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Reliable detection and classification of bacteria and other pathogens in the human body, animals, food, and water is crucial for improving and safeguarding public health. For instance, identifying the species and its antibiotic susceptibility is vital for effective bacterial infection treatment. Here we show that phase contrast time-lapse microscopy combined with deep learning is sufficient to classify four species of bacteria relevant to human health. The classification is performed on living bacteria and does not require fixation or staining, meaning that the bacterial species can be determined as the bacteria reproduce in a microfluidic device, enabling parallel determination of susceptibility to antibiotics. We assess the performance of convolutional neural networks and vision transformers, where the best model attained a class-average accuracy exceeding 98%. Our successful proof-of-principle results suggest that the methods should be challenged with data covering more species and clinically relevant isolates for future clinical use.

ObjectiveThe effect of colonoscopy on colorectal cancer mortality is limited by several factors, among them a certain miss rate, leading to limited adenoma detection rates (ADRs). We investigated the effect of an automatic polyp detection system based on deep learning on polyp detection rate and ADR.DesignIn an open, non-blinded trial, consecutive patients were prospectively randomised to undergo diagnostic colonoscopy with or without assistance of a real-time automatic polyp detection system providing a simultaneous visual notice and sound alarm on polyp detection. The primary outcome was ADR.ResultsOf 1058 patients included, 536 were randomised to standard colonoscopy, and 522 were randomised to colonoscopy with computer-aided diagnosis. The artificial intelligence (AI) system significantly increased ADR (29.1%vs20.3%, p<0.001) and the mean number of adenomas per patient (0.53vs0.31, p<0.001). This was due to a higher number of diminutive adenomas found (185vs102; p<0.001), while there was no statistical difference in larger adenomas (77vs58, p=0.075). In addition, the number of hyperplastic polyps was also significantly increased (114vs52, p<0.001).ConclusionsIn a low prevalent ADR population, an automatic polyp detection system during colonoscopy resulted in a significant increase in the number of diminutive adenomas detected, as well as an increase in the rate of hyperplastic polyps. The cost–benefit ratio of such effects has to be determined further.Trial registration numberChiCTR-DDD-17012221; Results.

There has been a vast increase in GI literature focused on the use of machine learning in endoscopy. The relative novelty of this field poses a challenge for reviewers and readers of GI journals. To appreciate scientific quality and novelty of machine learning studies, understanding of the technical basis and commonly used techniques is required. Clinicians often lack this technical background, while machine learning experts may be unfamiliar with clinical relevance and implications for daily practice. Therefore, there is an increasing need for a multidisciplinary, international evaluation on how to perform high-quality machine learning research in endoscopy. This review aims to provide guidance for readers and reviewers of peer-reviewed GI journals to allow critical appraisal of the most relevant quality requirements of machine learning studies. The paper provides an overview of common trends and their potential pitfalls and proposes comprehensive quality requirements in six overarching themes: terminology, data, algorithm description, experimental setup, interpretation of results and machine learning in clinical practice.

ObjectiveComplex phenotypes captured on histological slides represent the biological processes at play in individual cancers, but the link to underlying molecular classification has not been clarified or systematised. In colorectal cancer (CRC), histological grading is a poor predictor of disease progression, and consensus molecular subtypes (CMSs) cannot be distinguished without gene expression profiling. We hypothesise that image analysis is a cost-effective tool to associate complex features of tissue organisation with molecular and outcome data and to resolve unclassifiable or heterogeneous cases. In this study, we present an image-based approach to predict CRC CMS from standard H&E sections using deep learning.DesignTraining and evaluation of a neural network were performed using a total of n=1206 tissue sections with comprehensive multi-omic data from three independent datasets (training on FOCUS trial, n=278 patients; test on rectal cancer biopsies, GRAMPIAN cohort, n=144 patients; and The Cancer Genome Atlas (TCGA), n=430 patients). Ground truth CMS calls were ascertained by matching random forest and single sample predictions from CMS classifier.ResultsImage-based CMS (imCMS) accurately classified slides in unseen datasets from TCGA (n=431 slides, AUC)=0.84) and rectal cancer biopsies (n=265 slides, AUC=0.85). imCMS spatially resolved intratumoural heterogeneity and provided secondary calls correlating with bioinformatic prediction from molecular data. imCMS classified samples previously unclassifiable by RNA expression profiling, reproduced the expected correlations with genomic and epigenetic alterations and showed similar prognostic associations as transcriptomic CMS.ConclusionThis study shows that a prediction of RNA expression classifiers can be made from H&E images, opening the door to simple, cheap and reliable biological stratification within routine workflows.

Histological remission is evolving as an important treatment target in UC. We aimed to develop a simple histological index, aligned to endoscopy, correlated with clinical outcomes, and suited to apply to an artificial intelligence (AI) system to evaluate inflammatory activity.MethodsUsing a set of 614 biopsies from 307 patients with UC enrolled into a prospective multicentre study, we developed the Paddington International virtual ChromoendoScopy ScOre (PICaSSO) Histologic Remission Index (PHRI). Agreement with multiple other histological indices and validation for inter-reader reproducibility were assessed. Finally, to implement PHRI into a computer-aided diagnosis system, we trained and tested a novel deep learning strategy based on a CNN architecture to detect neutrophils, calculate PHRI and identify active from quiescent UC using a subset of 138 biopsies.ResultsPHRI is strongly correlated with endoscopic scores (Mayo Endoscopic Score and UC Endoscopic Index of Severity and PICaSSO) and with clinical outcomes (hospitalisation, colectomy and initiation or changes in medical therapy due to UC flare-up). A PHRI score of 1 could accurately stratify patients’ risk of adverse outcomes (hospitalisation, colectomy and treatment optimisation due to flare-up) within 12 months. Our inter-reader agreement was high (intraclass correlation 0.84). Our preliminary AI algorithm differentiated active from quiescent UC with 78% sensitivity, 91.7% specificity and 86% accuracy.ConclusionsPHRI is a simple histological index in UC, and it exhibits the highest correlation with endoscopic activity and clinical outcomes. A PHRI-based AI system was accurate in predicting histological remission.

