Artificial intelligence technique in detection of early esophageal cancer

Effectiveness of Artificial Intelligence in Screening Esophagogastroduodenoscopy

BACKGROUND

This retrospective study investigated the usefulness of the EW10-EG01 artificial intelligence (AI) application for screening esophagogastroduodenoscopy (EGD).

METHODOLOGY

A total of 7,655 subjects (4,863 men, 2,792 women; mean age 54.9±10.1 years) who underwent EGD during a medical checkup were enrolled in the study. The number of diagnosed upper gastrointestinal tumors was compared between EGD examinations performed with and without the AI system.

RESULTS

EGD examinations with and without the AI system were performed on 3,841 and 3,814 subjects, respectively. Biopsy procedures were more frequently performed, and examination time was longer in EGD with AI applications than in those without. Upper gastrointestinal tumors diagnosed by EGD with and without AI were 39 (1.02%) and 24 (0.63%), respectively (P = 0.062). There was a significant difference in the detection rate of esophageal and gastric tumors between EGD with (30, 0.78%) and without (14, 0.37%) the AI system (P = 0.017). When endoscopists were divided into three groups based on their experience with the EW10-EG01 application, higher detection rates of esophageal and gastric tumors were observed in each group when using EGD with AI.

CONCLUSIONS

Usage of the EW10-EG01 AI system may be useful for screening EGD due to the increased esophageal and gastric tumor detection rate.

Esophageal cancer screening, early detection and treatment: Current insights and future directions

Esophageal cancer ranks among the most prevalent malignant tumors globally, primarily due to its highly aggressive nature and poor survival rates. According to the 2020 global cancer statistics, there were approximately 604000 new cases of esophageal cancer, resulting in 544000 deaths. The 5-year survival rate hovers around a mere 15%-25%. Notably, distinct variations exist in the risk factors associated with the two primary histological types, influencing their worldwide incidence and distribution. Squamous cell carcinoma displays a high incidence in specific regions, such as certain areas in China, where it meets the cost-effectiveness criteria for widespread endoscopy-based early diagnosis within the local population. Conversely, adenocarcinoma (EAC) represents the most common histological subtype of esophageal cancer in Europe and the United States. The role of early diagnosis in cases of EAC originating from Barrett's esophagus (BE) remains a subject of controversy. The effectiveness of early detection for EAC, particularly those arising from BE, continues to be a debated topic. The variations in how early-stage esophageal carcinoma is treated in different regions are largely due to the differing rates of early-stage cancer diagnoses. In areas with higher incidences, such as China and Japan, early diagnosis is more common, which has led to the advancement of endoscopic methods as definitive treatments. These techniques have demonstrated remarkable efficacy with minimal complications while preserving esophageal functionality. Early screening, prompt diagnosis, and timely treatment are key strategies that can significantly lower both the occurrence and death rates associated with esophageal cancer.

Assessment of hyperspectral imaging and CycleGAN-simulated narrowband techniques to detect early esophageal cancer

The clinical signs and symptoms of esophageal cancer (EC) are often not discernible until the intermediate or advanced phases. The detection of EC in advanced stages significantly decreases the survival rate to below 20%. This study conducts a comparative analysis of the efficacy of several imaging techniques, including white light image (WLI), narrowband imaging (NBI), cycle-consistent adversarial network simulated narrowband image (CNBI), and hyperspectral imaging simulated narrowband image (HNBI), in the early detection of esophageal cancer (EC). In conjunction with Kaohsiung Armed Forces General Hospital, a dataset consisting of 1000 EC pictures was used, including 500 images captured using WLI and 500 images captured using NBI. The CycleGAN model was used to generate the CNBI dataset. Additionally, a novel method for HSI imaging was created with the objective of generating HNBI pictures. The evaluation of the efficacy of these four picture types in early detection of EC was conducted using three indicators: CIEDE2000, entropy, and the structural similarity index measure (SSIM). Results of the CIEDE2000, entropy, and SSIM analyses suggest that using CycleGAN to generate CNBI images and HSI model for creating HNBI images is superior in detecting early esophageal cancer compared to the use of conventional WLI and NBI techniques.

