Artificial intelligence for diagnosis and grading of prostate cancer in biopsies: a population-based, diagnostic study.

By P. Ström, K. Kartasalo, H. Olsson, L. Solorzano, B. Delahunt, D. Berney, D. Bostwick, A. Evans, D. Grignon, P. Humphrey and 22 more. The Lancet Oncology, 2020

504 citations recorded by the source corpus.

BACKGROUND An increasing volume of prostate biopsies and a worldwide shortage of urological pathologists puts a strain on pathology departments. Additionally, the high intra-observer and inter-observer variability in grading can result in overtreatment and undertreatment of prostate cancer. To alleviate these problems, we aimed to develop an artificial intelligence (AI) system with clinically acceptable accuracy for prostate cancer detection, localisation, and Gleason grading. METHODS We digitised 6682 slides from needle core biopsies from 976 randomly selected participants aged 50-69 in the Swedish prospective and population-based STHLM3 diagnostic study done between May 28, 2012, and Dec 30, 2014 (ISRCTN84445406), and another 271 from 93 men from outside the study. The resulting images were used to train deep neural networks for assessment of prostate biopsies. The networks were evaluated by predicting the presence, extent, and Gleason grade of malignant tissue for an independent test dataset comprising 1631 biopsies from 246 men from STHLM3 and an external validation dataset of 330 biopsies from 73 men. We also evaluated grading performance on 87 biopsies individually graded by 23 experienced urological pathologists from the International Society of Urological Pathology. We assessed discriminatory performance by receiver operating characteristics and tumour extent predictions by correlating predicted cancer length against measurements by the reporting pathologist. We quantified the concordance between grades assigned by the AI system and the expert urological pathologists using Cohen's kappa. FINDINGS The AI achieved an area under the receiver operating characteristics curve of 0·997 (95% CI 0·994-0·999) for distinguishing between benign (n=910) and malignant (n=721) biopsy cores on the independent test dataset and 0·986 (0·972-0·996) on the external validation dataset (benign n=108, malignant n=222). The correlation between cancer length predicted by the AI and assigned by the reporting pathologist was 0·96 (95% CI 0·95-0·97) for the independent test dataset and 0·87 (0·84-0·90) for the external validation dataset. For assigning Gleason grades, the AI achieved a mean pairwise kappa of 0·62, which was within the range of the corresponding values for the expert pathologists (0·60-0·73). INTERPRETATION An AI system can be trained to detect and grade cancer in prostate needle biopsy samples at a ranking comparable to that of international experts in prostate pathology. Clinical application could reduce pathology workload by reducing the assessment of benign biopsies and by automating the task of measuring cancer length in positive biopsy cores. An AI system with expert-level grading performance might contribute a second opinion, aid in standardising grading, and provide pathology expertise in parts of the world where it does not exist. FUNDING Swedish Research Council, Swedish Cancer Society, Swedish eScience Research Center, EIT Health.

Subfields: General Social Sciences, Political Science and International Relations

View Paper: https://www.semanticscholar.org/paper/b75246ba25f10bc002a18ee03d78981d7b48f376

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Citations in the corpus

Artificial intelligence for digital and computational pathology (2023, unknown): “Patches, nuclei, pixels, etc.”
A review of deep learning in medical imaging: Imaging traits, technology trends, case studies with progress highlights, and future promises (2020, background): “[223] both recently publish large cohort studies involving 1243 and 976 patients, respectively, and show that DL approaches could be used for achieving a performance of Gleason grading that is comparable to pathologists [224].”
Deep learning in cancer diagnosis, prognosis and treatment selection (2021, methodology): “…connections between genes) Vuong et al. [44] El Achi and Khoury [45] Trained CNNs on pathology images to predict grading of prostate [40 – 42], breast [43], colon cancer [44] and lymphoma [45] CNN & explainability Models trained on histopathology images to classify molecular subtypes of…”
Artificial intelligence in histopathology: enhancing cancer research and clinical oncology (2022, background): “Detection and grading of prostate cancer has received broad attention 27,33,34 due to the high prevalence of this disease and the typically large interobserver variation in histopathology assessment.”