Development and Validation of an Automated Algorithm for Real-time Detection of Neoplasia in Barrett's Esophagus using a Low-cost, Portable Microendoscope

项目摘要/摘要 建议对Barrett‘s食道(BE)进行内窥镜监测，以便早期诊断和治疗 肿瘤(即食管腺癌和高度不典型增生)。然而，肿瘤很难被发现。 常规白光内窥镜检查(WLE；敏感性%)，单独使用WLE可漏诊26%的肿瘤。在……上面 另一方面，共焦高分辨率显微内窥镜(CHRME)是一种低成本、便携式、可重复使用的成像技术 在内窥镜检查时提供食道粘膜的显微“光学活组织检查”图像的技术 并在专家手中具有89%以上的肿瘤检测灵敏度。尽管有这些优势， CHRME的传播受限于是否有专业的显微内窥镜医师能够解释 这些类似组织病理学的图像。自动解释cHRME图像的人工智能算法 可以通过在基于社区的BE中向用户提供实时计算机辅助诊断来弥补这一差距 监测环境和减少对专家审查的需要。 我的目标是开发和验证一个自动化的软件算法，用于实时检测BE肿瘤 使用cHRME。此外，我将通过纳入传统的临床风险因素来优化软件算法 进行全面的风险分层。因此，我提出以下具体目标：目标1：技术 发展：开发一种软件算法，自动解释BE瘤的cHRME图像 侦测。目标2.技术评价和优化：(A)验证cHRME自动化软件 BE中肿瘤的实时检测算法；(B)通过集成优化自动化软件算法 人口学、生活方式和临床危险因素对BE瘤的全面检测。目标3.技术 可接受性：(A)使用计算机辅助评估内窥镜医师的可接受性和经验 (B)评估自动化软件算法在临床BE肿瘤检测中的可行性。 这项提议的首要目标是开发促进传播的人工智能算法 将新的、低成本的技术应用到社区环境中，以实现快速、实时、准确的肿瘤检测。未来 纵向研究将侧重于验证使用宏观和微观的综合风险模型 在接受监视内窥镜检查的BE患者中预测未来肿瘤风险的指标。 我的长期目标是成为一名独立资助的研究人员，研究早期的新技术 胃肠道癌症检测。我组建了一个经验丰富的指导委员会，由资深的， 资助拥有技术开发、人工智能算法、流行病学专业知识的调查人员， 生物信息学和定性研究。我的职业发展计划包括额外的正式研究培训 人工智能方法论、机器学习和临床试验。有了支持和保护时间 由K23职业发展奖提供，我将能够完成我提出的研究和职业生涯 制定发展目标，并生成初步数据，以便在独立研究资金方面具有竞争力。

Project Summary/Abstract Endoscopic surveillance of Barrett’s esophagus (BE) is recommended for early diagnosis and treatment of neoplasia (i.e., esophageal adenocarcinoma and high-grade dysplasia). However, neoplasia is difficult to detect on regular white-light endoscopy (WLE; sensitivity 64%), and 26% of neoplasia is missed with WLE alone. On the other hand, confocal high-resolution microendoscopy (cHRME) is a low-cost, portable, reusable imaging technology that provides microscopic “optical biopsy” images of the esophageal mucosa at the time of endoscopy and has sensitivity of neoplasia detection upwards of 89% in the hands of experts. Despite these advantages, the dissemination of cHRME is limited by the availability of expert microendoscopists capable of interpreting these histopathology-like images. Artificial intelligence algorithms that automate interpretation of cHRME images could bridge this gap by providing a real-time computer-assisted diagnosis to users in community-based BE surveillance settings and reducing the need for expert review. My objective is to develop and validate an automated software algorithm for real-time BE neoplasia detection using cHRME. Furthermore, I will optimize the software algorithm by incorporating traditional clinical risk factors for comprehensive risk stratification. Thus, I propose the following Specific Aims: Aim 1: Technology Development: To develop a software algorithm that automates interpretation of cHRME images in BE neoplasia detection. Aim 2. Technology Evaluation and Optimization: (a) To validate the cHRME automated software algorithm for real-time neoplasia detection in BE; (b) To optimize the automated software algorithm by integrating demographic, lifestyle, and clinical risk factors for comprehensive BE neoplasia detection. Aim 3. Technology Acceptability: (a) To evaluate the acceptability and experiences of endoscopists using computer-assisted diagnosis; (b) To assess feasibility of the automated software algorithm in clinical BE neoplasia detection. The overarching goal of this proposal is to develop artificial intelligence algorithms that facilitate dissemination of novel, low-cost technologies into community settings for rapid, real-time, accurate neoplasia detection. Future longitudinal studies will focus on validation of comprehensive risk models that use macroscopic and microscopic metrics to predict future neoplasia risk in BE patients undergoing surveillance endoscopy. My long-term goal is to become an independently funded investigator in novel techniques for early gastrointestinal cancer detection. I have assembled an experienced mentoring committee comprised of senior, funded investigators with expertise in technology development, artificial intelligence algorithms, epidemiology, bioinformatics, and qualitative research. My career development plan includes additional formal research training in artificial intelligence methodology, machine learning, and clinical trials. With the support and protected time provided by the K23 Career Development Award, I will be able to complete my proposed research and career development goals and generate preliminary data to be competitive for independent research funding.