Gastrointestinal cancer classification and prognostication from histology using deep learning: Systematic review

European Journal of Cancer, vol. 155, pp. 200–215

Abstract

BACKGROUND: Gastrointestinal cancers account for approximately 20% of all cancer diagnoses and are responsible for 22.5% of cancer deaths worldwide. Artificial intelligence-based diagnostic support systems, in particular convolutional neural network (CNN)-based image analysis tools, have shown great potential in medical computer vision. In this systematic review, we summarise recent studies reporting CNN-based approaches for digital biomarkers for characterization and prognostication of gastrointestinal cancer pathology. METHODS: Pubmed and Medline were screened for peer-reviewed papers dealing with CNN-based gastrointestinal cancer analyses from histological slides, published between 2015 and 2020.Seven hundred and ninety titles and abstracts were screened, and 58 full-text articles were assessed for eligibility. RESULTS: Sixteen publications fulfilled our inclusion criteria dealing with tumor or precursor lesion characterization or prognostic and predictive biomarkers: 14 studies on colorectal or rectal cancer, three studies on gastric cancer and none on esophageal cancer. These studies were categorised according to their end-points: polyp characterization, tumor characterization and patient outcome. Regarding the translation into clinical practice, we identified several studies demonstrating generalization of the classifier with external tests and comparisons with pathologists, but none presenting clinical implementation. CONCLUSIONS: Results of recent studies on CNN-based image analysis in gastrointestinal cancer pathology are promising, but studies were conducted in observational and retrospective settings. Large-scale trials are needed to assess performance and predict clinical usefulness. Furthermore, large-scale trials are required for approval of CNN-based prediction models as medical devices.

Authors 14

1. Sara Kuntz

   German Cancer Research Center

   Affiliation as printed

   Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany

2. Eva Krieghoff‐Henning

   German Cancer Research Center

   Affiliation as printed

   Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany

3. Jakob Nikolas Kather Aachen Department of Medicine III

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany

4. Tanja B. Jutzi

   German Cancer Research Center

   Affiliation as printed

   Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany

5. Julia Höhn

   German Cancer Research Center

   Affiliation as printed

   Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany

6. Lennard Kiehl

   German Cancer Research Center

   Affiliation as printed

   Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany

7. Achim Hekler

   German Cancer Research Center

   Affiliation as printed

   Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany

8. Elizabeth Alwers

   German Cancer Research Center

   Affiliation as printed

   Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany

9. Christof V. Kalle

   Berlin Institute of Health at Charité - Universitätsmedizin Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Clinical-Translational Sciences, Charité University Medicine and Berlin Institute of Health (BIH), Berlin, Germany

10. Stefan Fröhling

    German Cancer Research Center · National Center for Tumor Diseases

    Affiliation as printed

    Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany

11. Jochen Sven Utikal

    German Cancer Research Center · Heidelberg University

    Affiliation as printed

    Department of Dermatology, Heidelberg University, Mannheim, Germany; Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Department of Dermatology, Heidelberg University, Mannheim, Germany

    Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany

12. Hermann Brenner

    German Cancer Research Center · National Center for Tumor Diseases · Deutsches Konsortium für Translationale Krebsforschung

    Affiliation as printed

    Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany

    Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Division of Preventive Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), Heidelberg, Germany

    German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany

13. Michael Hoffmeister

    German Cancer Research Center

    Affiliation as printed

    Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany

14. Titus Josef Brinker corresponding

    German Cancer Research Center

    Affiliation as printed

    Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany. Electronic address: titus.brinker@dkfz.de

    Digital Biomarkers for Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany