Journal Article
. 2018 Oct; 9:32.
doi: 10.4103/jpi.jpi_31_18.

Diagnostic Performance of Deep Learning Algorithms Applied to Three Common Diagnoses in Dermatopathology

Thomas George Olsen 1 B Hunter Jackson 2 Theresa Ann Feeser 3 Michael N Kent 1 John C Moad 1 Smita Krishnamurthy 1 Denise D Lunsford 3 Rajath E Soans 2 
  • PMID: 30294501
  •     38 References
  •     21 citations


Background: Artificial intelligence is advancing at an accelerated pace into clinical applications, providing opportunities for increased efficiency, improved accuracy, and cost savings through computer-aided diagnostics. Dermatopathology, with emphasis on pattern recognition, offers a unique opportunity for testing deep learning algorithms.

Aims: This study aims to determine the accuracy of deep learning algorithms to diagnose three common dermatopathology diagnoses.

Methods: Whole slide images (WSI) of previously diagnosed nodular basal cell carcinomas (BCCs), dermal nevi, and seborrheic keratoses were annotated for areas of distinct morphology. Unannotated WSIs, consisting of five distractor diagnoses of common neoplastic and inflammatory diagnoses, were included in each training set. A proprietary fully convolutional neural network was developed to train algorithms to classify test images as positive or negative relative to ground truth diagnosis.

Results: Artificial intelligence system accurately classified 123/124 (99.45%) BCCs (nodular), 113/114 (99.4%) dermal nevi, and 123/123 (100%) seborrheic keratoses.

Conclusions: Artificial intelligence using deep learning algorithms is a potential adjunct to diagnosis and may result in improved workflow efficiencies for dermatopathologists and laboratories.

Keywords: Artificial intelligence; computational pathology; computer-aided diagnosis; deep learning algorithm; dermatopathology; digital pathology; whole slide images.

