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Published in: Gastric Cancer 4/2018

01-07-2018 | Original Article

Application of artificial intelligence using a convolutional neural network for detecting gastric cancer in endoscopic images

Authors: Toshiaki Hirasawa, Kazuharu Aoyama, Tetsuya Tanimoto, Soichiro Ishihara, Satoki Shichijo, Tsuyoshi Ozawa, Tatsuya Ohnishi, Mitsuhiro Fujishiro, Keigo Matsuo, Junko Fujisaki, Tomohiro Tada

Published in: Gastric Cancer | Issue 4/2018

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Abstract

Background

Image recognition using artificial intelligence with deep learning through convolutional neural networks (CNNs) has dramatically improved and been increasingly applied to medical fields for diagnostic imaging. We developed a CNN that can automatically detect gastric cancer in endoscopic images.

Methods

A CNN-based diagnostic system was constructed based on Single Shot MultiBox Detector architecture and trained using 13,584 endoscopic images of gastric cancer. To evaluate the diagnostic accuracy, an independent test set of 2296 stomach images collected from 69 consecutive patients with 77 gastric cancer lesions was applied to the constructed CNN.

Results

The CNN required 47 s to analyze 2296 test images. The CNN correctly diagnosed 71 of 77 gastric cancer lesions with an overall sensitivity of 92.2%, and 161 non-cancerous lesions were detected as gastric cancer, resulting in a positive predictive value of 30.6%. Seventy of the 71 lesions (98.6%) with a diameter of 6 mm or more as well as all invasive cancers were correctly detected. All missed lesions were superficially depressed and differentiated-type intramucosal cancers that were difficult to distinguish from gastritis even for experienced endoscopists. Nearly half of the false-positive lesions were gastritis with changes in color tone or an irregular mucosal surface.

