Evaluation of an enhanced ResNet-18 classification model for rapid On-site diagnosis in respiratory cytology

Abstract Objective Rapid on-site evaluation (ROSE) of respiratory cytology specimens is a critical technique for accurate and timely diagnosis of lung cancer. However, in China, limited familiarity with the Diff-Quik staining method and a shortage of trained cytopathologists hamper utilization of ROSE. Therefore, developing an improved deep learning model to assist clinicians in promptly and accurately evaluating Diff-Quik stained cytology samples during ROSE has important clinical value. Methods Retrospectively, 116 digital images of Diff-Quik stained cytology samples were obtained from whole slide scans. These included 6 diagnostic categories - carcinoid, normal cells, adenocarcinoma, squamous cell carcinoma, non-small cell carcinoma, and small cell carcinoma. All malignant diagnoses were confirmed by histopathology and immunohistochemistry. The test image set was presented to 3 cytopathologists from different hospitals with varying levels of experience, as well as an artificial intelligence system, as single-choice questions. Results The diagnostic accuracy of the cytopathologists correlated with their years of practice and hospital setting. The AI model demonstrated proficiency comparable to the humans. Importantly, all combinations of AI assistance and human cytopathologist increased diagnostic efficiency to varying degrees. Conclusions This deep learning model shows promising capability as an aid for on-site diagnosis of respiratory cytology samples. However, human expertise remains essential to the diagnostic process.