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Cai LQ, Yang DQ, Wang RJ, Huang H, Shi YX. Establishing and clinically validating a machine learning model for predicting unplanned reoperation risk in colorectal cancer. World J Gastroenterol 2024; 30:2991-3004. [PMID: 38946868 PMCID: PMC11212699 DOI: 10.3748/wjg.v30.i23.2991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/07/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Colorectal cancer significantly impacts global health, with unplanned reoperations post-surgery being key determinants of patient outcomes. Existing predictive models for these reoperations lack precision in integrating complex clinical data.
AIM To develop and validate a machine learning model for predicting unplanned reoperation risk in colorectal cancer patients.
METHODS Data of patients treated for colorectal cancer (n = 2044) at the First Affiliated Hospital of Wenzhou Medical University and Wenzhou Central Hospital from March 2020 to March 2022 were retrospectively collected. Patients were divided into an experimental group (n = 60) and a control group (n = 1984) according to unplanned reoperation occurrence. Patients were also divided into a training group and a validation group (7:3 ratio). We used three different machine learning methods to screen characteristic variables. A nomogram was created based on multifactor logistic regression, and the model performance was assessed using receiver operating characteristic curve, calibration curve, Hosmer-Lemeshow test, and decision curve analysis. The risk scores of the two groups were calculated and compared to validate the model.
RESULTS More patients in the experimental group were ≥ 60 years old, male, and had a history of hypertension, laparotomy, and hypoproteinemia, compared to the control group. Multiple logistic regression analysis confirmed the following as independent risk factors for unplanned reoperation (P < 0.05): Prognostic Nutritional Index value, history of laparotomy, hypertension, or stroke, hypoproteinemia, age, tumor-node-metastasis staging, surgical time, gender, and American Society of Anesthesiologists classification. Receiver operating characteristic curve analysis showed that the model had good discrimination and clinical utility.
CONCLUSION This study used a machine learning approach to build a model that accurately predicts the risk of postoperative unplanned reoperation in patients with colorectal cancer, which can improve treatment decisions and prognosis.
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Affiliation(s)
- Li-Qun Cai
- Department of Colorectal and Anal Surgery, Whenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
| | - Da-Qing Yang
- Department of Colorectal and Anal Surgery, Whenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
| | - Rong-Jian Wang
- Department of Colorectal and Anal Surgery, Whenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
| | - He Huang
- Department of Colorectal and Anal Surgery, Whenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
| | - Yi-Xiong Shi
- Department of Colorectal and Anorectal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
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Nijssen DJ, Joosten JJ, Osterkamp J, van den Elzen RM, de Bruin DM, Svendsen MBS, Dalsgaard MW, Gisbertz SS, Hompes R, Achiam MP, van Berge Henegouwen MI. Quantification of fluorescence angiography for visceral perfusion assessment: measuring agreement between two software algorithms. Surg Endosc 2024; 38:2805-2816. [PMID: 38594365 PMCID: PMC11078848 DOI: 10.1007/s00464-024-10794-y] [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: 11/27/2023] [Accepted: 03/09/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Indocyanine green fluorescence angiography (ICG-FA) may reduce perfusion-related complications of gastrointestinal anastomosis. Software implementations for quantifying ICG-FA are emerging to overcome a subjective interpretation of the technology. Comparison between quantification algorithms is needed to judge its external validity. This study aimed to measure the agreement for visceral perfusion assessment between two independently developed quantification software implementations. METHODS This retrospective cohort analysis included standardized ICG-FA video recordings of patients who underwent esophagectomy with gastric conduit reconstruction between August 2020 until February 2022. Recordings were analyzed by two quantification software implementations: AMS and CPH. The quantitative parameter used to measure visceral perfusion was the normalized maximum slope derived from fluorescence time curves. The agreement between AMS and CPH was evaluated in a Bland-Altman analysis. The relation between the intraoperative measurement of perfusion and the incidence of anastomotic leakage was determined for both software implementations. RESULTS Seventy pre-anastomosis ICG-FA recordings were included in the study. The Bland-Altman analysis indicated a mean relative difference of + 58.2% in the measurement of the normalized maximum slope when comparing the AMS software to CPH. The agreement between AMS and CPH deteriorated as the magnitude of the measured values increased, revealing a proportional (linear) bias (R2 = 0.512, p < 0.001). Neither the AMS nor the CPH measurements of the normalized maximum slope held a significant relationship with the occurrence of anastomotic leakage (median of 0.081 versus 0.074, p = 0.32 and 0.041 vs 0.042, p = 0.51, respectively). CONCLUSION This is the first study to demonstrate technical differences in software implementations that can lead to discrepancies in ICG-FA quantification in human clinical cases. The possible variation among software-based quantification methods should be considered when interpreting studies that report quantitative ICG-FA parameters and derived thresholds, as there may be a limited external validity.
