Deep learning assists detection of esophageal cancer and precursor lesions in a prospective, randomized controlled study.

Journal: Science translational medicine
Published Date: Apr 17, 2024

Abstract

Endoscopy is the primary modality for detecting asymptomatic esophageal squamous cell carcinoma (ESCC) and precancerous lesions. Improving detection rate remains challenging. We developed a system based on deep convolutional neural networks (CNNs) for detecting esophageal cancer and precancerous lesions [high-risk esophageal lesions (HrELs)] and validated its efficacy in improving HrEL detection rate in clinical practice (trial registration ChiCTR2100044126 at www.chictr.org.cn). Between April 2021 and March 2022, 3117 patients ≥50 years old were consecutively recruited from Taizhou Hospital, Zhejiang Province, and randomly assigned 1:1 to an experimental group (CNN-assisted endoscopy) or a control group (unassisted endoscopy) based on block randomization. The primary endpoint was the HrEL detection rate. In the intention-to-treat population, the HrEL detection rate [28 of 1556 (1.8%)] was significantly higher in the experimental group than in the control group [14 of 1561 (0.9%), = 0.029], and the experimental group detection rate was twice that of the control group. Similar findings were observed between the experimental and control groups [28 of 1524 (1.9%) versus 13 of 1534 (0.9%), respectively; = 0.021]. The system's sensitivity, specificity, and accuracy for detecting HrELs were 89.7, 98.5, and 98.2%, respectively. No adverse events occurred. The proposed system thus improved HrEL detection rate during endoscopy and was safe. Deep learning assistance may enhance early diagnosis and treatment of esophageal cancer and may become a useful tool for esophageal cancer screening.

Authors

  • Shao-Wei Li
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Li-Hui Zhang
    Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, China.
  • Yue Cai
    Department of Anesthesiology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China.
  • Xian-Bin Zhou
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Xin-Yu Fu
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Ya-Qi Song
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Shi-Wen Xu
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Shen-Ping Tang
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Ren-Quan Luo
    Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, China.
  • Qin Huang
    Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
  • Ling-Ling Yan
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Sai-Qin He
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Yu Zhang
    College of Marine Electrical Engineering, Dalian Maritime University, Dalian, China.
  • Jun Wang
    Department of Speech, Language, and Hearing Sciences and the Department of Neurology, The University of Texas at Austin, Austin, TX 78712, USA.
  • Shu-Qiong Ge
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Bin-Bin Gu
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Jin-Bang Peng
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Yi Wang
    Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
  • Li-Na Fang
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Wei-Dan Wu
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Wen-Guang Ye
    Department of Gastroenterology, Zhejiang University School Medicine Affiliated Hangzhou Cancer Hospital, Hangzhou 310000, China.
  • Min Zhu
    Department of Infectious Diseases, Affiliated Taizhou Hospital of Wenzhou Medical University, No.50 Ximeng Road, Taizhou, 317000, China.
  • Ding-Hai Luo
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Xiu-Xiu Jin
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Hai-Deng Yang
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Jing-Jing Zhou
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Zhen-Zhen Wang
    School of Traditional Chinese Medicine, Shenyang Pharmaceutical University Benxi 117004, China.
  • Jian-Fen Wu
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Qiao-Qiao Qin
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Yan-di Lu
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Fei Wang
    Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, United States.
  • Ya-Hong Chen
    Health Management Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Xia Chen
    Tianjin Eye Hospital, 4 Gansu Road, Tianjin, 300020, China.
  • Shan-Jing Xu
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Tao-Hsin Tung
    Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Chen-Wen Luo
    Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Li-Ping Ye
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.
  • Hong-Gang Yu
    Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430000, China.
  • Xin-Li Mao
    Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China.

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