AI-based large-scale screening of gastric cancer from noncontrast CT imaging.

Journal: Nature medicine
Published Date: Jun 24, 2025

Abstract

Early detection through screening is critical for reducing gastric cancer (GC) mortality. However, in most high-prevalence regions, large-scale screening remains challenging due to limited resources, low compliance and suboptimal detection rate of upper endoscopic screening. Therefore, there is an urgent need for more efficient screening protocols. Noncontrast computed tomography (CT), routinely performed for clinical purposes, presents a promising avenue for large-scale designed or opportunistic screening. Here we developed the Gastric Cancer Risk Assessment Procedure with Artificial Intelligence (GRAPE), leveraging noncontrast CT and deep learning to identify GC. Our study comprised three phases. First, we developed GRAPE using a cohort from 2 centers in China (3,470 GC and 3,250 non-GC cases) and validated its performance on an internal validation set (1,298 cases, area under curve = 0.970) and an independent external cohort from 16 centers (18,160 cases, area under curve = 0.927). Subgroup analysis showed that the detection rate of GRAPE increased with advancing T stage but was independent of tumor location. Next, we compared the interpretations of GRAPE with those of radiologists and assessed its potential in assisting diagnostic interpretation. Reader studies demonstrated that GRAPE significantly outperformed radiologists, improving sensitivity by 21.8% and specificity by 14.0%, particularly in early-stage GC. Finally, we evaluated GRAPE in real-world opportunistic screening using 78,593 consecutive noncontrast CT scans from a comprehensive cancer center and 2 independent regional hospitals. GRAPE identified persons at high risk with GC detection rates of 24.5% and 17.7% in 2 regional hospitals, with 23.2% and 26.8% of detected cases in T1/T2 stage. Additionally, GRAPE detected GC cases that radiologists had initially missed, enabling earlier diagnosis of GC during follow-up for other diseases. In conclusion, GRAPE demonstrates strong potential for large-scale GC screening, offering a feasible and effective approach for early detection. ClinicalTrials.gov registration: NCT06614179 .

