerous lesions from normal mucosa. Automated detection of oral cancerous lesions by AI would be a rapid, non-invasive diagnostic tool that could provide immediate results on the diagnostic work-up of oral cancer. This method has the potential to be used as a clinical tool for the early diagnosis of pathological lesions.

The Effectiveness of Artificial Intelligence in Detection of Oral Cancer

Aim

The early detection of oral cancer (OC) at the earliest stage significantly increases survival rates. Recently, there has been an increasing interest in the use of artificial intelligence (AI) technologies in diagnostic medicine. This study aimed to critically analyse the available evidence concerning the utility of AI in the diagnosis of OC. Special consideration was given to the diagnostic accuracy of AI and its ability to identify the early stages of OC.

Materials and methods

From the date of inception to December 2021, 4 databases (PubMed, Scopus, EBSCO, and OVID) were searched. Three independent authors selected studies on the basis of strict inclusion criteria. The risk of bias and applicability were assessed using the prediction model risk of bias assessment tool. Of the 606 initial records, 17 studies with a total of 7245 patients and 69,425 images were included. Ten statistical methods were used to assess AI performance in the included studies. Six studies used supervised machine learning, whilst 11 used deep learning. The results of deep learning ranged with an accuracy of 81% to 99.7%, sensitivity 79% to 98.75%, specificity 82% to 100%, and area under the curve (AUC) 79% to 99.5%.

Results

Results obtained from supervised machine learning demonstrated an accuracy ranging from 43.5% to 100%, sensitivity of 94% to 100%, specificity 16% to 100%, and AUC of 93%.

Conclusions

There is no clear consensus regarding the best AI method for OC detection. AI is a valuable diagnostic tool that represents a large evolutionary leap in the detection of OC in its early stages. Based on the evidence, deep learning, such as a deep convolutional neural network, is more accurate in the early detection of OC compared to supervised machine learning.

Scarcity of publicly available oral cancer image datasets for machine learning research

Publicly available image datasets of pathologies have easy accessibility and thus, are increasingly being used in the field of machine learning and medical diagnosis. As oral cancer is the most common head and neck cancer with an increasing incidence rate, it is of paramount importance to know the status of publicly available datasets. We designed a systematic search (PubMed, Google Scholar, Google Dataset Search, and Google) to identify the publicly available oral cancer image datasets. After carefully screening 332 articles/datasets, only one met the selection criteria and was available publicly. However, it contained images of cancerous lesions of only lips and tongue. This first-of-its-kind analysis made realize a dire need for publicly available datasets in oral cancer. It will help researchers in the development of effective machine learning algorithms for oral cancer.

Application of machine learning in oral and maxillofacial surgery

Oral and maxillofacial anatomy is extremely complex, and medical imaging is critical in the diagnosis and treatment of soft and bone tissue lesions. Hence, there exists accumulating imaging data without being properly utilized over the last decades. As a result, problems are emerging regarding how to integrate and interpret a large amount of medical data and alleviate clinicians’ workload. Recently, artificial intelligence has been developing rapidly to analyze complex medical data, and machine learning is one of the specific methods of achieving this goal, which is based on a set of algorithms and previous results. Machine learning has been considered useful in assisting early diagnosis, treatment planning, and prognostic estimation through extracting key features and building mathematical models by computers. Over the past decade, machine learning techniques have been applied to the field of oral and maxillofacial surgery and increasingly achieved expert-level performance. Thus, we hold a positive attitude towards developing machine learning for reducing the number of medical errors, improving the quality of patient care, and optimizing clinical decision-making in oral and maxillofacial surgery. In this review, we explore the clinical application of machine learning in maxillofacial cysts and tumors, maxillofacial defect reconstruction, orthognathic surgery, and dental implant and discuss its current problems and solutions.