人工智能系统对胃癌前状态检出率影响的单中心自身对照临床研究

The effect of artificial intelligence system on the diagnosis rate of precancerous state of gastric cancer: a single center self‑controlled clinical study

摘要:

目的 评估人工智能系统对胃癌前状态检出率的影响。方法 采用单中心自身对照研究方法，在控制内镜主机、内镜型号、操作医师、季节气候等混杂因素一致的前提下，以病理学为金标准，统计分析并对比武汉市第八医院在传统胃镜操作阶段（2019-09-01—2019-11-30）和人工智能系统辅助内镜操作阶段（2020-09-01—2020-11-15）胃癌前状态（包括胃黏膜萎缩和肠上皮化生）检出率，并按照医师年资分层做亚组分析。结果 与传统胃镜操作相比，人工智能系统可显著提高胃黏膜萎缩［13.3%（38/286）比7.4%（24/323），χ2=5.689，P=0.017］和肠上皮化生检出率［33.9%（97/286）比26.0%（84/323），χ2=4.544，P=0.033］。在低年资医师（小于5年内镜经验）中，人工智能系统对胃黏膜萎缩［11.9%（22/185）比5.8%（11/189），χ2=4.284，P=0.038］和肠上皮化生检出率［30.3%（56/185）比20.6%（39/189），χ2=4.580，P=0.032］的提升作用更加显著；在高年资医师（大于10年内镜经验）中，尽管胃黏膜萎缩和肠上皮化生检出率稍增加，但差异无统计学意义。结论 人工智能系统有潜力提升内镜医师尤其是低年资内镜医师癌前状态检出率，减少早期胃癌漏诊。

Abstract:

Objective To evaluate the impact of artificial intelligence (AI) system on the diagnosis rate of precancerous state of gastric cancer. Methods A single center self‑controlled study was conducted under the premise that such factors were controlled as mainframe and model of the endoscope, operating doctor, season and climate, and pathology was taken as the gold standard. The diagnosis rate of precancerous state of gastric cancer, including atrophic gastritis (AG) and intestinal metaplasia (IM) in traditional gastroscopy (from September 1, 2019 to November 30, 2019) and AI assisted endoscopy (from September 1, 2020 to November 15, 2020) in the Eighth Hospital of Wuhan was statistically analyzed and compared, and the subgroup analysis was conducted according to the seniority of doctors. Results Compared with traditional gastroscopy, AI system could significantly improve the diagnosis rate of AG [13.3% (38/286) VS 7.4% (24/323), χ2=5.689, P=0.017] and IM [33.9% (97/286) VS 26.0% (84/323), χ2=4.544, P=0.033]. For the junior doctors (less than 5 years of endoscopic experience), AI system had a more significant effect on the diagnosis rate of AG [11.9% (22/185) VS 5.8% (11/189), χ2=4.284, P=0.038] and IM [30.3% (56/185) VS 20.6% (39/189), χ2=4.580, P=0.032]. For the senior doctors (more than 10 years of endoscopic experience), although the diagnosis rate of AG and IM increased slightly, the difference was not statistically significant. Conclusion AI system shows the potential to improve the diagnosis rate of precancerous state of gastric cancer, especially for junior endoscopists, and to reduce missed diagnosis of early gastric cancer.