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Artificial intelligence in the diagnosis of gastric precancerous conditions by image-enhanced endoscopy: a multicenter, diagnostic study (with video)

  • Author Footnotes
    ∗ Drs Xu, Zhou, and Wu contributed equally to this article.
    Ming Xu
    Footnotes
    ∗ Drs Xu, Zhou, and Wu contributed equally to this article.
    Affiliations
    Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China

    Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China

    Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
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  • Author Footnotes
    ∗ Drs Xu, Zhou, and Wu contributed equally to this article.
    Wei Zhou
    Footnotes
    ∗ Drs Xu, Zhou, and Wu contributed equally to this article.
    Affiliations
    Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China

    Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China

    Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
    Search for articles by this author
  • Author Footnotes
    ∗ Drs Xu, Zhou, and Wu contributed equally to this article.
    Lianlian Wu
    Footnotes
    ∗ Drs Xu, Zhou, and Wu contributed equally to this article.
    Affiliations
    Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China

    Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China

    Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
    Search for articles by this author
  • Jun Zhang
    Affiliations
    Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China

    Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China

    Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
    Search for articles by this author
  • Jing Wang
    Affiliations
    Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China

    Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China

    Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
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  • Ganggang Mu
    Affiliations
    Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China

    Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China

    Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
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  • Xu Huang
    Affiliations
    Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China

    Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China

    Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
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  • Yanxia Li
    Affiliations
    Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China

    Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China

    Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
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  • Jingping Yuan
    Affiliations
    Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China
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  • Zhi Zeng
    Affiliations
    Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China
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  • Yonggui Wang
    Affiliations
    School of Geography and Information Engineering, China University of Geosciences, Wuhan, China
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  • Li Huang
    Affiliations
    Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China

    Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China

    Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
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  • Jun Liu
    Correspondence
    Reprint requests: Honggang Yu, MD, and Jun Liu, MM, Department of Gastroenterology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Rd, Wuhan 430060, Hubei Province, China.
    Affiliations
    Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China

    Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
    Search for articles by this author
  • Honggang Yu
    Correspondence
    Reprint requests: Honggang Yu, MD, and Jun Liu, MM, Department of Gastroenterology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Rd, Wuhan 430060, Hubei Province, China.
    Affiliations
    Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China

    Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China

    Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
    Search for articles by this author
  • Author Footnotes
    ∗ Drs Xu, Zhou, and Wu contributed equally to this article.
Published:March 12, 2021DOI:https://doi.org/10.1016/j.gie.2021.03.013

      Background and Aims

      Gastric precancerous conditions, including gastric atrophy (GA) and intestinal metaplasia (IM), play an important role in the development of gastric cancer. Image-enhanced endoscopy (IEE) shows great potential in diagnosing gastric precancerous conditions and adenocarcinoma. In this study, a deep convolutional neural network system, named ENDOANGEL, was constructed to detect gastric precancerous conditions by IEE.

      Methods

      Endoscopic images were retrospectively obtained from 5 hospitals in China for the development, validation, and internal and external test of the system. Prospective consecutive patients receiving IEE were enrolled from January 13, 2020 to October 29, 2020 in Renmin Hospital of Wuhan University to assess in real time the applicability of the proposed computer-aided detection (CADe) system in clinical practice, and the performance of CADe was compared with that of endoscopists.

      Results

      Six thousand two hundred fifty endoscopic images from 760 patients and 98 video clips from 77 individuals undergoing IEE were enrolled in this study. The diagnostic accuracy of GA was .901 (95% confidence interval [CI], .883-.917) in the internal test set, .864 (95% CI, .842-.884) in the multicenter external test set, and .878 (95% CI, .796-.935) in the prospective video test set. The diagnostic accuracy of IM was .908 (95% CI, .889-.924) in the internal test set, .859 (95% CI, .837-.880) in the multicenter external test set, and .898 (95% CI, .820-.950) in the prospective video test set. CADe achieved similar diagnostic accuracy to that of the experts for detecting GA (.869 [95% CI, .790-.927] vs .846 [95% CI, .808-.879], P = .396) and IM (.888 [95% CI, .812-.941] vs .820 [95% CI, .780-.855], P = .117) and was superior to that of nonexperts for GA (.750 [95% CI, .711-.786], P = .008) and IM (.736 [95% CI, .697-.773], P = .028).

      Conclusions

      CADe achieved high diagnostic accuracy in gastric precancerous conditions, which was similar to that of experts and superior to that of nonexperts. Thus, CADe provides possibilities for a wide application in assisting in the diagnosis of gastric precancerous conditions.

      Abbreviations:

      AI (artificial intelligence), AUC (area under curve), BLI (blue laser imaging), CADe (computer-aided detection), CI (confidence interval), DCNN (deep convolutional neutral network), GA (gastric atrophy), IEE (image-enhanced endoscopy), IM (intestinal metaplasia), MAPS II (management of epithelial precancerous conditions and lesions in the stomach), ME (magnifying endoscopy), NBI (narrow-band imaging), NPV (negative predictive value), PPV (positive predictive value), ROC (receiver operating characteristic), WLE (white-light endoscopy)
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