Application of convolutional neural network-based endoscopic imaging in esophageal cancer or high-grade dysplasia: A systematic review and meta-analysis

BACKGROUND

Esophageal cancer is the seventh-most common cancer type worldwide, accounting for 5% of death from malignancy. Development of novel diagnostic techniques has facilitated screening, early detection, and improved prognosis. Convolutional neural network (CNN)-based image analysis promises great potential for diagnosing and determining the prognosis of esophageal cancer, enabling even early detection of dysplasia.

AIM

To conduct a meta-analysis of the diagnostic accuracy of CNN models for the diagnosis of esophageal cancer and high-grade dysplasia (HGD).

METHODS

PubMed, EMBASE, Web of Science and Cochrane Library databases were searched for articles published up to November 30, 2022. We evaluated the diagnostic accuracy of using the CNN model with still image-based analysis and with video-based analysis for esophageal cancer or HGD, as well as for the invasion depth of esophageal cancer. The pooled sensitivity, pooled specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the curve (AUC) were estimated, together with the 95% confidence intervals (CI). A bivariate method and hierarchical summary receiver operating characteristic method were used to calculate the diagnostic test accuracy of the CNN model. Meta-regression and subgroup analyses were used to identify sources of heterogeneity.

RESULTS

A total of 28 studies were included in this systematic review and meta-analysis. Using still image-based analysis for the diagnosis of esophageal cancer or HGD provided a pooled sensitivity of 0.95 (95%CI: 0.92-0.97), pooled specificity of 0.92 (0.89-0.94), PLR of 11.5 (8.3-16.0), NLR of 0.06 (0.04-0.09), DOR of 205 (115-365), and AUC of 0.98 (0.96-0.99). When video-based analysis was used, a pooled sensitivity of 0.85 (0.77-0.91), pooled specificity of 0.73 (0.59-0.83), PLR of 3.1 (1.9-5.0), NLR of 0.20 (0.12-0.34), DOR of 15 (6-38) and AUC of 0.87 (0.84-0.90) were found. Prediction of invasion depth resulted in a pooled sensitivity of 0.90 (0.87-0.92), pooled specificity of 0.83 (95%CI: 0.76-0.88), PLR of 7.8 (1.9-32.0), NLR of 0.10 (0.41-0.25), DOR of 118 (11-1305), and AUC of 0.95 (0.92-0.96).

CONCLUSION

CNN-based image analysis in diagnosing esophageal cancer and HGD is an excellent diagnostic method with high sensitivity and specificity that merits further investigation in large, multicenter clinical trials.

Systematic meta-analysis of computer-aided detection to detect early esophageal cancer using hyperspectral imaging

One of the leading causes of cancer deaths is esophageal cancer (EC) because identifying it in early stage is challenging. Computer-aided diagnosis (CAD) could detect the early stages of EC have been developed in recent years. Therefore, in this study, complete meta-analysis of selected studies that only uses hyperspectral imaging to detect EC is evaluated in terms of their diagnostic test accuracy (DTA). Eight studies are chosen based on the Quadas-2 tool results for systematic DTA analysis, and each of the methods developed in these studies is classified based on the nationality of the data, artificial intelligence, the type of image, the type of cancer detected, and the year of publishing. Deeks' funnel plot, forest plot, and accuracy charts were made. The methods studied in these articles show the automatic diagnosis of EC has a high accuracy, but external validation, which is a prerequisite for real-time clinical applications, is lacking.

Biomarkers for Early Detection, Prognosis, and Therapeutics of Esophageal Cancers

Esophageal cancer (EC) is the deadliest cancer worldwide, with a 92% annual mortality rate per incidence. Esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) are the two major types of ECs, with EAC having one of the worst prognoses in oncology. Limited screening techniques and a lack of molecular analysis of diseased tissues have led to late-stage presentation and very low survival durations. The five-year survival rate of EC is less than 20%. Thus, early diagnosis of EC may prolong survival and improve clinical outcomes. Cellular and molecular biomarkers are used for diagnosis. At present, esophageal biopsy during upper endoscopy and histopathological analysis is the standard screening modality for both ESCC and EAC. However, this is an invasive method that fails to yield a molecular profile of the diseased compartment. To decrease the invasiveness of the procedures for diagnosis, researchers are proposing non-invasive biomarkers for early diagnosis and point-of-care screening options. Liquid biopsy involves the collection of body fluids (blood, urine, and saliva) non-invasively or with minimal invasiveness. In this review, we have critically discussed various biomarkers and specimen retrieval techniques for ESCC and EAC.