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Affiliation(s)
- D J Nijssen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - J J Joosten
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - J Osterkamp
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - R M van den Elzen
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, The Netherlands
| | - D M de Bruin
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, The Netherlands
| | - M B S Svendsen
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Computer Science, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| | - M W Dalsgaard
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - S S Gisbertz
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - R Hompes
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - M P Achiam
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - M I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.
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3
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Lu S, Li Z, Chen X, Chen F, Yao H, Sun X, Cheng Y, Wang L, Dai P. Vaginal microbiota molecular profiling and diagnostic performance of artificial intelligence-assisted multiplex PCR testing in women with bacterial vaginosis: a single-center experience. Front Cell Infect Microbiol 2024; 14:1377225. [PMID: 38644962 PMCID: PMC11026559 DOI: 10.3389/fcimb.2024.1377225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Background Bacterial vaginosis (BV) is a most common microbiological syndrome. The use of molecular methods, such as multiplex real-time PCR (mPCR) and next-generation sequencing, has revolutionized our understanding of microbial communities. Here, we aimed to use a novel multiplex PCR test to evaluate the microbial composition and dominant lactobacilli in non-pregnant women with BV, and combined with machine learning algorithms to determine its diagnostic significance. Methods Residual material of 288 samples of vaginal secretions derived from the vagina from healthy women and BV patients that were sent for routine diagnostics was collected and subjected to the mPCR test. Subsequently, Decision tree (DT), random forest (RF), and support vector machine (SVM) hybrid diagnostic models were constructed and validated in a cohort of 99 women that included 74 BV patients and 25 healthy controls, and a separate cohort of 189 women comprising 75 BV patients, 30 intermediate vaginal microbiota subjects and 84 healthy controls, respectively. Results The rate or abundance of Lactobacillus crispatus and Lactobacillus jensenii were significantly reduced in BV-affected patients when compared with healthy women, while Lactobacillus iners, Gardnerella vaginalis, Atopobium vaginae, BVAB2, Megasphaera type 2, Prevotella bivia, and Mycoplasma hominis were significantly increased. Then the hybrid diagnostic models were constructed and validated by an independent cohort. The model constructed with support vector machine algorithm achieved excellent prediction performance (Area under curve: 0.969, sensitivity: 90.4%, specificity: 96.1%). Moreover, for subjects with a Nugent score of 4 to 6, the SVM-BV model might be more robust and sensitive than the Nugent scoring method. Conclusion The application of this mPCR test can be effectively used in key vaginal microbiota evaluation in women with BV, intermediate vaginal microbiota, and healthy women. In addition, this test may be used as an alternative to the clinical examination and Nugent scoring method in diagnosing BV.
