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Chanda T, Hauser K, Hobelsberger S, Bucher TC, Garcia CN, Wies C, Kittler H, Tschandl P, Navarrete-Dechent C, Podlipnik S, Chousakos E, Crnaric I, Majstorovic J, Alhajwan L, Foreman T, Peternel S, Sarap S, Özdemir İ, Barnhill RL, Llamas-Velasco M, Poch G, Korsing S, Sondermann W, Gellrich FF, Heppt MV, Erdmann M, Haferkamp S, Drexler K, Goebeler M, Schilling B, Utikal JS, Ghoreschi K, Fröhling S, Krieghoff-Henning E, Brinker TJ. Dermatologist-like explainable AI enhances trust and confidence in diagnosing melanoma. Nat Commun 2024; 15:524. [PMID: 38225244 PMCID: PMC10789736 DOI: 10.1038/s41467-023-43095-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/31/2023] [Indexed: 01/17/2024] Open
Abstract
Artificial intelligence (AI) systems have been shown to help dermatologists diagnose melanoma more accurately, however they lack transparency, hindering user acceptance. Explainable AI (XAI) methods can help to increase transparency, yet often lack precise, domain-specific explanations. Moreover, the impact of XAI methods on dermatologists' decisions has not yet been evaluated. Building upon previous research, we introduce an XAI system that provides precise and domain-specific explanations alongside its differential diagnoses of melanomas and nevi. Through a three-phase study, we assess its impact on dermatologists' diagnostic accuracy, diagnostic confidence, and trust in the XAI-support. Our results show strong alignment between XAI and dermatologist explanations. We also show that dermatologists' confidence in their diagnoses, and their trust in the support system significantly increase with XAI compared to conventional AI. This study highlights dermatologists' willingness to adopt such XAI systems, promoting future use in the clinic.
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Affiliation(s)
- Tirtha Chanda
- Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katja Hauser
- Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sarah Hobelsberger
- Department of Dermatology, University Hospital, Technical University Dresden, Dresden, Germany
| | - Tabea-Clara Bucher
- Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Carina Nogueira Garcia
- Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christoph Wies
- Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty of University Heidelberg, Heidelberg, Germany
| | - Harald Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Philipp Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastian Podlipnik
- Dermatology Department, Hospital Clínic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Emmanouil Chousakos
- 1st Department of Pathology, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Iva Crnaric
- Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | | | - Linda Alhajwan
- Department of Dermatology, Dubai London Clinic, Dubai, United Arab Emirates
| | | | - Sandra Peternel
- Department of Dermatovenereology, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | | | - İrem Özdemir
- Department of Dermatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Raymond L Barnhill
- Department of Translational Research, Institut Curie, Unit of Formation and Research of Medicine University of Paris, Paris, France
| | | | - Gabriela Poch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Berlin, Germany
| | - Sören Korsing
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Wiebke Sondermann
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Erdmann
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Konstantin Drexler
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Bastian Schilling
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Jochen S Utikal
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Kamran Ghoreschi
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Berlin, Germany
| | - Stefan Fröhling
- Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eva Krieghoff-Henning
- Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Titus J Brinker
- Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Santana YRT, Oliveira LFC, Lima GM, Timbó RV, Pires EM, de Brito AR, Martins ACT, Magalhães VS, de Faria ACM, Urdapilleta AAA, Roger I, de Andrade RR, Martins LPF, Pellegrini M, de Carvalho FCA, Araújo DD, Barroso DH, Garcia CN, Feldmeier H, Gomes CM. Tungiasis in the Sanumás Amerindians in the Amazon Rainforest, Brazil: Prevalence, Intensity and Morbidity. Trop Med Infect Dis 2023; 8:386. [PMID: 37624324 PMCID: PMC10459173 DOI: 10.3390/tropicalmed8080386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/16/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Tungiasis is a disease associated with extreme poverty. We aimed to evaluate the prevalence of tungiasis in six different settlements of the Sanumás indigenous community in a remote area in the Auaris region, Yanomami territory, Brazil. METHODS We conducted an observational study to detect clinical and epidemiological factors associated with tungiasis using a cross-sectional strategy and multivariate logistic regression. Soil analysis was performed by visual and microscopic methods. RESULTS We examined 555 persons, 45 of whom had active tungiasis; 18 cases were classified as mild, 16 as moderate and 11 as severe. The disease was significantly more prevalent in children than in adults (odds ratio (OR) 15.77; 95% confidence interval (CI) = 5.34-67.91; p < 0.001). Soil infestation was significantly related to the occurrence of human tungiasis (OR = 12.29; 95% CI = 3.75-45.88). The sex and GPS location of the houses were not related to the occurrence of tungiasis. CONCLUSIONS We conclude that tungiasis is an important problem in the Sanumás community, especially for children. We suggest that interruption of the off-host transmission cycle, together with regular treatment [human and animal interventions], must be prioritized to achieve control of tungiasis in indigenous populations.
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Affiliation(s)
- Yago Ranniere Teixeira Santana
- Secretaria Especial de Saúde Indígena (SESAI), Ministério da Saúde do Brasil, Brasília 70.910-900, Brazil; (Y.R.T.S.); (L.F.C.O.); (E.M.P.)