Artificial intelligence assists precision medicine in cancer treatment

Cancer is a major medical problem worldwide. Due to its high heterogeneity, the use of the same drugs or surgical methods in patients with the same tumor may have different curative effects, leading to the need for more accurate treatment methods for tumors and personalized treatments for patients. The precise treatment of tumors is essential, which renders obtaining an in-depth understanding of the changes that tumors undergo urgent, including changes in their genes, proteins and cancer cell phenotypes, in order to develop targeted treatment strategies for patients. Artificial intelligence (AI) based on big data can extract the hidden patterns, important information, and corresponding knowledge behind the enormous amount of data. For example, the ML and deep learning of subsets of AI can be used to mine the deep-level information in genomics, transcriptomics, proteomics, radiomics, digital pathological images, and other data, which can make clinicians synthetically and comprehensively understand tumors. In addition, AI can find new biomarkers from data to assist tumor screening, detection, diagnosis, treatment and prognosis prediction, so as to providing the best treatment for individual patients and improving their clinical outcomes.

Convolutional neural network-based artificial intelligence for the diagnosis of early esophageal cancer based on endoscopic images: A meta-analysis

BACKGROUND

Early screening and treatment of esophageal cancer (EC) is particularly important for the survival and prognosis of patients. However, early EC is difficult to diagnose by a routine endoscopic examination. Therefore, convolutional neural network (CNN)-based artificial intelligence (AI) has become a very promising method in the diagnosis of early EC using endoscopic images. The aim of this study was to evaluate the diagnostic performance of CNN-based AI for detecting early EC based on endoscopic images.

METHODS

A comprehensive search was performed to identify relevant English articles concerning CNN-based AI in the diagnosis of early EC based on endoscopic images (from the date of database establishment to April 2022). The pooled sensitivity (SEN), pooled specificity (SPE), positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR) with 95% confidence interval (CI), summary receiver operating characteristic (SROC) curve, and area under the curve (AUC) for the accuracy of CNN-based AI in the diagnosis of early EC based on endoscopic images were calculated. We used the I2 test to assess heterogeneity and investigated the source of heterogeneity by performing meta-regression analysis. Publication bias was assessed using Deeks' funnel plot asymmetry test.

RESULTS

Seven studies met the eligibility criteria. The SEN and SPE were 0.90 (95% confidence interval [CI]: 0.82-0.94) and 0.91 (95% CI: 0.79-0.96), respectively. The LR+ of the malignant ultrasonic features was 9.8 (95% CI: 3.8-24.8) and the LR- was 0.11 (95% CI: 0.06-0.21), revealing that CNN-based AI exhibited an excellent ability to confirm or exclude early EC on endoscopic images. Additionally, SROC curves showed that the AUC of the CNN-based AI in the diagnosis of early EC based on endoscopic images was 0.95 (95% CI: 0.93-0.97), demonstrating that CNN-based AI has good diagnostic value for early EC based on endoscopic images.

CONCLUSIONS

Based on our meta-analysis, CNN-based AI is an excellent diagnostic tool with high sensitivity, specificity, and AUC in the diagnosis of early EC based on endoscopic images.

Intelligent Identification of Early Esophageal Cancer by Band-Selective Hyperspectral Imaging

In this study, the combination of hyperspectral imaging (HSI) technology and band selection was coupled with color reproduction. The white-light images (WLIs) were simulated as narrow-band endoscopic images (NBIs). As a result, the blood vessel features in the endoscopic image became more noticeable, and the prediction performance was improved. In addition, a single-shot multi-box detector model for predicting the stage and location of esophageal cancer was developed to evaluate the results. A total of 1780 esophageal cancer images, including 845 WLIs and 935 NBIs, were used in this study. The images were divided into three stages based on the pathological features of esophageal cancer: normal, dysplasia, and squamous cell carcinoma. The results showed that the mean average precision (mAP) reached 80% in WLIs, 85% in NBIs, and 84% in HSI images. This study's results showed that HSI has more spectral features than white-light imagery, and it improves accuracy by about 5% and matches the results of NBI predictions.

