Diagnostic accuracy of convolutional neural network-based endoscopic image analysis in diagnosing gastric cancer and predicting its invasion depth: a systematic review and meta-analysis.

ABSTRACT

BACKGROUND AND AIMS: This study aimed to evaluate the accuracy and effectiveness of the convolutional neural network (CNN) in diagnosing gastric cancer and predicting the invasion depth of gastric cancer and to compare the performance of the CNN with that of endoscopists. METHODS: PubMed, Embase, Web of Science, and gray literature were searched until July 23, 2021 for studies that assessed the diagnostic accuracy of CNN-assisted examinations for gastric cancer or the invasion depth of gastric cancer. Studies meeting inclusion criteria were included in the systematic review and meta-analysis. RESULTS: Seventeen studies comprising 51,446 images and 174 videos of 5539 patients were included. The pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and area under the curve (AUC) of the CNN for diagnosing gastric cancer were 89% (95% confidence interval [CI], 85-93), 93% (95% CI, 88-97), 13.4 (95% CI, 7.3-25.5), .11 (95% CI, .07-.17), and .94 (95% CI, .91-.98), respectively. The performance of the CNN in diagnosing gastric cancer was not significantly different from that of expert endoscopists (.95 vs .90, P > .05) and was better than that of overall endoscopists (experts and nonexperts) (.95 vs .87, P < .05). The pooled sensitivity, specificity, LR+, LR-, and AUC of the CNN for predicting the invasion depth of gastric cancer were 82% (95% CI, 78-85), 90% (95% CI, 82-95), 8.4 (95% CI, 4.2-16.8), .20 (95% CI, .16-.26), and .90 (95% CI, .87-.93), respectively. CONCLUSIONS: The CNN is highly accurate in diagnosing gastric cancer and predicting the invasion depth of gastric cancer. The performance of the CNN in diagnosing gastric cancer is not significantly different from that of expert endoscopists. Studies of the real-time performance of the CNN for gastric cancer diagnosis are needed to confirm these findings.