Conclusion

The constructed CNN system for detecting gastric cancer could process numerous stored endoscopic images in a very short time with a clinically relevant diagnostic ability. It may be well applicable to daily clinical practice to reduce the burden of endoscopists.
Literature
2.
go back to reference Sano T, Coit DG, Kim HH, Roviello F, Kassab P, Wittekind C, et al. Proposal of a new stage grouping of gastric cancer for TNM classification: international Gastric Cancer Association staging project. Gastric Cancer. 2017;20:217–25.CrossRefPubMed Sano T, Coit DG, Kim HH, Roviello F, Kassab P, Wittekind C, et al. Proposal of a new stage grouping of gastric cancer for TNM classification: international Gastric Cancer Association staging project. Gastric Cancer. 2017;20:217–25.CrossRefPubMed
3.
go back to reference Katai H, Ishikawa T, Akazawa K, Isobe Y, Miyashiro I, Oda I, et al. Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001–2007). Gastric Cancer. 2017. https://doi.org/10.1007/s10120-017-0716-7 (Epub ahead of print).CrossRefPubMed Katai H, Ishikawa T, Akazawa K, Isobe Y, Miyashiro I, Oda I, et al. Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001–2007). Gastric Cancer. 2017. https://​doi.​org/​10.​1007/​s10120-017-0716-7 (Epub ahead of print).CrossRefPubMed
4.
go back to reference Itoh H, Oohata Y, Nakamura K, Nagata T, Mibu R, Nakayama F. Complete ten-year postgastrectomy follow-up of early gastric cancer. Am J Surg. 1989;158:14–6.CrossRefPubMed Itoh H, Oohata Y, Nakamura K, Nagata T, Mibu R, Nakayama F. Complete ten-year postgastrectomy follow-up of early gastric cancer. Am J Surg. 1989;158:14–6.CrossRefPubMed
6.
7.
9.
go back to reference Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut. 2009;58:331–6.CrossRefPubMed Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut. 2009;58:331–6.CrossRefPubMed
10.
go back to reference Choi MK, Kim GH, Park DY, Song GA, Kim DU, Ryu DY, et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center experience. Surg Endosc. 2013;27:4250–8.CrossRefPubMed Choi MK, Kim GH, Park DY, Song GA, Kim DU, Ryu DY, et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center experience. Surg Endosc. 2013;27:4250–8.CrossRefPubMed
11.
go back to reference Ahn JY, Jung HY. Long-term outcome of extended endoscopic submucosal dissection for early gastric cancer with differentiated histology. Clin Endosc. 2013;46:463–6.CrossRefPubMedPubMedCentral Ahn JY, Jung HY. Long-term outcome of extended endoscopic submucosal dissection for early gastric cancer with differentiated histology. Clin Endosc. 2013;46:463–6.CrossRefPubMedPubMedCentral
12.
go back to reference Gotoda T, Iwasaki M, Kusano C, Seewald S, Oda I. Endoscopic resection of early gastric cancer treated by guideline and expanded National Cancer Centre criteria. Br J Surg. 2010;97:868–71.CrossRefPubMed Gotoda T, Iwasaki M, Kusano C, Seewald S, Oda I. Endoscopic resection of early gastric cancer treated by guideline and expanded National Cancer Centre criteria. Br J Surg. 2010;97:868–71.CrossRefPubMed
14.
go back to reference Hosokawa O, Hattori M, Douden K, Hayashi H, Ohta K, Kaizaki Y. Difference in accuracy between gastroscopy and colonoscopy for detection of cancer. Hepatogastroenterology. 2007;54:442–4.PubMed Hosokawa O, Hattori M, Douden K, Hayashi H, Ohta K, Kaizaki Y. Difference in accuracy between gastroscopy and colonoscopy for detection of cancer. Hepatogastroenterology. 2007;54:442–4.PubMed
15.
go back to reference Hosokawa O, Tsuda S, Kidani E, Watanabe K, Tanigawa Y, Shirasaki S, et al. Diagnosis of gastric cancer up to three years after negative upper gastrointestinal endoscopy. Endoscopy. 1998;30:669–74.CrossRefPubMed Hosokawa O, Tsuda S, Kidani E, Watanabe K, Tanigawa Y, Shirasaki S, et al. Diagnosis of gastric cancer up to three years after negative upper gastrointestinal endoscopy. Endoscopy. 1998;30:669–74.CrossRefPubMed
16.
go back to reference Amin A, Gilmour H, Graham L, Paterson-Brown S, Terrace J, Crofts TJ. Gastric adenocarcinoma missed at endoscopy. J R Coll Surg Edinb. 2002;47:681–4.PubMed Amin A, Gilmour H, Graham L, Paterson-Brown S, Terrace J, Crofts TJ. Gastric adenocarcinoma missed at endoscopy. J R Coll Surg Edinb. 2002;47:681–4.PubMed
17.
go back to reference Yalamarthi S, Witherspoon P, McCole D, Auld CD. Missed diagnoses in patients with upper gastrointestinal cancers. Endoscopy. 2004;36:874–9.CrossRefPubMed Yalamarthi S, Witherspoon P, McCole D, Auld CD. Missed diagnoses in patients with upper gastrointestinal cancers. Endoscopy. 2004;36:874–9.CrossRefPubMed
18.
go back to reference Voutilainen ME, Juhola MT. Evaluation of the diagnostic accuracy of gastroscopy to detect gastric tumours: clinicopathological features and prognosis of patients with gastric cancer missed on endoscopy. Eur J Gastroenterol Hepatol. 2005;17:1345–9.CrossRefPubMed Voutilainen ME, Juhola MT. Evaluation of the diagnostic accuracy of gastroscopy to detect gastric tumours: clinicopathological features and prognosis of patients with gastric cancer missed on endoscopy. Eur J Gastroenterol Hepatol. 2005;17:1345–9.CrossRefPubMed
19.
go back to reference Zhang Q, Chen ZY, Chen CD, Liu T, Tang XW, Ren YT, et al. Training in early gastric cancer diagnosis improves the detection rate of early gastric cancer: an observational study in China. Medicine (Baltimore). 2015;94:e384.CrossRef Zhang Q, Chen ZY, Chen CD, Liu T, Tang XW, Ren YT, et al. Training in early gastric cancer diagnosis improves the detection rate of early gastric cancer: an observational study in China. Medicine (Baltimore). 2015;94:e384.CrossRef