Deep Learning Algorithms for Detection of Lymph Node Metastases From Breast Cancer: Helping Artificial Intelligence Be Seen.
Jeffrey Alan Golden.
JAMA, 2017 Dec 14; 318(22). PMID: 29234791
Quantitative comparison of immunohistochemical staining measured by digital image analysis versus pathologist visual scoring.
Anthony E Rizzardi, Arthur T Johnson, +5 authors, Stephen C Schmechel.
Diagn Pathol, 2012 Apr 21; 7. PMID: 22515559    Free PMC article.
Highly Cited.
Validation of whole slide imaging for primary diagnosis in surgical pathology.
Thomas W Bauer, Lynn Schoenfield, +3 authors, Walter H Henricks.
Arch Pathol Lab Med, 2013 Jan 18; 137(4). PMID: 23323732
The Next Era: Deep Learning in Pharmaceutical Research.
Sean Ekins.
Pharm Res, 2016 Sep 08; 33(11). PMID: 27599991    Free PMC article.
Virtual reality microscope versus conventional microscope regarding time to diagnosis: an experimental study.
Rebecca Randell, Roy A Ruddle, +3 authors, Darren Treanor.
Histopathology, 2012 Aug 14; 62(2). PMID: 22882289
Assessment of algorithms for mitosis detection in breast cancer histopathology images.
Mitko Veta, Paul J van Diest, +26 authors, Josien P W Pluim.
Med Image Anal, 2014 Dec 31; 20(1). PMID: 25547073
Diagnostic Accuracy of Virtual Pathology vs Traditional Microscopy in a Large Dermatopathology Study.
Michael N Kent, Thomas G Olsen, +10 authors, Michael A Bottomley.
JAMA Dermatol, 2017 Oct 20; 153(12). PMID: 29049424    Free PMC article.
Digital pathology: current status and future perspectives.
Shaimaa Al-Janabi, André Huisman, Paul J Van Diest.
Histopathology, 2011 Apr 12; 61(1). PMID: 21477260
A deep learning architecture for image representation, visual interpretability and automated basal-cell carcinoma cancer detection.
Angel Alfonso Cruz-Roa, John Edison Arevalo Ovalle, Anant Madabhushi, Fabio Augusto González Osorio.
Med Image Comput Comput Assist Interv, 2014 Mar 01; 16(Pt 2). PMID: 24579166
Digital pathology and image analysis augment biospecimen annotation and biobank quality assurance harmonization.
Bih-Rong Wei, R Mark Simpson.
Clin Biochem, 2013 Dec 24; 47(4-5). PMID: 24362266    Free PMC article.
Artificial Intelligence in Medical Practice: The Question to the Answer?
D Douglas Miller, Eric W Brown.
Am J Med, 2017 Nov 12; 131(2). PMID: 29126825
Highly Cited. Review.
Deep Learning for Classification of Colorectal Polyps on Whole-slide Images.
Bruno Korbar, Andrea M Olofson, +5 authors, Saeed Hassanpour.
J Pathol Inform, 2017 Aug 23; 8. PMID: 28828201    Free PMC article.
Introduction of the Thin Prep Imaging System (TIS): experience in a high volume academic practice.
Mamatha Chivukula, Reda S Saad, +3 authors, David J Dabbs.
Cytojournal, 2007 Feb 10; 4. PMID: 17288596    Free PMC article.
Implementation of large-scale routine diagnostics using whole slide imaging in Sweden: Digital pathology experiences 2006-2013.
Sten Thorstenson, Jesper Molin, Claes Lundström.
J Pathol Inform, 2014 May 21; 5(1). PMID: 24843825    Free PMC article.
Diagnostic time in digital pathology: A comparative study on 400 cases.
Aleksandar Vodovnik.
J Pathol Inform, 2016 Mar 10; 7. PMID: 26955502    Free PMC article.
Large scale tissue histopathology image classification, segmentation, and visualization via deep convolutional activation features.
Yan Xu, Zhipeng Jia, +4 authors, Eric I-Chao Chang.
BMC Bioinformatics, 2017 May 28; 18(1). PMID: 28549410    Free PMC article.
Deep learning for digital pathology image analysis: A comprehensive tutorial with selected use cases.
Andrew Janowczyk, Anant Madabhushi.
J Pathol Inform, 2016 Aug 27; 7. PMID: 27563488    Free PMC article.
Highly Cited.
Automated Classification of Benign and Malignant Proliferative Breast Lesions.
Evani Radiya-Dixit, David Zhu, Andrew H Beck.
Sci Rep, 2017 Aug 31; 7(1). PMID: 28852119    Free PMC article.
Accelerating Very Deep Convolutional Networks for Classification and Detection.
Xiangyu Zhang, Jianhua Zou, Kaiming He, Jian Sun.
IEEE Trans Pattern Anal Mach Intell, 2015 Nov 26; 38(10). PMID: 26599615
A comprehensive analysis of a web-based dermatopathology second opinion consultation practice.
Artur Zembowicz, Adeel Ahmad, Stephen R Lyle.
Arch Pathol Lab Med, 2011 Mar 04; 135(3). PMID: 21366464
Comparative diagnostic accuracy in virtual dermatopathology.
Ellen Mooney, Antoinette F Hood, +2 authors, Gregor B E Jemec.
Skin Res Technol, 2011 Jan 22; 17(2). PMID: 21251087
Dermatologist-level classification of skin cancer with deep neural networks.
Andre Esteva, Brett Kuprel, +4 authors, Sebastian Thrun.
Nature, 2017 Jan 25; 542(7639). PMID: 28117445    Free PMC article.
Highly Cited.
Digital pathology consultations-a new era in digital imaging, challenges and practical applications.
Gonzalo Romero Lauro, William Cable, +4 authors, Liron Pantanowitz.
J Digit Imaging, 2013 Jan 30; 26(4). PMID: 23359091    Free PMC article.
Automated quantification of MART1-verified Ki67 indices by digital image analysis in melanocytic lesions.
Patricia Switten Nielsen, Rikke Riber-Hansen, Jakob Raundahl, Torben Steiniche.
Arch Pathol Lab Med, 2012 Jun 01; 136(6). PMID: 22646269
Virtual microscopy: an evaluation of its validity and diagnostic performance in routine histologic diagnosis of skin tumors.
Patricia Switten Nielsen, Jan Lindebjerg, +3 authors, Bjarne Nielsen.
Hum Pathol, 2010 Sep 28; 41(12). PMID: 20869750
Diagnostic Assessment of Deep Learning Algorithms for Detection of Lymph Node Metastases in Women With Breast Cancer.
Babak Ehteshami Bejnordi, Mitko Veta, +67 authors, Rui Venâncio.
JAMA, 2017 Dec 14; 318(22). PMID: 29234806    Free PMC article.
Highly Cited.
Review of the current state of whole slide imaging in pathology.
Liron Pantanowitz, Paul N Valenstein, +5 authors, Terence J Colgan.
J Pathol Inform, 2011 Sep 03; 2. PMID: 21886892    Free PMC article.
Highly Cited.
Accelerating Innovation in Health IT.
Robert S Rudin, David W Bates, Calum MacRae.
N Engl J Med, 2016 Sep 01; 375(9). PMID: 27579633    Free PMC article.
Fully Convolutional Networks for Semantic Segmentation.
Evan Shelhamer, Jonathan Long, Trevor Darrell.
IEEE Trans Pattern Anal Mach Intell, 2016 Jun 01; 39(4). PMID: 27244717
Highly Cited.
Validation of diagnostic accuracy with whole-slide imaging compared with glass slide review in dermatopathology.
Kabeer K Shah, Julia S Lehman, +3 authors, Carilyn N Wieland.
J Am Acad Dermatol, 2016 Oct 16; 75(6). PMID: 27742174
Validation of Digital Pathology for Primary Histopathological Diagnosis of Routine, Inflammatory Dermatopathology Cases.
Jonathan J Lee, Jaroslaw Jedrych, Liron Pantanowitz, Jonhan Ho.
Am J Dermatopathol, 2017 Aug 02; 40(1). PMID: 28763335
Image analysis and machine learning in digital pathology: Challenges and opportunities.
Anant Madabhushi, George Lee.
Med Image Anal, 2016 Jul 18; 33. PMID: 27423409    Free PMC article.
Highly Cited. Review.
The Diagnostic Concordance of Whole Slide Imaging and Light Microscopy: A Systematic Review.
Edward Goacher, Rebecca Randell, Bethany Williams, Darren Treanor.
Arch Pathol Lab Med, 2016 Jul 12; 141(1). PMID: 27399211
Systematic Review.
OpenSlide: A vendor-neutral software foundation for digital pathology.
Adam Goode, Benjamin Gilbert, +2 authors, Mahadev Satyanarayanan.
J Pathol Inform, 2013 Nov 19; 4. PMID: 24244884    Free PMC article.
Whole slide images for primary diagnostics in dermatopathology: a feasibility study.
Shaimaa Al-Janabi, André Huisman, +5 authors, Paul J van Diest.
J Clin Pathol, 2011 Oct 28; 65(2). PMID: 22031590
The role of balanced training and testing data sets for binary classifiers in bioinformatics.
Qiong Wei, Roland L Dunbrack.
PLoS One, 2013 Jul 23; 8(7). PMID: 23874456    Free PMC article.
Virtual microscopy using whole-slide imaging as an enabler for teledermatopathology: A paired consultant validation study.
Ayman Al Habeeb, Andrew Evans, Danny Ghazarian.
J Pathol Inform, 2012 Mar 23; 3. PMID: 22439122    Free PMC article.
Rapid and accurate intraoperative pathological diagnosis by artificial intelligence with deep learning technology.
Jing Zhang, Yanlin Song, +5 authors, Xuelei Ma.
Med Hypotheses, 2017 Sep 17; 107. PMID: 28915974
Clinical protein science in translational medicine targeting malignant melanoma.
Jeovanis Gil, Lazaro Hiram Betancourt, +35 authors, György Marko-Varga.
Cell Biol Toxicol, 2019 Mar 23; 35(4). PMID: 30900145    Free PMC article.
Tailored for Real-World: A Whole Slide Image Classification System Validated on Uncurated Multi-Site Data Emulating the Prospective Pathology Workload.
Julianna D Ianni, Rajath E Soans, +9 authors, Jason B Lee.
