CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(10): E1497-E1503
DOI: 10.1055/a-1512-5175
Original article

Algorithm combining virtual chromoendoscopy features for colorectal polyp classification

Ramon-Michel Schreuder
1   Department of Gastroenterology and Hepatology, Catharina Cancer Institute, Catharina Hospital Eindhoven, The Netherlands
,
Qurine E.W. van der Zander
2   Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
3   GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
,
Roger Fonollà
4   Department of Electrical Engineering, Eindhoven University of Technology, The Netherlands
,
Lennard P.L. Gilissen
1   Department of Gastroenterology and Hepatology, Catharina Cancer Institute, Catharina Hospital Eindhoven, The Netherlands
,
Arnold Stronkhorst
1   Department of Gastroenterology and Hepatology, Catharina Cancer Institute, Catharina Hospital Eindhoven, The Netherlands
,
Birgitt Klerkx
1   Department of Gastroenterology and Hepatology, Catharina Cancer Institute, Catharina Hospital Eindhoven, The Netherlands
,
Peter H.N. de With
4   Department of Electrical Engineering, Eindhoven University of Technology, The Netherlands
,
Ad M. Masclee
2   Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
,
Fons van der Sommen
4   Department of Electrical Engineering, Eindhoven University of Technology, The Netherlands
,
Erik J. Schoon
1   Department of Gastroenterology and Hepatology, Catharina Cancer Institute, Catharina Hospital Eindhoven, The Netherlands
› Author Affiliations

Abstract

Background and study aims Colonoscopy is considered the gold standard for decreasing colorectal cancer incidence and mortality. Optical diagnosis of colorectal polyps (CRPs) is an ongoing challenge in clinical colonoscopy and its accuracy among endoscopists varies widely. Computer-aided diagnosis (CAD) for CRP characterization may help to improve this accuracy. In this study, we investigated the diagnostic accuracy of a novel algorithm for polyp malignancy classification by exploiting the complementary information revealed by three specific modalities.

Methods We developed a CAD algorithm for CRP characterization based on high-definition, non-magnified white light (HDWL), Blue light imaging (BLI) and linked color imaging (LCI) still images from routine exams. All CRPs were collected prospectively and classified into benign or premalignant using histopathology as gold standard. Images and data were used to train the CAD algorithm using triplet network architecture. Our training dataset was validated using a threefold cross validation.

Results In total 609 colonoscopy images of 203 CRPs of 154 consecutive patients were collected. A total of 174 CRPs were found to be premalignant and 29 were benign. Combining the triplet network features with all three image enhancement modalities resulted in an accuracy of 90.6 %, 89.7 % sensitivity, 96.6 % specificity, a positive predictive value of 99.4 %, and a negative predictive value of 60.9 % for CRP malignancy classification. The classification time for our CAD algorithm was approximately 90 ms per image.

Conclusions Our novel approach and algorithm for CRP classification differentiates accurately between benign and premalignant polyps in non-magnified endoscopic images. This is the first algorithm combining three optical modalities (HDWL/BLI/LCI) exploiting the triplet network approach.



