A Novel Model Based on Deep Convolutional Neural Network Improves Diagnostic Accuracy of Intramucosal Gastric Cancer (With Video)

Prediction of intramucosal gastric cancer (GC) is a big challenge. It is not clear whether artificial intelligence could assist endoscopists in the diagnosis.A deep convolutional neural networks (DCNN) model was developed via retrospectively collected 3407 endoscopic images from 666 gastric cancer patients from two Endoscopy Centers (training dataset). The DCNN model's performance was tested with 228 images from 62 independent patients (testing dataset). The endoscopists evaluated the image and video testing dataset with or without the DCNN model's assistance, respectively. Endoscopists' diagnostic performance was compared with or without the DCNN model's assistance and investigated the effects of assistance using correlations and linear regression analyses.The DCNN model discriminated intramucosal GC from advanced GC with an AUC of 0.942 (95% CI, 0.915-0.970), a sensitivity of 90.5% (95% CI, 84.1%-95.4%), and a specificity of 85.3% (95% CI, 77.1%-90.9%) in the testing dataset. The diagnostic performance of novice endoscopists was comparable to those of expert endoscopists with the DCNN model's assistance (accuracy: 84.6% vs. 85.5%, sensitivity: 85.7% vs. 87.4%, specificity: 83.3% vs. 83.0%). The mean pairwise kappa value of endoscopists was increased significantly with the DCNN model's assistance (0.430-0.629 vs. 0.660-0.861). The diagnostic duration reduced considerably with the assistance of the DCNN model from 4.35s to 3.01s. The correlation between the perseverance of effort and diagnostic accuracy of endoscopists was diminished using the DCNN model (r: 0.470 vs. 0.076).An AI-assisted system was established and found useful for novice endoscopists to achieve comparable diagnostic performance with experts.