Sci Rep, 2020 Feb 23; 10(1). PMID: 32081956    Free PMC article.
Applications of machine learning in drug discovery and development.
Jessica Vamathevan, Dominic Clark, +8 authors, Shanrong Zhao.
Nat Rev Drug Discov, 2019 Apr 13; 18(6). PMID: 30976107    Free PMC article.
Highly Cited. Review.
High-throughput quantitative histology in systemic sclerosis skin disease using computer vision.
Chase Correia, Seamus Mawe, +12 authors, J Matthew Mahoney.
Arthritis Res Ther, 2020 Mar 17; 22(1). PMID: 32171325    Free PMC article.
Artificial intelligence with multi-functional machine learning platform development for better healthcare and precision medicine.
Zeeshan Ahmed, Khalid Mohamed, Saman Zeeshan, XinQi Dong.
Database (Oxford), 2020 Mar 19; 2020. PMID: 32185396    Free PMC article.
The Enterprise Imaging Value Proposition.
Cheryl A Petersilge.
J Digit Imaging, 2019 Nov 05; 33(1). PMID: 31677010    Free PMC article.
Semi-Supervised Nests of Melanocytes Segmentation Method Using Convolutional Autoencoders.
Dariusz Kucharski, Pawel Kleczek, +2 authors, Marek Gorgon.
Sensors (Basel), 2020 Mar 15; 20(6). PMID: 32168748    Free PMC article.
Artificial Intelligence Applications in Dermatology: Where Do We Stand?
Arieh Gomolin, Elena Netchiporouk, Robert Gniadecki, Ivan V Litvinov.
Front Med (Lausanne), 2020 Apr 17; 7. PMID: 32296706    Free PMC article.
Machine Learning in Dermatology: Current Applications, Opportunities, and Limitations.
Stephanie Chan, Vidhatha Reddy, +3 authors, Wilson Liao.
Dermatol Ther (Heidelb), 2020 Apr 08; 10(3). PMID: 32253623    Free PMC article.
Clinical-grade computational pathology using weakly supervised deep learning on whole slide images.
Gabriele Campanella, Matthew G Hanna, +7 authors, Thomas J Fuchs.
Nat Med, 2019 Jul 17; 25(8). PMID: 31308507    Free PMC article.
Highly Cited.
Construction and Utilization of a Neural Network Model to Predict Current Procedural Terminology Codes from Pathology Report Texts.
Jay J Ye.
J Pathol Inform, 2019 May 07; 10. PMID: 31057982    Free PMC article.
The revolving door for AI and pathologists-docendo discimus?
Simone L Van Es, Anant Madabhushi.
J Med Artif Intell, 2019 Aug 03; 2. PMID: 31372599    Free PMC article.
Attitudes Toward Artificial Intelligence Within Dermatopathology: An International Online Survey.
Sam Polesie, Phillip H McKee, +4 authors, John Paoli.
Front Med (Lausanne), 2020 Nov 17; 7. PMID: 33195357    Free PMC article.
Deep learning for dermatologists: Part II. Current applications.
Pranav Puri, Nneka Comfere, +16 authors, Dennis H Murphree.
J Am Acad Dermatol, 2020 May 20;. PMID: 32428608    Free PMC article.
Recent advances in bioelectronics chemistry.
Yin Fang, Lingyuan Meng, +3 authors, Bozhi Tian.
Chem Soc Rev, 2020 Jul 17; 49(22). PMID: 32672777    Free PMC article.
Artificial Intelligence in Dermatology: A Practical Introduction to a Paradigm Shift.
Bell R Eapen.
Indian Dermatol Online J, 2020 Dec 22; 11(6). PMID: 33344334    Free PMC article.
Osteoid Metaplasia in Femoral Artery Plaques Is Associated With the Clinical Severity of Lower Extremity Artery Disease in Men.
Mirjami Laivuori, Johanna Tolva, +8 authors, Juha Sinisalo.
Front Cardiovasc Med, 2020 Dec 29; 7. PMID: 33363220    Free PMC article.
Computer vision applied to dual-energy computed tomography images for precise calcinosis cutis quantification in patients with systemic sclerosis.
Anita C Chandrasekaran, Zhicheng Fu, +7 authors, Monique E Hinchcliff.
Arthritis Res Ther, 2021 Jan 08; 23(1). PMID: 33407814    Free PMC article.
Artificial Intelligence-Aided Recognition of Pathological Characteristics and Subtype Classification of Superficial Perivascular Dermatitis.
Yingqiu Bao, Jing Zhang, +3 authors, Yu Fu.
Front Med (Lausanne), 2021 Aug 03; 8. PMID: 34336900    Free PMC article.
Deeply Supervised UNet for Semantic Segmentation to Assist Dermatopathological Assessment of Basal Cell Carcinoma.
Jean Le'Clerc Arrastia, Nick Heilenkötter, +6 authors, Peter Maass.
J Imaging, 2021 Aug 31; 7(4). PMID: 34460521    Free PMC article.
Artificial Intelligence in Dermatopathology: New Insights and Perspectives.
Gerardo Cazzato, Anna Colagrande, +14 authors, Giuseppe Ingravallo.
Dermatopathology (Basel), 2021 Sep 26; 8(3). PMID: 34563035    Free PMC article.