Convolutional neural network-based artificial intelligence for the diagnosis of early esophageal cancer based on endoscopic images: A meta-analysis

BACKGROUND

Early screening and treatment of esophageal cancer (EC) is particularly important for the survival and prognosis of patients. However, early EC is difficult to diagnose by a routine endoscopic examination. Therefore, convolutional neural network (CNN)-based artificial intelligence (AI) has become a very promising method in the diagnosis of early EC using endoscopic images. The aim of this study was to evaluate the diagnostic performance of CNN-based AI for detecting early EC based on endoscopic images.

METHODS

A comprehensive search was performed to identify relevant English articles concerning CNN-based AI in the diagnosis of early EC based on endoscopic images (from the date of database establishment to April 2022). The pooled sensitivity (SEN), pooled specificity (SPE), positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR) with 95% confidence interval (CI), summary receiver operating characteristic (SROC) curve, and area under the curve (AUC) for the accuracy of CNN-based AI in the diagnosis of early EC based on endoscopic images were calculated. We used the I² test to assess heterogeneity and investigated the source of heterogeneity by performing meta-regression analysis. Publication bias was assessed using Deeks' funnel plot asymmetry test.

RESULTS

Seven studies met the eligibility criteria. The SEN and SPE were 0.90 (95% confidence interval [CI]: 0.82-0.94) and 0.91 (95% CI: 0.79-0.96), respectively. The LR+ of the malignant ultrasonic features was 9.8 (95% CI: 3.8-24.8) and the LR- was 0.11 (95% CI: 0.06-0.21), revealing that CNN-based AI exhibited an excellent ability to confirm or exclude early EC on endoscopic images. Additionally, SROC curves showed that the AUC of the CNN-based AI in the diagnosis of early EC based on endoscopic images was 0.95 (95% CI: 0.93-0.97), demonstrating that CNN-based AI has good diagnostic value for early EC based on endoscopic images.

CONCLUSIONS

Based on our meta-analysis, CNN-based AI is an excellent diagnostic tool with high sensitivity, specificity, and AUC in the diagnosis of early EC based on endoscopic images.

Artificial Intelligence in the Diagnosis of Upper Gastrointestinal Diseases

Artificial intelligence (AI) has enormous potential to support clinical routine workflows and therefore is gaining increasing popularity among medical professionals. In the field of gastroenterology, investigations on AI and computer-aided diagnosis (CAD) systems have mainly focused on the lower gastrointestinal (GI) tract. However, numerous CAD tools have been tested also in upper GI disorders showing encouraging results. The main application of AI in the upper GI tract is endoscopy; however, the need to analyze increasing loads of numerical and categorical data in short times has pushed researchers to investigate applications of AI systems in other upper GI settings, including gastroesophageal reflux disease, eosinophilic esophagitis, and motility disorders. AI and CAD systems will be increasingly incorporated into daily clinical practice in the coming years, thus at least basic notions will be soon required among physicians. For noninsiders, the working principles and potential of AI may be as fascinating as obscure. Accordingly, we reviewed systematic reviews, meta-analyses, randomized controlled trials, and original research articles regarding the performance of AI in the diagnosis of both malignant and benign esophageal and gastric diseases, also discussing essential characteristics of AI.

Improving the Classification Performance of Esophageal Disease on Small Dataset by Semi-supervised Efficient Contrastive Learning

The classification of esophageal disease based on gastroscopic images is important in the clinical treatment, and is also helpful in providing patients with follow-up treatment plans and preventing lesion deterioration. In recent years, deep learning has achieved many satisfactory results in gastroscopic image classification tasks. However, most of them need a training set that consists of large numbers of images labeled by experienced experts. To reduce the image annotation burdens and improve the classification ability on small labeled gastroscopic image datasets, this study proposed a novel semi-supervised efficient contrastive learning (SSECL) classification method for esophageal disease. First, an efficient contrastive pair generation (ECPG) module was proposed to generate efficient contrastive pairs (ECPs), which took advantage of the high similarity features of images from the same lesion. Then, an unsupervised visual feature representation containing the general feature of esophageal gastroscopic images is learned by unsupervised efficient contrastive learning (UECL). At last, the feature representation will be transferred to the down-stream esophageal disease classification task. The experimental results have demonstrated that the classification accuracy of SSECL is 92.57%, which is better than that of the other state-of-the-art semi-supervised methods and is also higher than the classification method based on transfer learning (TL) by 2.28%. Thus, SSECL has solved the challenging problem of improving the classification result on small gastroscopic image dataset by fully utilizing the unlabeled gastroscopic images and the high similarity information among images from the same lesion. It also brings new insights into medical image classification tasks.