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Affiliation(s)
- Sihai Lu
- National Engineering Research Center for Miniaturized Detection Systems, Northwest University, Xi’an, China
- Department of Research and Development, Shaanxi Lifegen Co., Ltd., Xi’an, China
| | - Zhuo Li
- National Engineering Research Center for Miniaturized Detection Systems, Northwest University, Xi’an, China
- Clinical Laboratory, The First Affiliated Hospital of Xi’an Medical University, Xi’an, China
| | - Xinyue Chen
- National Engineering Research Center for Miniaturized Detection Systems, Northwest University, Xi’an, China
- Department of Research and Development, Shaanxi Lifegen Co., Ltd., Xi’an, China
| | - Fengshuangze Chen
- National Engineering Research Center for Miniaturized Detection Systems, Northwest University, Xi’an, China
- Academic Center, Henry M Gunn High School, Palo Alto, CA, United States
| | - Hao Yao
- National Engineering Research Center for Miniaturized Detection Systems, Northwest University, Xi’an, China
| | - Xuena Sun
- Department of Research and Development, Shaanxi Lifegen Co., Ltd., Xi’an, China
| | - Yimin Cheng
- Department of Obstetrics and Gynecology, The Hospital of Xi’ an Shiyou University, Xi’an, China
| | - Liehong Wang
- Department of Obstetrics and Gynecology, Qinghai Red Cross Hospital, Qinghai, Xining, China
| | - Penggao Dai
- National Engineering Research Center for Miniaturized Detection Systems, Northwest University, Xi’an, China
- Department of Research and Development, Shaanxi Lifegen Co., Ltd., Xi’an, China
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El-Sayed A, Salman S, Alrubaiy L. The adoption of artificial intelligence assisted endoscopy in the Middle East: challenges and future potential. Transl Gastroenterol Hepatol 2023; 8:42. [PMID: 38021356 PMCID: PMC10643188 DOI: 10.21037/tgh-23-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/07/2023] [Indexed: 12/01/2023] Open
Abstract
The use of artificial intelligence (AI) in endoscopy has shown immense potential to enhance diagnostic accuracy, streamline procedures, and improve patient outcomes. There are potential uses in every field of endoscopy, from improving adenoma detection rate (ADR) in colonoscopy to reducing read time in capsule endoscopy or minimizing blind spots in gastroscopy. Indeed, some of these systems are already licensed and in commercial use across the world. In the Middle East, where healthcare systems are rapidly evolving, there is a growing interest in adopting AI technologies to revolutionise endoscopic practices. This article provides an overview of the advancements, potential opportunities and challenges associated with the implementation of AI in endoscopy within the Middle East region. Our aim is to contribute to the ongoing dialogue surrounding the implementation of AI in endoscopy and consider some of the factors that are particularly relevant in the Middle Eastern context, including the need to train the models for local populations, cost and training, as well as trying to ensure equity of access for patients. It provides valuable insights for healthcare professionals, policymakers, and researchers interested in leveraging AI to enhance endoscopic procedures, improve patient care, and address the unique healthcare needs of the Middle East population.
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Affiliation(s)
- Ahmed El-Sayed
- Gastroenterology Department, Chelsea & Westminster Hospital, London, UK
| | - Sara Salman
- University of Sheffield Medical School, Sheffield, UK
| | - Laith Alrubaiy
- Gastroenterology Department, Healthpoint Hospital, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
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5
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Seah D, Cheng Z, Vendrell M. Fluorescent Probes for Imaging in Humans: Where Are We Now? ACS NANO 2023; 17:19478-19490. [PMID: 37787658 PMCID: PMC10604082 DOI: 10.1021/acsnano.3c03564] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
Optical imaging has become an indispensable technology in the clinic. The molecular design of cell-targeted and highly sensitive materials, the validation of specific disease biomarkers, and the rapid growth of clinically compatible instrumentation have altogether revolutionized the way we use optical imaging in clinical settings. One prime example is the application of cancer-targeted molecular imaging agents in both trials and routine clinical use to define the margins of tumors and to detect lesions that are "invisible" to the surgeons, leading to improved resection of malignant tissues without compromising viable structures. In this Perspective, we summarize some of the key research advances in chemistry, biology, and engineering that have accelerated the translation of optical imaging technologies for use in human patients. Finally, our paper comments on several research areas where further work will likely render the next generation of technologies for translational optical imaging.
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Affiliation(s)
- Deborah Seah
- School
of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University Singapore 637371, Singapore
- Centre
for Inflammation Research, The University
of Edinburgh, EH16 4UU Edinburgh, U.K.
| | - Zhiming Cheng
- Centre
for Inflammation Research, The University
of Edinburgh, EH16 4UU Edinburgh, U.K.
- IRR
Chemistry Hub, Institute for Regeneration and Repair, The University of Edinburgh, EH16 4UU Edinburgh, U.K.
| | - Marc Vendrell
- Centre
for Inflammation Research, The University
of Edinburgh, EH16 4UU Edinburgh, U.K.
- IRR
Chemistry Hub, Institute for Regeneration and Repair, The University of Edinburgh, EH16 4UU Edinburgh, U.K.
