Development of a Tongue Image-Based Machine Learning Tool for the Diagnosis of Colorectal Cancer: A Prospective Multicentre Clinical Cohort Study

Colorectal cancer (CRC) remains a persistent major global health burden, with traditional diagnostic methods like colonoscopy suffering from suboptimal patient compliance rates. This study develops an intelligent diagnostic model based on tongue images to assist in CRC diagnosis, leveraging the integrative potential of traditional tongue diagnosis and modern machine learning. Between June 2023 and July 2024, we collected and processed 1,389 tongue images from CRC patients and 1,543 from non-colorectal cancer (NCRC) participants. Our methodology combines innovative image segmentation using the Segment Anything Model (SAM) with Grounding DINO, extracts both hand-crafted features (color, texture, shape) and deep learning features via Swin-Transformer, and employs feature fusion and selection techniques. The diagnostic model achieves an accuracy of 87.93% (F1-score: 0.9072) in internal validation. In an independent external cohort of 119 CRC patients and 221 NCRC participants, it demonstrates 85.18% precision (recall: 85%, F1-score: 0.8507). This non-invasive, cost-effective approach demonstrates significant potential as a complementary screening tool for CRC, particularly in regions with limited access to conventional diagnostic resources.