20.
go back to reference Yamazato T, Oyama T, Yoshida T, Baba Y, Yamanouchi K, Ishii Y, et al. Two years’ intensive training in endoscopic diagnosis facilitates detection of early gastric cancer. Intern Med. 2012;51:1461–5.CrossRefPubMed Yamazato T, Oyama T, Yoshida T, Baba Y, Yamanouchi K, Ishii Y, et al. Two years’ intensive training in endoscopic diagnosis facilitates detection of early gastric cancer. Intern Med. 2012;51:1461–5.CrossRefPubMed
21.
go back to reference Yoshida S, Yamaguchi H, Tajiri H, Saito D, Hijikata A, Yoshimori M, et al. Diagnosis of early gastric cancer seen as less malignant endoscopically. Jpn J Clin Oncol. 1984;14:225–41.PubMed Yoshida S, Yamaguchi H, Tajiri H, Saito D, Hijikata A, Yoshimori M, et al. Diagnosis of early gastric cancer seen as less malignant endoscopically. Jpn J Clin Oncol. 1984;14:225–41.PubMed
22.
go back to reference Esteva A, Kuprel B, Novoa RA, Ko J, Swetter SM, Blau HM, et al. Dermatologist-level classification of skin cancer with deep neural networks. Nature. 2017;542:115–8.CrossRefPubMed Esteva A, Kuprel B, Novoa RA, Ko J, Swetter SM, Blau HM, et al. Dermatologist-level classification of skin cancer with deep neural networks. Nature. 2017;542:115–8.CrossRefPubMed
23.
go back to reference Bibault JE, Giraud P, Burgun A. Big Data and machine learning in radiation oncology: state of the art and future prospects. Cancer Lett. 2016;382:110–7.CrossRefPubMed Bibault JE, Giraud P, Burgun A. Big Data and machine learning in radiation oncology: state of the art and future prospects. Cancer Lett. 2016;382:110–7.CrossRefPubMed
24.
go back to reference Gulshan V, Peng L, Coram M, Stumpe MC, Wu D, Narayanaswamy A, et al. Development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus photographs. JAMA. 2016;316:2402–10.CrossRefPubMed Gulshan V, Peng L, Coram M, Stumpe MC, Wu D, Narayanaswamy A, et al. Development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus photographs. JAMA. 2016;316:2402–10.CrossRefPubMed
25.
go back to reference Misawa M, Kudo SE, Mori Y, Takeda K, Maeda Y, Kataoka S, et al. Accuracy of computer-aided diagnosis based on narrow-band imaging endocytoscopy for diagnosing colorectal lesions: comparison with experts. Int J Comput Assist Radiol Surg. 2017;12:757–66.CrossRefPubMed Misawa M, Kudo SE, Mori Y, Takeda K, Maeda Y, Kataoka S, et al. Accuracy of computer-aided diagnosis based on narrow-band imaging endocytoscopy for diagnosing colorectal lesions: comparison with experts. Int J Comput Assist Radiol Surg. 2017;12:757–66.CrossRefPubMed
28.
go back to reference Szegedy C, Liu W, Jia Y, Sermanet P, Reed S, Anguelov D, et al.: Going deeper with convolutions. In: Proceedings of the IEEE Conference on Computer Vision and Pattern Recognition. 2015:1–9. Szegedy C, Liu W, Jia Y, Sermanet P, Reed S, Anguelov D, et al.: Going deeper with convolutions. In: Proceedings of the IEEE Conference on Computer Vision and Pattern Recognition. 2015:1–9.
29.
go back to reference Deng, J. Dong W, Socher R, Li L, Li K, Fei-Fei L. Imagenet: A large-scale hierarchical image database. In: EEE Conference on Computer Vision and Pattern Recognition. 2009:248–55. Deng, J. Dong W, Socher R, Li L, Li K, Fei-Fei L. Imagenet: A large-scale hierarchical image database. In: EEE Conference on Computer Vision and Pattern Recognition. 2009:248–55.
32.
go back to reference Yao K, Doyama H, Gotoda T, Ishikawa H, Nagahama T, Yokoi C, et al. Diagnostic performance and limitations of magnifying narrow-band imaging in screening endoscopy of early gastric cancer: a prospective multicenter feasibility study. Gastric Cancer. 2014;17:669–79.CrossRefPubMed Yao K, Doyama H, Gotoda T, Ishikawa H, Nagahama T, Yokoi C, et al. Diagnostic performance and limitations of magnifying narrow-band imaging in screening endoscopy of early gastric cancer: a prospective multicenter feasibility study. Gastric Cancer. 2014;17:669–79.CrossRefPubMed
33.
go back to reference Gotoda T, Uedo N, Yoshinaga S, Tanuma T, Morita Y, Doyama H, et al. Basic principles and practice of gastric cancer screening using high-definition white-light gastroscopy: eyes can only see what the brain knows. Dig Endosc. 2016;28(Suppl 1):2–15.CrossRefPubMed Gotoda T, Uedo N, Yoshinaga S, Tanuma T, Morita Y, Doyama H, et al. Basic principles and practice of gastric cancer screening using high-definition white-light gastroscopy: eyes can only see what the brain knows. Dig Endosc. 2016;28(Suppl 1):2–15.CrossRefPubMed
34.
go back to reference Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. Gastric Cancer. 2011;14:101–12 (3rd English edition).CrossRef Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. Gastric Cancer. 2011;14:101–12 (3rd English edition).CrossRef
35.
go back to reference Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy. 1969;1:87–97.CrossRef Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy. 1969;1:87–97.CrossRef
Metadata
Title
Application of artificial intelligence using a convolutional neural network for detecting gastric cancer in endoscopic images
Authors
Toshiaki Hirasawa
Kazuharu Aoyama
Tetsuya Tanimoto
Soichiro Ishihara
Satoki Shichijo
Tsuyoshi Ozawa
Tatsuya Ohnishi
Mitsuhiro Fujishiro
Keigo Matsuo
Junko Fujisaki
Tomohiro Tada
Publication date
01-07-2018
Publisher
Springer Japan
Published in
Gastric Cancer / Issue 4/2018
Print ISSN: 1436-3291
Electronic ISSN: 1436-3305
DOI
https://doi.org/10.1007/s10120-018-0793-2

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