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Patel I, Rehman S, McKay S, Bartlett D, Mirza D. Use of Near-Infrared Fluorescence Techniques in Minimally Invasive Surgery for Colorectal Liver Metastases. J Clin Med 2023; 12:5536. [PMID: 37685603 PMCID: PMC10488819 DOI: 10.3390/jcm12175536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/04/2023] [Accepted: 08/12/2023] [Indexed: 09/10/2023] Open
Abstract
Colorectal liver metastases (CRLM) afflict a significant proportion of patients with colorectal cancer (CRC), ranging from 25% to 30% of patients throughout the course of the disease. In recent years, there has been a surge of interest in the application of near-infrared fluorescence (NIRF) imaging as an intraoperative imaging technique for liver surgery. The utilisation of NIRF-guided liver surgery, facilitated by the administration of fluorescent dye indocyanine green (ICG), has gained traction in numerous medical institutions worldwide. This innovative approach aims to enhance lesion differentiation and provide valuable guidance for surgical margins. The use of ICG, particularly in minimally invasive surgery, has the potential to improve lesion detection rates, increase the likelihood of achieving R0 resection, and enable anatomically guided resections. However, it is important to acknowledge the limitations of ICG, such as its low specificity. Consequently, there has been a growing demand for the development of tumour-specific fluorescent probes and the advancement of camera systems, which are expected to address these concerns and further refine the accuracy and reliability of intraoperative fluorescence imaging in liver surgery. While NIRF imaging has been extensively studied in patients with CRLM, it is worth noting that a significant proportion of published research has predominantly focused on the detection of hepatocellular carcinoma (HCC). In this study, we present a comprehensive literature review of the existing literature pertaining to intraoperative fluorescence imaging in minimally invasive surgery for CRLM. Moreover, our analysis places specific emphasis on the techniques employed in liver resection using ICG, with a focus on tumour detection in minimal invasive surgery (MIS). Additionally, we delve into recent developments in this field and offer insights into future perspectives for further advancements.
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Affiliation(s)
- Ishaan Patel
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Saad Rehman
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Siobhan McKay
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
- Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW 2065, Australia
| | - David Bartlett
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Darius Mirza
- Hon Professor of HPB and Transplant Surgery, University of Birmingham, Edgbaston, Birmingham B15 2TH, UK
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Sharma A, Kumar R, Yadav G, Garg P. Artificial intelligence in intestinal polyp and colorectal cancer prediction. Cancer Lett 2023; 565:216238. [PMID: 37211068 DOI: 10.1016/j.canlet.2023.216238] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/23/2023]
Abstract
Artificial intelligence (AI) algorithms and their application to disease detection and decision support for healthcare professions have greatly evolved in the recent decade. AI has been widely applied and explored in gastroenterology for endoscopic analysis to diagnose intestinal cancers, premalignant polyps, gastrointestinal inflammatory lesions, and bleeding. Patients' responses to treatments and prognoses have both been predicted using AI by combining multiple algorithms. In this review, we explored the recent applications of AI algorithms in the identification and characterization of intestinal polyps and colorectal cancer predictions. AI-based prediction models have the potential to help medical practitioners diagnose, establish prognoses, and find accurate conclusions for the treatment of patients. With the understanding that rigorous validation of AI approaches using randomized controlled studies is solicited before widespread clinical use by health authorities, the article also discusses the limitations and challenges associated with deploying AI systems to diagnose intestinal malignancies and premalignant lesions.
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Affiliation(s)
- Anju Sharma
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research, S.A.S Nagar, 160062, Punjab, India
| | - Rajnish Kumar
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow Campus, Uttar Pradesh, 226010, India; Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | - Garima Yadav
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow Campus, Uttar Pradesh, 226010, India
| | - Prabha Garg
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research, S.A.S Nagar, 160062, Punjab, India.
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Sutton PA, van Dam MA, Cahill RA, Mieog S, Polom K, Vahrmeijer AL, van der Vorst J. Fluorescence-guided surgery: comprehensive review. BJS Open 2023; 7:7162090. [PMID: 37183598 PMCID: PMC10183714 DOI: 10.1093/bjsopen/zrad049] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Despite significant improvements in preoperative workup and surgical planning, surgeons often rely on their eyes and hands during surgery. Although this can be sufficient in some patients, intraoperative guidance is highly desirable. Near-infrared fluorescence has been advocated as a potential technique to guide surgeons during surgery. METHODS A literature search was conducted to identify relevant articles for fluorescence-guided surgery. The literature search was performed using Medical Subject Headings on PubMed for articles in English until November 2022 and a narrative review undertaken. RESULTS The use of invisible light, enabling real-time imaging, superior penetration depth, and the possibility to use targeted imaging agents, makes this optical imaging technique increasingly popular. Four main indications are described in this review: tissue perfusion, lymph node assessment, anatomy of vital structures, and tumour tissue imaging. Furthermore, this review provides an overview of future opportunities in the field of fluorescence-guided surgery. CONCLUSION Fluorescence-guided surgery has proven to be a widely innovative technique applicable in many fields of surgery. The potential indications for its use are diverse and can be combined. The big challenge for the future will be in bringing experimental fluorophores and conjugates through trials and into clinical practice, as well as validation of computer visualization with large data sets. This will require collaborative surgical groups focusing on utility, efficacy, and outcomes for these techniques.
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Affiliation(s)
- Paul A Sutton
- The Colorectal and Peritoneal Oncology Centre, Christie Hospital, Manchester, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Martijn A van Dam
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ronan A Cahill
- RAC, UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
- RAC, Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sven Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Karol Polom
- Clinic of Oncological, Transplantation and General Surgery, Gdansk Medical University, Gdansk, Poland
| | | | - Joost van der Vorst
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Knoblauch M, Kühn F, von Ehrlich-Treuenstätt V, Werner J, Renz BW. Diagnostic and Therapeutic Management of Early Colorectal Cancer. Visc Med 2023; 39:10-16. [PMID: 37265550 PMCID: PMC10230821 DOI: 10.1159/000526633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/17/2022] [Indexed: 03/03/2024] Open
Abstract
Background Early colorectal cancer (eCRC) is defined as cancer that does not cross the submucosal layer of the colon or rectum, including carcinoma in situ (pTis), pT1a, and pT1b. Early carcinomas differ in their prognosis depending on the risk profile. The differentiation between low and high risk is essential. The low-risk group includes R0-resected, well (G1) or moderately (G2) differentiated tumors without lymphatic vessel invasion (L0), without blood vessel invasion (V0) and a tumor size ≤3 cm. In this constellation, the estimated risk of lymph node metastasis is around 1% or below. The high-risk group includes tumors with incomplete resection (Rx), poor (G3) or undifferentiated (G4) carcinomas, and/or lymphatic and blood vessel invasion (L1) and size ≥3 cm. In a "high-risk" situation, there is a risk for lymph node metastasis of up to 23%. Summary The incidence of eCRC is rising with a rate of 10% in all endoscopically removed lesions during colonoscopy. For a correct histological evaluation, all suspected lesions should be completely resected. In case of a pT1 lesion in the rectum, pelvic magnetic resonance imaging should be performed to evaluate for suspicious lymph nodes. The therapeutic approach for eCRC is based on histological assessment and ranges from endoscopic resection to radical oncological surgery. The advantages, disadvantages, and associated risks of the individual treatment strategy need to be carefully discussed on a tumor board and with the patient. Key Messages Treatment options for early colorectal cancer depend on the histological assessment. Poorly differentiated carcinomas, a Kudo ≥ SM2 classified lesion, and a Haggitt level 4 always represent a "high-risk" situation. It should also be mentioned that in rectal cancer, local surgical tumor excision (full-wall excision) is also sufficient for pT1 carcinomas with a "low-risk" constellation (G1/G2; L0, size <3 cm) and an R0 resection.
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Preoperative Immunocite-Derived Ratios Predict Surgical Complications Better when Artificial Neural Networks Are Used for Analysis-A Pilot Comparative Study. J Pers Med 2023; 13:jpm13010101. [PMID: 36675762 PMCID: PMC9861480 DOI: 10.3390/jpm13010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
We aimed to comparatively assess the prognostic preoperative value of the main peripheral blood components and their ratios-the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR)-to the use of artificial-neural-network analysis in determining undesired postoperative outcomes in colorectal cancer patients. Our retrospective study included 281 patients undergoing elective radical surgery for colorectal cancer in the last seven years. The preoperative values of SII, NLR, LMR, and PLR were analyzed in relation to postoperative complications, with a special emphasis on their ability to accurately predict the occurrence of anastomotic leak. A feed-forward fully connected multilayer perceptron network (MLP) was trained and tested alongside conventional statistical tools to assess the predictive value of the abovementioned blood markers in terms of sensitivity and specificity. Statistically significant differences and moderate correlation levels were observed for SII and NLR in predicting the anastomotic leak rate and degree of postoperative complications. No correlations were found between the LMR and PLR or the abovementioned outcomes. The MLP network analysis showed superior prediction value in terms of both sensitivity (0.78 ± 0.07; 0.74 ± 0.04; 0.71 ± 0.13) and specificity (0.81 ± 0.11; 0.69 ± 0.03; 0.9 ± 0.04) for all the given tasks. Preoperative SII and NLR appear to be modest prognostic factors for anastomotic leakage and overall morbidity. Using an artificial neural network offers superior prognostic results in the preoperative risk assessment for overall morbidity and anastomotic leak rate.
