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Kiani A, Uyumazturk B, Rajpurkar P, Wang A, Gao R, Jones E, Yu Y, Langlotz CP, Ball RL, Montine TJ, Martin BA, Berry GJ, Ozawa MG, Hazard FK, Brown RA, Chen SB, Wood M, Allard LS, Ylagan L, Ng AY, Shen J. Impact of a deep learning assistant on the histopathologic classification of liver cancer. NPJ Digit Med 2020; 3:23. [PMID: 32140566 PMCID: PMC7044422 DOI: 10.1038/s41746-020-0232-8] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 02/06/2020] [Indexed: 12/15/2022] Open
Abstract
Artificial intelligence (AI) algorithms continue to rival human performance on a variety of clinical tasks, while their actual impact on human diagnosticians, when incorporated into clinical workflows, remains relatively unexplored. In this study, we developed a deep learning-based assistant to help pathologists differentiate between two subtypes of primary liver cancer, hepatocellular carcinoma and cholangiocarcinoma, on hematoxylin and eosin-stained whole-slide images (WSI), and evaluated its effect on the diagnostic performance of 11 pathologists with varying levels of expertise. Our model achieved accuracies of 0.885 on a validation set of 26 WSI, and 0.842 on an independent test set of 80 WSI. Although use of the assistant did not change the mean accuracy of the 11 pathologists (p = 0.184, OR = 1.281), it significantly improved the accuracy (p = 0.045, OR = 1.499) of a subset of nine pathologists who fell within well-defined experience levels (GI subspecialists, non-GI subspecialists, and trainees). In the assisted state, model accuracy significantly impacted the diagnostic decisions of all 11 pathologists. As expected, when the model's prediction was correct, assistance significantly improved accuracy (p = 0.000, OR = 4.289), whereas when the model's prediction was incorrect, assistance significantly decreased accuracy (p = 0.000, OR = 0.253), with both effects holding across all pathologist experience levels and case difficulty levels. Our results highlight the challenges of translating AI models into the clinical setting, and emphasize the importance of taking into account potential unintended negative consequences of model assistance when designing and testing medical AI-assistance tools.
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Affiliation(s)
- Amirhossein Kiani
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Bora Uyumazturk
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Pranav Rajpurkar
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Alex Wang
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Rebecca Gao
- Stanford University School of Medicine, Stanford, CA USA
| | - Erik Jones
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Yifan Yu
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Curtis P. Langlotz
- Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Stanford, CA USA
- Department of Radiology, Stanford University, Stanford, CA USA
| | - Robyn L. Ball
- Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Stanford, CA USA
| | - Thomas J. Montine
- Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Stanford, CA USA
- Department of Pathology, Stanford University, Stanford, CA USA
| | - Brock A. Martin
- Department of Pathology, Stanford University, Stanford, CA USA
| | - Gerald J. Berry
- Department of Pathology, Stanford University, Stanford, CA USA
| | | | | | - Ryanne A. Brown
- Department of Pathology, Stanford University, Stanford, CA USA
| | - Simon B. Chen
- Department of Pathology, Stanford University, Stanford, CA USA
| | - Mona Wood
- Department of Pathology, Stanford University, Stanford, CA USA
| | - Libby S. Allard
- Department of Pathology, Stanford University, Stanford, CA USA
| | - Lourdes Ylagan
- Department of Pathology, Stanford University, Stanford, CA USA
| | - Andrew Y. Ng
- Department of Computer Science, Stanford University, Stanford, CA USA
| | - Jeanne Shen
- Center for Artificial Intelligence in Medicine & Imaging, Stanford University, Stanford, CA USA
- Department of Pathology, Stanford University, Stanford, CA USA
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Gao P, Li X, Zhao Z, Zhang N, Ma K, Li L. Diagnostic errors in fatal medical malpractice cases in Shanghai, China: 1990-2015. Diagn Pathol 2019; 14:8. [PMID: 30704492 PMCID: PMC6357365 DOI: 10.1186/s13000-019-0785-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/15/2019] [Indexed: 11/16/2022] Open
Abstract
Background Medical disputes remain unabated in China. Previous studies have shown the changes of diagnostic discrepancy over time in developed countries, but diagnostic discrepancy remains understudied in China, especially in the setting of medical disputes. We sought to describe the year-based changes of diagnostic discrepancies in medical disputes, and to identify factors associated with classes of diagnostic discrepancy. Methods We conducted a retrospective cohort study of all medically disputed cases from 1990 through 2015 in Shanghai, China, with use of necropsy as the gold standard for diagnosis. Cases were grouped based on national legislative eras. Diagnostic discrepancy was classified as major errors (class I and II), minor errors (class III and IV), no discrepancy (class V) and undetermined (class VI) based on discrepancy severity. Results There were 482 medical disputes. Cases were predominantly males (male: female = 1.6:1) and concentrated in patients less than 10 years old or between 50 and 70 years. Major and minor discrepancy accounted for 51.7 and 34.8%, respectively. Fifty-five cases (11.2%) were non-discrepant (Class V). The dispute rate remained high before the first round of legislation (mean 0.31 per 1 million patients) but declined dramatically afterwards (R2 = − 0.82, p < 0.001 for time trends). Over the national legislative eras, the annual number of cases with diagnostic errors declined steadily. Incidence rates of discrepancy decreased significantly for class I (R2 = − 0.73, p = 0.024), II (R2 = − 0.48, p = 0.013), III (R2 = − 0.69, p < 0.0001), IV (R2 = − 0.69, p < 0.0001) and V discrepancy (R2 = − 0.58, p = 0.0018). Diseases from the respiratory system had significantly lower risks of any diagnostic errors (OR = 0.48, 95% 0.24–0.95, p = 0.036). A neoplasm carrier increased by 92% the risk of any diagnostic error (OR = 1.92; 95%CI 1.18–3.14; p = 0.009) and hypertension reduced by 78% the risk of minor errors (OR = 0.22, 95%CI 0.06–0.91, p = 0.036). Severity of discrepancy relieved over years and associated with ageing in patients with cardiovascular diseases (p = 0.01). Conclusions The rate of fatal medical disputes and diagnostic discrepancy declined after stepwise legislations in China. Respiratory diseases, neoplasm carrier and hypertension could be independent predictors for assessing diagnostic errors.
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Affiliation(s)
- Pan Gao
- Department of Pathology, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Diabetes Institute, Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200032, People's Republic of China
| | - Xiaoqiang Li
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, 200032, People's Republic of China
| | - Ziqin Zhao
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Nong Zhang
- Department of Pathology, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, People's Republic of China
| | - Kaijun Ma
- Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Public Security Bureau, 803 North Zhongshan Road, Hongkou District, Shanghai, 200083, People's Republic of China.
| | - Liliang Li
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, 200032, People's Republic of China. .,Shanghai Key Laboratory of Crime Scene Evidence, Shanghai Public Security Bureau, 803 North Zhongshan Road, Hongkou District, Shanghai, 200083, People's Republic of China.
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