- Programa de Pós-Graduação em Saúde Coletiva, Universidade de Brasília, Brasília 70.910-900, Brazil
| | - Lucas Felipe Carvalho Oliveira
- Secretaria Especial de Saúde Indígena (SESAI), Ministério da Saúde do Brasil, Brasília 70.910-900, Brazil; (Y.R.T.S.); (L.F.C.O.); (E.M.P.)
| | - Gabriela Mafra Lima
- Distrito Sanitário Especial Indígena (DSEI) Yanomami, Boa Vista 69.301-08, Brazil;
| | - Renata Velôzo Timbó
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília, Brasília 70.910-900, Brazil; (R.V.T.); (A.C.T.M.); (I.R.); (R.R.d.A.); (D.H.B.); (C.N.G.)
| | - Eliane Mateus Pires
- Secretaria Especial de Saúde Indígena (SESAI), Ministério da Saúde do Brasil, Brasília 70.910-900, Brazil; (Y.R.T.S.); (L.F.C.O.); (E.M.P.)
| | - Amanda Ramos de Brito
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Roraima, Boa Vista 69.310-000, Brazil; (A.R.d.B.); (F.C.A.d.C.)
| | - Ana Carolina Tardin Martins
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília, Brasília 70.910-900, Brazil; (R.V.T.); (A.C.T.M.); (I.R.); (R.R.d.A.); (D.H.B.); (C.N.G.)
| | - Vivyanne Santiago Magalhães
- Secretaria de Vigilância em Saúde, do Ministério da Saúde do Brasil, Brasília 70.723-040, Brazil; (V.S.M.); (A.C.M.d.F.)
| | - Ana Carolina Mota de Faria
- Secretaria de Vigilância em Saúde, do Ministério da Saúde do Brasil, Brasília 70.723-040, Brazil; (V.S.M.); (A.C.M.d.F.)
| | | | - Isabelle Roger
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília, Brasília 70.910-900, Brazil; (R.V.T.); (A.C.T.M.); (I.R.); (R.R.d.A.); (D.H.B.); (C.N.G.)
| | - Rafael Rocha de Andrade
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília, Brasília 70.910-900, Brazil; (R.V.T.); (A.C.T.M.); (I.R.); (R.R.d.A.); (D.H.B.); (C.N.G.)
| | | | - Marcos Pellegrini
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Roraima, Boa Vista 69.310-000, Brazil; (A.R.d.B.); (F.C.A.d.C.)
| | | | | | - Daniel Holanda Barroso
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília, Brasília 70.910-900, Brazil; (R.V.T.); (A.C.T.M.); (I.R.); (R.R.d.A.); (D.H.B.); (C.N.G.)
| | - Carina Nogueira Garcia
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília, Brasília 70.910-900, Brazil; (R.V.T.); (A.C.T.M.); (I.R.); (R.R.d.A.); (D.H.B.); (C.N.G.)
| | - Hermann Feldmeier
- Institute of Microbiology, Infectious Diseases and Immunology, Charité—University Medicine Berlin, D-14195 Berlin, Germany;
| | - Ciro Martins Gomes
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília, Brasília 70.910-900, Brazil; (R.V.T.); (A.C.T.M.); (I.R.); (R.R.d.A.); (D.H.B.); (C.N.G.)
- Programa de Pós-Graduação em Patologia Molecular, Universidade de Brasília, Brasília 70.910-900, Brazil
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Nogueira LB, Garcia CN, Costa MSCD, Moraes MBD, Kurizky PS, Gomes CM. Non-tuberculous cutaneous mycobacterioses. An Bras Dermatol 2021; 96:527-538. [PMID: 34275692 PMCID: PMC8441525 DOI: 10.1016/j.abd.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 03/22/2021] [Accepted: 04/13/2021] [Indexed: 11/22/2022] Open
Abstract
Non-tuberculous mycobacteriosis, previously known as atypical, anonymous, opportunistic, or unclassified mycobacteriosis, refers to pathogenic mycobacterioses other than those caused by Mycobacterium tuberculosis and Mycobacterium leprae. These mycobacteria are known for their environmental distribution, mainly in water and soil. The incidence of non-tuberculous mycobacteriosis has been increasing in all countries and skin infections are being increasingly studied, mainly with the increase in immunosuppressive conditions and the development of new medications that affect immunological function. In the present article, a detailed narrative review of the literature is carried out to study the main non-tuberculous mycobacteriosis that cause diseases of the skin and appendages. The article also aims to present a historical context, followed by epidemiological, microbiological, and clinical characteristics of these diseases. Practical considerations about the diagnosis and treatment of non-tuberculous mycobacteriosis are detailed.
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Affiliation(s)
- Lais Bastos Nogueira
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, DF, Brazil
| | | | | | | | - Patrícia Shu Kurizky
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, DF, Brazil; Postgraduate Program in Medical Sciences, Universidade de Brasília, Brasília, DF, Brazil
| | - Ciro Martins Gomes
- Postgraduate Program in Tropical Medicine, Universidade de Brasília, Brasília, DF, Brazil; Postgraduate Program in Medical Sciences, Universidade de Brasília, Brasília, DF, Brazil.
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