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11
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Modern Machine Learning Practices in Colorectal Surgery: A Scoping Review. J Clin Med 2022; 11:jcm11092431. [PMID: 35566555 PMCID: PMC9100508 DOI: 10.3390/jcm11092431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/12/2022] [Accepted: 03/29/2022] [Indexed: 12/09/2022] Open
Abstract
Objective: The use of machine learning (ML) has revolutionized every domain of medicine. Surgeons are now using ML models for disease detection and outcome prediction with high precision. ML-guided colorectal surgeries are more efficient than conventional surgical procedures. The primary aim of this paper is to provide an overview of the latest research on “ML in colorectal surgery”, with its viable applications. Methods: PubMed, Google Scholar, Medline, and Cochrane library were searched. Results: After screening, 27 articles out of 172 were eventually included. Among all of the reviewed articles, those found to fit the criteria for inclusion had exclusively focused on ML in colorectal surgery, with justified applications. We identified existing applications of ML in colorectal surgery. Additionally, we discuss the benefits, risks, and safety issues. Conclusions: A better, more sustainable, and more efficient method, with useful applications, for ML in surgery is possible if we and data scientists work together to address the drawbacks of the current approach. Potential problems related to patients’ perspectives also need to be resolved. The development of accurate technologies alone will not solve the problem of perceived unreliability from the patients’ end. Confidence can only be developed within society if more research with precise results is carried out.
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Sterkenburg AJ, Hooghiemstra WTR, Schmidt I, Ntziachristos V, Nagengast WB, Gorpas D. Standardization and implementation of fluorescence molecular endoscopy in the clinic. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-210302SS-PERR. [PMID: 35170264 PMCID: PMC8847121 DOI: 10.1117/1.jbo.27.7.074704] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/19/2022] [Indexed: 05/26/2023]
Abstract
SIGNIFICANCE Near-infrared fluorescence molecular endoscopy (NIR-FME) is an innovative technique allowing for in vivo visualization of molecular processes in hollow organs. Despite its potential for clinical translation, NIR-FME still faces challenges, for example, the lack of consensus in performing quality control and standardization of procedures and systems. This may hamper the clinical approval of the technology by authorities and its acceptance by endoscopists. Until now, several clinical trials using NIR-FME have been performed. However, most of these trials had different study designs, making comparison difficult. AIM We describe the need for standardization in NIR-FME, provide a pathway for setting up a standardized clinical study, and describe future perspectives for NIR-FME. Body: Standardization is challenging due to many parameters. Invariable parameters refer to the hardware specifications. Variable parameters refer to movement or tissue optical properties. Phantoms can be of aid when defining the influence of these variables or when standardizing a procedure. CONCLUSION There is a need for standardization in NIR-FME and hurdles still need to be overcome before a widespread clinical implementation of NIR-FME can be realized. When these hurdles are overcome, clinical outcomes can be compared and systems can be benchmarked, enabling clinical implementation.
