Comparison of performances of artificial intelligence versus expert endoscopists for real-time assisted diagnosis of esophageal squamous cell carcinoma (with video)

Background and Aims Narrow-band imaging (NBI) is currently regarded as the standard modality for diagnosing esophageal squamous cell carcinoma (SCC). We developed a computerized image-analysis system for diagnosing esophageal SCC by NBI and estimated its performance with video images. Methods Altogether, 23,746 images from 1544 pathologically proven superficial esophageal SCCs and 4587 images from 458 noncancerous and normal tissue were used to construct an artificial intelligence (AI) system. Five- to 9-second video clips from 144 patients captured by NBI or blue-light imaging were used as the validation dataset. These video images were diagnosed by the AI system and 13 board-certified specialists (experts). Results The diagnostic process was divided into 2 parts: detection (identify suspicious lesions) and characterization (differentiate cancer from noncancer). The sensitivities, specificities, and accuracies for the detection of SCC were, respectively, 91%, 51%, and 63% for the AI system and 79%, 72%, and 75% for the experts. The sensitivity of the AI system was significantly higher than that of the experts, but its specificity was significantly lower. Sensitivities, specificities, and accuracy for the characterization of SCC were, respectively, 86%, 89%, and 88% for the AI system and 74%, 76%, and 75% for the experts. The receiver operating characteristic curve showed that the AI system had significantly better diagnostic performance than the experts. Conclusions Our AI system showed significantly higher sensitivity for detecting SCC and higher accuracy for characterizing SCC from noncancerous tissue than endoscopic experts.