Publication History

Received: 26 December 2020

Accepted: 11 May 2021

Article published online:
16 September 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Torre LA, Bray F, Siegel RL. et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65: 87-108
  • 2 van de Wetering AJ, Meulen LW, Bogie RM. et al. Optical diagnosis of diminutive polyps in the Dutch Bowel Cancer Screening Program: Are we ready to start?. Endosc Int Open 2020; 8: E257-E265
  • 3 Ladabaum U, Fioritto A, Mitani AK. et al. Real-time optical biopsy of colon polyps with narrow band imaging in community practice does not yet meet key thresholds for clinical decisions. Gastroenterology 2013; 144: 81-91
  • 4 Rees CJ, Rajasekhar PT, Wilson A. et al. Narrow band imaging optical diagnosis of small colorectal polyps in routine clinical practice: the Detect Inspect Characterise Resect and Discard 2 (DISCARD 2) study. Gut 2017; 66: 887-895
  • 5 Rex DK, Kahi C, OʼBrien M. et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2011; 73: 419-422
  • 6 Muguruma N, Miyamoto H, Okahisa T. et al. Endoscopic Molecular imaging: status and future perspective. Clin Endosc 2013; 46: 603-610
  • 7 Yoshida N, Yagi N, Inada Y. et al. Ability of a novel blue laser imaging system for the diagnosis of colorectal polyps. Dig Endosc 2014; 26: 250-258
  • 8 Min M, Su S, He W. et al. Computer-aided diagnosis of colorectal polyps using linked color imaging colonoscopy to predict histology. Sci Rep 2019; 9: 2881
  • 9 Gross S, Trautwein C, Behrens A. et al. Computer-based classification of small colorectal polyps by using narrow-band imaging with optical magnification. Gastrointest Endosc 2011; 74: 1354-1359
  • 10 Kominami Y, Yoshida S, Tanaka S. et al. Computer-aided diagnosis of colorectal polyp histology by using a real-time image recognition system and narrow-band imaging magnifying colonoscopy. Gastrointest Endosc 2016; 83: 643-649
  • 11 Chen PJ, Lin MC, Lai MJ. et al. Accurate classification of diminutive colorectal polyps using computer-aided analysis. Gastroenterology 2018; 154: 568-575
  • 12 Gross S, Trautwein C, Behrens A. et al. Computer-based classification of small colorectal polyps by using narrow-band imaging with optical magnification. Gastrointest Endosc 2011; 74: 1354-1359
  • 13 Kiesslich R, Burg J, Vieth M. et al. Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo. Gastroenterology 2004; 127: 706-713
  • 14 Kominami Y, Yoshida S, Tanaka SB. et al. Computer-aided diagnosis of colorectal polyp histology by using a real-time image recognition system and narrow-band imaging magnifying colonoscopy. Gastrointest Endosc 2016; 83: 643-649
  • 15 Kudo SE, Mori Y, Wakamura K. et al. Endocytoscopy can provide additional diagnostic ability to magnifying chromoendoscopy for colorectal neoplasms. J Gastroenterol Hepatol 2014; 29: 83-90
  • 16 Mesejo P, Pizarro D, Abergel A. et al. Computer-aided classification of gastrointestinal lesions in regular colonoscopy. IEEE Trans Med Imaging 2016; 35: 2051-2063
  • 17 Misawa M, Kudo SE, Mori Y. et al. Characterization of Colorectal lesions using a computer-aided diagnostic system for narrow-band imaging endocytoscopy. Gastroenterology 2016; 150: 1531-1532
  • 18 Mori Y, Kudo SE, Wakamura K. et al. Novel computer-aided diagnostic system for colorectal lesions by using endocytoscopy (with videos). Gastrointest Endosc 2015; 81: 621-629
  • 19 Mori Y, Kudo SE, Chiu PW. et al. Impact of an automated system for endocytoscopic diagnosis of small colorectal lesions: an international web-based study. Endoscopy 2016; 48: 1110-1118
  • 20 Takeda K, Kudo SE, Mori Y. et al. Accuracy of diagnosing invasive colorectal cancer using computer-aided endocytoscopy. Endoscopy 2017; 49: 798-802
  • 21 Takemura Y, Yoshida S, Tanaka S. et al. Computer-aided system for predicting the histology of colorectal tumors by using narrow-band imaging magnifying colonoscopy (with video). Gastrointest Endosc 2012; 75: 179-185
  • 22 Tischendorf JJ, Gross S, Winograd R. et al. Computer-aided classification of colorectal polyps based on vascular patterns: a pilot study. Endoscopy 2010; 42: 203-207
  • 23 Komeda Y, Handa H, Watanabe TT. et al. Computer-aided diagnosis based on convolutional neural network system for colorectal polyp classification: preliminary experience. Oncology 2017; 93: 30-34
  • 24 Byrne MF, Chapados N, Soudan F. et al. Real-time differentiation of adenomatous and hyperplastic diminutive colorectal polyps during analysis of unaltered videos of standard colonoscopy using a deep learning model. Gut 2019; 68: 94-100
  • 25 Cheng Tao Pu LZ, Maicas G. et al. Computer-aided diagnosis for characterisation of colorectal lesions: a comprehensive software including serrated lesions. Gastrointest Endosc 2020; 92: 891-899
  • 26 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297