In the field of cultural heritage, applied dyes on textiles are studied to explore their great artistic and historic values. Dye analysis is essential and important to plan correct restoration, preservation and display strategy in museums and art galleries. However, most of the existing diagnostic technologies are destructive to the historical objects. In contrast to that, spectral reflectance imaging is potential as a non-destructive and spatially resolved technique. There have been hardly any studies in classification of dyes in textile fibers using spectral imaging. In this study, we show that spectral imaging with machine learning technique is capable in preliminary screening of dyes into the natural or synthetic class. At first, sparse logistic regression algorithm is applied on reflectance data of dyed fibers to determine some discriminating bands. Then support vector machine algorithm (SVM) is applied for classification considering the reflectance of the selected spectral bands. The results show nine selected bands in short wave infrared region (SWIR, 1000–2500 nm) classify dyes with 97.4% accuracy (kappa 0.94). Interestingly, the results show that fairly accurate dye classification can be achieved using the bands at 1480nm, 1640 nm, and 2330 nm. This indicates possibilities to build an inexpensive handheld screening device for field studies.

Root and butt-rot (RBR) has a significant impact on both the material and economic outcome of timber harvesting, and therewith on the individual forest owner and collectively on the forest and wood processing industries. An accurate recording of the presence of RBR during timber harvesting would enable a mapping of the location and extent of the problem, providing a basis for evaluating spread in a climate anticipated to enhance pathogenic growth in the future. Therefore, a system to automatically identify and detect the presence of RBR would constitute an important contribution in addressing the problem without increasing workload complexity for the machine operator. In this study we developed and evaluated an approach based on RGB images to automatically detect tree-stumps and classify them as to the absence or presence of rot. Furthermore, since knowledge of the extent of RBR is valuable in categorizing logs, we also classify stumps to three classes of infestation; rot = 0%, 0% < rot < 50% and rot >= 50%. In this work we used deep learning approaches and conventional machine learning algorithms for detection and classification tasks. The results showed that tree-stumps were detected with precision rate of 95% and recall of 80%. Using only the correct output (TP) of the stump detector, stumps without and with root and butt-rot were correctly classified with accuracy of 83.5% and 77.5%. Classifying rot to three classes resulted in 79.4%, 72.4% and 74.1% accuracy for stumps with rot = 0%, 0% < rot < 50% and rot >= 50\\%, respectively. With some modifications, the algorithm developed could be used either during the harvesting operation to detect RBR regions on the tree-stumps or as a RBR detector for post-harvest assessment of tree-stumps and logs.

ObjectiveDiagnostic tests, such as Immunoscore, predict prognosis in patients with colon cancer. However, additional prognostic markers could be detected on pathological slides using artificial intelligence tools.DesignWe have developed a software to detect colon tumour, healthy mucosa, stroma and immune cells on CD3 and CD8 stained slides. The lymphocyte density and surface area were quantified automatically in the tumour core (TC) and invasive margin (IM). Using a LASSO algorithm, DGMate (DiGital tuMor pArameTErs), we detected digital parameters within the tumour cells related to patient outcomes.ResultsWithin the dataset of 1018 patients, we observed that a poorer relapse-free survival (RFS) was associated with high IM stromal area (HR 5.65; 95% CI 2.34 to 13.67; p<0.0001) and high DGMate (HR 2.72; 95% CI 1.92 to 3.85; p<0.001). Higher CD3+ TC, CD3+ IM and CD8+ TC densities were significantly associated with a longer RFS. Analysis of variance showed that CD3+ TC yielded a similar prognostic value to the classical CD3/CD8 Immunoscore (p=0.44). A combination of the IM stromal area, DGMate and CD3, designated ‘DGMuneS’, outperformed Immunoscore when used in estimating patients’ prognosis (C-index=0.601 vs 0.578, p=0.04) and was independently associated with patient outcomes following Cox multivariate analysis. A predictive nomogram based on DGMuneS and clinical variables identified a group of patients with less than 10% relapse risk and another group with a 50% relapse risk.ConclusionThese findings suggest that artificial intelligence can potentially improve patient care by assisting pathologists in better defining stage III colon cancer patients’ prognosis.

Artificial intelligence (AI) can extract complex information from visual data. Histopathology images of gastrointestinal (GI) and liver cancer contain a very high amount of information which human observers can only partially make sense of. Complementing human observers, AI allows an in-depth analysis of digitised histological slides of GI and liver cancer and offers a wide range of clinically relevant applications. First, AI can automatically detect tumour tissue, easing the exponentially increasing workload on pathologists. In addition, and possibly exceeding pathologist’s capacities, AI can capture prognostically relevant tissue features and thus predict clinical outcome across GI and liver cancer types. Finally, AI has demonstrated its capacity to infer molecular and genetic alterations of cancer tissues from histological digital slides. These are likely only the first of many AI applications that will have important clinical implications. Thus, pathologists and clinicians alike should be aware of the principles of AI-based pathology and its ability to solve clinically relevant problems, along with its limitations and biases.