Prognostic features of the tumour microenvironment in oesophageal adenocarcinoma

Oesophageal adenocarcinoma (OAC) is a disease with an incredibly poor survival rate and a complex makeup. The growth and spread of OAC tumours are profoundly influenced by their surrounding microenvironment and the properties of the tumour itself. Constant crosstalk between the tumour and its microenvironment is key to the survival of the tumour and ultimately the death of the patient. The tumour microenvironment (TME) is composed of a complex milieu of cell types including cancer associated fibroblasts (CAFs) which make up the tumour stroma, endothelial cells which line blood and lymphatic vessels and infiltrating immune cell populations. These various cell types and the tumour constantly communicate through environmental cues including fluctuations in pH, hypoxia and the release of mitogens such as cytokines, chemokines and growth factors, many of which help promote malignant progression. Eventually clusters of tumour cells such as tumour buds break away and spread through the lymphatic system to nearby lymph nodes or enter the circulation forming secondary metastasis. Collectively, these factors need to be considered when assessing and treating patients clinically. This review aims to summarise the ways in which these various factors are currently assessed and how they relate to patient treatment and outcome at an individual level.

Modern Diagnosis of Early Esophageal Cancer: From Blood Biomarkers to Advanced Endoscopy and Artificial Intelligence

Simple Summary

Esophageal cancer (EC) has a poor prognosis when the diagnosis is delayed, but curative treatment is possible if the diagnosis is timely. The disease subtly progresses before symptoms prompt patients to seek medical attention. Effective pre-symptomatic screening strategies may improve the outcome of the disease. Recent evidence provided insights into early diagnosis of EC via blood tests, advanced endoscopic imaging, and artificial intelligence. Accordingly, we reviewed available strategies to diagnose early EC.

Abstract

Esophageal cancer (EC) is the seventh most common cancer and the sixth cause of cancer death worldwide. Histologically, esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) account for up to 90% and 20% of all ECs, respectively. Clinical symptoms such as dysphagia, odynophagia, and bolus impaction occur late in the natural history of the disease, and the diagnosis is often delayed. The prognosis of ESCC and EAC is poor in advanced stages, being survival rates less than 20% at five years. However, when the diagnosis is achieved early, curative treatment is possible, and survival exceeds 80%. For these reasons, mass screening strategies for EC are highly desirable, and several options are currently under investigation. Blood biomarkers offer an inexpensive, non-invasive screening strategy for cancers, and novel technologies have allowed the identification of candidate markers for EC. The esophagus is easily accessible via endoscopy, and endoscopic imaging represents the gold standard for cancer surveillance. However, lesion recognition during endoscopic procedures is hampered by interobserver variability. To fill this gap, artificial intelligence (AI) has recently been explored and provided encouraging results. In this review, we provide a summary of currently available options to achieve early diagnosis of EC, focusing on blood biomarkers, advanced endoscopy, and AI.

Deep learning for diagnosis of precancerous lesions in upper gastrointestinal endoscopy: A review

Upper gastrointestinal (GI) cancers are the leading cause of cancer-related deaths worldwide. Early identification of precancerous lesions has been shown to minimize the incidence of GI cancers and substantiate the vital role of screening endoscopy. However, unlike GI cancers, precancerous lesions in the upper GI tract can be subtle and difficult to detect. Artificial intelligence techniques, especially deep learning algorithms with convolutional neural networks, might help endoscopists identify the precancerous lesions and reduce interobserver variability. In this review, a systematic literature search was undertaken of the Web of Science, PubMed, Cochrane Library and Embase, with an emphasis on the deep learning-based diagnosis of precancerous lesions in the upper GI tract. The status of deep learning algorithms in upper GI precancerous lesions has been systematically summarized. The challenges and recommendations targeting this field are comprehensively analyzed for future research.