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Lin A, Song L, Wang Y, Yan K, Tang H. Future prospects of deep learning in esophageal cancer diagnosis and clinical decision support (Review). Oncol Lett 2025; 29:293. [PMID: 40271007 PMCID: PMC12016012 DOI: 10.3892/ol.2025.15039] [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: 11/26/2024] [Accepted: 03/18/2025] [Indexed: 04/25/2025] Open
Abstract
Esophageal cancer (EC) is one of the leading causes of cancer-related mortality worldwide, still faces significant challenges in early diagnosis and prognosis. Early EC lesions often present subtle symptoms and current diagnostic methods are limited in accuracy due to tumor heterogeneity, lesion morphology and variable image quality. These limitations are particularly prominent in the early detection of precancerous lesions such as Barrett's esophagus. Traditional diagnostic approaches, such as endoscopic examination, pathological analysis and computed tomography, require improvements in diagnostic precision and staging accuracy. Deep learning (DL), a key branch of artificial intelligence, shows great promise in improving the detection of early EC lesions, distinguishing benign from malignant lesions and aiding cancer staging and prognosis. However, challenges remain, including image quality variability, insufficient data annotation and limited generalization. The present review summarized recent advances in the application of DL to medical images obtained through various imaging techniques for the diagnosis of EC at different stages. It assesses the role of DL in tumor pathology, prognosis prediction and clinical decision support, highlighting its advantages in EC diagnosis and prognosis evaluation. Finally, it provided an objective analysis of the challenges currently facing the field and prospects for future applications.
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Affiliation(s)
- Aiting Lin
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, P.R. China
- Department of Thoracic Surgery, The Second Affiliated Hospital of Naval Medical University, Shanghai 200003, P.R. China
| | - Lirong Song
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, P.R. China
| | - Ying Wang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, P.R. China
| | - Kai Yan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, P.R. China
| | - Hua Tang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Naval Medical University, Shanghai 200003, P.R. China
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Dell’Anna G, Mandarino F, Centanni L, Lodola I, Fanizza J, Fasulo E, Bencardino S, Fuccio L, Facciorusso A, Donatelli G, Parigi TL, Furfaro F, D’Amico F, Massironi S, Malesci A, Ungaro F, Danese S, Annese V. Transforming Gastrointestinal Diagnosis with Molecular Endoscopy: Challenges and Opportunities. Int J Mol Sci 2025; 26:4834. [PMID: 40429975 PMCID: PMC12112569 DOI: 10.3390/ijms26104834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2025] [Revised: 05/09/2025] [Accepted: 05/15/2025] [Indexed: 05/29/2025] Open
Abstract
Molecular endoscopy represents a transformative advance in the detection, diagnosis, and management of gastrointestinal diseases, addressing the critical limitations of conventional techniques. Current diagnostic standards, such as white light endoscopy (WLE), often fail to detect early-stage lesions, particularly in high-risk populations like Barrett's esophagus or inflammatory bowel disease patients. To overcome these challenges, molecular endoscopy, using fluorescent molecular probes, may offer ultimate precision by targeting disease-specific biomarkers. Technologies like Confocal Laser Endomicroscopy (CLE) and Immunoendoscopy are revolutionizing in vivo diagnostics, enabling the real-time visualization of tissue microarchitecture and physiological mechanisms. Fluorescence molecular endoscopy (FME) enhances the detection of precancerous and cancerous lesions, even those undetectable by conventional methods, by highlighting subtle molecular changes. Clinical applications include early tumor detection, therapy response monitoring, and improved lesion characterization. Despite these advancements, challenges persist, including high costs, a lack of standardization, and the need for specialized training. Recent innovations, such as a multi-parametric rigid standard, aim to ensure the reliable performance assessment and quality control of FME systems, addressing subjective variability and improving reproducibility. In addition, the integration of artificial intelligence (AI) with molecular endoscopy offers the potential to further reduce detection errors and significantly enhance diagnostic accuracy. This advancement underscores the potential of molecular endoscopy for personalized GI disease management, while highlighting the need for ongoing research to refine the technology, validate its clinical utility, and overcome the barriers to routine clinical application.
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Affiliation(s)
- Giuseppe Dell’Anna
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy
| | - Francesco Mandarino
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Lucia Centanni
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Ilaria Lodola
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Jacopo Fanizza
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Ernesto Fasulo
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Sarah Bencardino
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Lorenzo Fuccio
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, via Massarenti 9, 40138 Bologna, Italy;
| | - Antonio Facciorusso
- Faculty of Medicine and Surgery, University of Salento, Piazza Tancredi 7, 73100 Lecce, Italy;
| | - Gianfranco Donatelli
- Unité d’Endoscopie Interventionnelle, Hopital Privé des Peupliers, Ramsay Générale de Santé, 75013 Paris, France;
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
| | - Tommaso Lorenzo Parigi
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Federica Furfaro
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Ferdinando D’Amico
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Sara Massironi
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Alberto Malesci
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Federica Ungaro
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Silvio Danese
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Vito Annese
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
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