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Affiliation(s)
- Andrea J. Sterkenburg
- University of Groningen, University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, The Netherlands
| | - Wouter T. R. Hooghiemstra
- University of Groningen, University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, The Netherlands
| | - Iris Schmidt
- University of Groningen, University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, The Netherlands
| | - Vasilis Ntziachristos
- Technical University of Munich, School of Medicine, Chair of Biological Imaging, Central Institute for Translational Cancer Research (TranslaTUM), Munich, Germany
- Helmholtz Zentrum München (GmbH), Institute of Biological and Medical Imaging, Neuherberg, Germany
| | - Wouter B. Nagengast
- University of Groningen, University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, The Netherlands
| | - Dimitris Gorpas
- Technical University of Munich, School of Medicine, Chair of Biological Imaging, Central Institute for Translational Cancer Research (TranslaTUM), Munich, Germany
- Helmholtz Zentrum München (GmbH), Institute of Biological and Medical Imaging, Neuherberg, Germany
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Hardy NP, Cahill RA. Digital surgery for gastroenterological diseases. World J Gastroenterol 2021; 27:7240-7246. [PMID: 34876786 PMCID: PMC8611203 DOI: 10.3748/wjg.v27.i42.7240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/27/2021] [Accepted: 10/20/2021] [Indexed: 02/06/2023] Open
Abstract
Advances in machine learning, computer vision and artificial intelligence methods, in combination with those in processing and cloud computing capability, portend the advent of true decision support during interventions in real-time and soon perhaps in automated surgical steps. Such capability, deployed alongside technology intraoperatively, is termed digital surgery and can be delivered without the need for high-end capital robotic investment. An area close to clinical usefulness right now harnesses advances in near infrared endolaparoscopy and fluorescence guidance for tissue characterisation through the use of biophysics-inspired algorithms. This represents a potential synergistic methodology for the deep learning methods currently advancing in ophthalmology, radiology, and recently gastroenterology via colonoscopy. As databanks of more general surgical videos are created, greater analytic insights can be derived across the operative spectrum of gastroenterological disease and operations (including instrumentation and operative step sequencing and recognition, followed over time by surgeon and instrument performance assessment) and linked to value-based outcomes. However, issues of legality, ethics and even morality need consideration, as do the limiting effects of monopolies, cartels and isolated data silos. Furthermore, the role of the surgeon, surgical societies and healthcare institutions in this evolving field needs active deliberation, as the default risks relegation to bystander or passive recipient. This editorial provides insight into this accelerating field by illuminating the near-future and next decade evolutionary steps towards widespread clinical integration for patient and societal benefit.
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Affiliation(s)
- Niall Philip Hardy
- UCD Centre for Precision Surgery, University College Dublin, Dublin D07 Y9AW, Ireland
| | - Ronan Ambrose Cahill
- UCD Centre for Precision Surgery, University College Dublin, Dublin D07 Y9AW, Ireland
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Mitsala A, Tsalikidis C, Pitiakoudis M, Simopoulos C, Tsaroucha AK. Artificial Intelligence in Colorectal Cancer Screening, Diagnosis and Treatment. A New Era. ACTA ACUST UNITED AC 2021; 28:1581-1607. [PMID: 33922402 PMCID: PMC8161764 DOI: 10.3390/curroncol28030149] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/09/2021] [Accepted: 04/20/2021] [Indexed: 12/24/2022]
Abstract
The development of artificial intelligence (AI) algorithms has permeated the medical field with great success. The widespread use of AI technology in diagnosing and treating several types of cancer, especially colorectal cancer (CRC), is now attracting substantial attention. CRC, which represents the third most commonly diagnosed malignancy in both men and women, is considered a leading cause of cancer-related deaths globally. Our review herein aims to provide in-depth knowledge and analysis of the AI applications in CRC screening, diagnosis, and treatment based on current literature. We also explore the role of recent advances in AI systems regarding medical diagnosis and therapy, with several promising results. CRC is a highly preventable disease, and AI-assisted techniques in routine screening represent a pivotal step in declining incidence rates of this malignancy. So far, computer-aided detection and characterization systems have been developed to increase the detection rate of adenomas. Furthermore, CRC treatment enters a new era with robotic surgery and novel computer-assisted drug delivery techniques. At the same time, healthcare is rapidly moving toward precision or personalized medicine. Machine learning models have the potential to contribute to individual-based cancer care and transform the future of medicine.
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Affiliation(s)
- Athanasia Mitsala
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, Dragana, 68100 Alexandroupolis, Greece; (C.T.); (M.P.); (C.S.)
- Correspondence: ; Tel.: +30-6986423707
| | - Christos Tsalikidis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, Dragana, 68100 Alexandroupolis, Greece; (C.T.); (M.P.); (C.S.)
| | - Michail Pitiakoudis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, Dragana, 68100 Alexandroupolis, Greece; (C.T.); (M.P.); (C.S.)
| | - Constantinos Simopoulos
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, Dragana, 68100 Alexandroupolis, Greece; (C.T.); (M.P.); (C.S.)
| | - Alexandra K. Tsaroucha
- Laboratory of Experimental Surgery & Surgical Research, Democritus University of Thrace Medical School, Dragana, 68100 Alexandroupolis, Greece;
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