Authors

  • Can Hu
    Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
  • Yingda Xia
    Department of Computer Science, Johns Hopkins University, Baltimore, Maryland.
  • Zhilin Zheng
    Hupan Laboratory, Hangzhou, China.
  • Mengxuan Cao
    Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang.
  • Guoliang Zheng
    Department of Gastric Surgery, Liaoning Cancer Hospital, Shenyang, China.
  • Shangqi Chen
    Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo.
  • Jiancheng Sun
    Department of Gastrointestinal Surgery, The Affiliated Hospital of Wenzhou Medical University, Wenzhou.
  • Wujie Chen
    Department of Radiology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou.
  • Qi Zheng
    School of Labor Economics, Capital University of Economics and Business, Beijing, China.
  • Siwei Pan
    Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
  • Yanqiang Zhang
    Industrial Research Institute of Robotics and Intelligent Equipment, Harbin Institute of Technology, Weihai 264209, China. 15732031132@163.com.
  • Jiahui Chen
    Molecular Analytics and Photonics (MAP) Lab, Program of Polymer and Color Chemistry, Department of Textile Engineering, Chemistry and Science, North Carolina State University, 1020 Main Campus Drive, Raleigh, NC, 27606, USA.
  • Pengfei Yu
    Xijing Hospital, Fourth Military Medical University, Xi'an, China.
  • Jingli Xu
    Department of Gastric Surgery.
  • Jianwei Xu
    School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
  • Zhongwei Qiu
    Alibaba DAMO Academy, Hangzhou, China; Zhejiang University, Hangzhou, China.
  • Tiancheng Lin
    Shanghai Key Lab of Digital Media Processing and Transmission, Shanghai Jiao Tong University, China; MoE Key Lab of Artificial Intelligence, AI Institute, Shanghai Jiao Tong University, China.
  • Boxiang Yun
    Hupan Laboratory, Hangzhou, China.
  • Jiawen Yao
    PAII Inc., Bethesda, Maryland.
  • Wenchao Guo
    Hupan Laboratory, Hangzhou, China.
  • Chen Gao
    Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.
  • Xianghui Kong
    Department of Urology, Wenzhou People's Hospital, Wenzhou, China.
  • Keda Chen
    Department of Urology, Wenzhou People's Hospital, Wenzhou, China.
  • Zhengle Wen
    Department of Urology, Pingyang People's Hospital, Wenzhou, China.
  • Guanxia Zhu
    Department of Radiology, Longgang People's Hospital, Wenzhou, China.
  • Jinfang Qiao
    Department of Radiology, Yuyao People's Hospital, Ningbo, China.
  • Yibo Pan
    Department of Radiology, Cixi People's Hospital, Ningbo, China.
  • Huan Li
    National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
  • Xijun Gong
    Department of Radiology, Second Affiliated Hospital of Anhui Medical University, Hefei, China.
  • Zaisheng Ye
    Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, 350000, China.
  • Weiqun Ao
    Department of Radiology, Tongde Hospital of Zhejiang Province, No. 234 Gucui Road, Zhejiang Province, 310012, Hangzhou, China. 78123858@qq.com.
  • Lei Zhang
    Division of Gastroenterology, Union Hospital, Tongji Medical College Medical College, Huazhong University of Science and Technology, Wuhan, China.
  • Xing Yan
    State Key Laboratory of Remote Sensing Science, College of Global Change and Earth System Science, Beijing Normal University, Beijing 100875, China.
  • Yahan Tong
    Department of Radiology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou.
  • Xinxin Yang
    Department of General Surgery, the First Affiliated Hospital of Jiamusi University, Jiamusi 154000, Heilongjiang, China.
  • Xiaozhong Zheng
    Department of Radiology, Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
  • Shufeng Fan
    Department of Radiology, Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
  • Jielu Cao
    Department of Radiology, Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
  • Cheng Yan
    Department of Biochemistry and Molecular Medicine, George Washington University, Washington, DC 20037, USA, Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Center for Bioinformatics and Information Technology, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20892-9760, USA, NASA Jet Propulsion Laboratory, Pasadena, CA, USA, Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20892-9760, USA, Wellcome Trust Sanger Institute, Cambridge, UK and McCormick Genomic and Proteomic Center, George Washington University, Washington, DC 20037, USA.
  • Kangjie Xie
    Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Hangzhou, China.
  • Shengjie Zhang
    CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institutes for Biological Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China.
  • Yao Wang
    Department of Gastrointestinal Surgery, Zhongshan People's Hospital, Zhongshan, Guangdong, China.
  • Lin Zheng
    Department of Minimally Invasive Intervention, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, ZhengZhou, 450008, China.
  • Yingjie Wu
    Sichuan University - Pittsburgh Institute (SCUPI), Sichuan University, Chengdu, 610207, China. yingjie.wu@scu.edu.cn.
  • Zufeng Ge
    Department of Radiology, Fenghua People's Hospital, Ningbo, China.
  • Xiyuan Tian
    Department of Radiology, Fenghua People's Hospital, Ningbo, China.
  • Xin Zhang
    First Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, Shenyang, China.
  • Yan Wang
    College of Animal Science and Technology, Beijing University of Agriculture, Beijing, China.
  • Ruolan Zhang
    Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang.
  • Yizhou Wei
    Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
  • Weiwei Zhu
    Department of Urology, Bayi Children's Hospital, Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China.
  • Jianfeng Zhang
    Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China.
  • Hanjun Qiu
    Department of Orthopedics, Fenghua People's Hospital, Ningbo, China. 289971282@qq.com.
  • Miaoguang Su
    Department of Radiology, Pingyang People's Hospital, Wenzhou, China. 39265825@qq.com.
  • Lei Shi
  • Zhiyuan Xu
    Department of Electrical Engineering and Computer Science, Syracuse University, Syracuse, NY, 13210.
  • Ling Zhang
  • Xiangdong Cheng
    Department of Gastric Surgery.

Keywords

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