Diagnosing acute promyelocytic leukemia by using convolutional neural network

Advancing Meibography Assessment and Automated Meibomian Gland Detection Using Gray Value Profiles

Objective: This study introduces a novel method for the automated detection and quantification of meibomian gland morphology using gray value distribution profiles. The approach addresses limitations in traditional manual and deep learning-based meibography analysis, which are often time-consuming and prone to variability. Methods: This study enrolled 100 volunteers (mean age 40 ± 16 years, range 18-85) who suffered from dry eye and responded to the Ocular Surface Disease Index questionnaire for scoring ocular discomfort symptoms and infrared meibography for capturing imaging of meibomian glands. By leveraging pixel brightness variations, the algorithm provides real-time detection and classification of long, medium, and short meibomian glands, offering a quantitative assessment of gland atrophy. Results: A novel parameter, namely "atrophy index", a quantitative measure of gland degeneration, is introduced. Atrophy index is the first instrumental measurement to assess single- and multiple-gland morphology. Conclusions: This tool provides a robust, scalable metric for integrating quantitative meibography into clinical practice, making it suitable for real-time screening and advancing the management of dry eyes owing to meibomian gland dysfunction.

Artificial intelligence-assisted early screening of acute promyelocytic leukaemia in blood smears: a prospective evaluation of MC-100i

Objectives

Identification of abnormal promyelocytes is crucial for early diagnosis of Acute promyelocytic leukaemia (APL) and for reducing the early mortality rate of APL patients, which can be achieved by microscopic blood smear observation. However, microscopic observation has shortcomings, including interobserver variability and training difficulty. This is the first study evaluating the performance of MC-100i, an artificial intelligence (AI)-based digital morphology analyser, in identifying abnormal promyelocytes in blood smears and thus assisting in the early screening of APL.

Methods

One hundred ninety-two patients suspected of having APL were enrolled prospectively. The precision, accuracy, consistency with manual classification and turnaround time of MC-100i were studied in detail.

Results

The precision of MC-100i in identifying all cell types was acceptable. MC-100i had excellent performance in preclassifying normal cell types, but its sensitivities for identifying blasts, abnormal promyelocytes, promyelocytes and neutrophilic myelocytes were relatively low, respectively. The Passing-Bablok and Bland-Altman tests revealed that the preclassification abnormal promyelocyte percentage obtained with MC-100i was proportionally different from that obtained with manual classification, whereas the postclassification and manual classification results were consistent. The clinical sensitivity and specificity for the early screening of APL were 95.8% and 100.0%, respectively. The turnaround and classification times were significantly shorter with the use of MC-100i for both the technologist and the experienced expert.

Conclusions

MC-100i is an effective tool for identifying abnormal promyelocytes in blood smears and assisting in the early screening of APL. It is useful when experienced morphological experts or advanced tests are not available.

Towards Diagnostic Intelligent Systems in Leukemia Detection and Classification: A Systematic Review and Meta-analysis

OBJECTIVE

Leukemia is a type of blood cancer that begins in the bone marrow and results in high numbers of abnormal white blood cells. Automated detection and classification of leukemia and its subtypes using artificial intelligence (AI) and machine learning (ML) algorithms plays a significant role in the early diagnosis and treatment of this fatal disease. This study aimed to review and synthesize research findings on AI-based approaches in leukemia detection and classification from peripheral blood smear images.

METHODS

A systematic literature search was conducted across four e-databases (Web of Science, PubMed, Scopus, and IEEE Xplore) from January 2015 to March 2023 by searching the keywords "Leukemia," "Machine Learning," and "Blood Smear Image," as well as their synonyms. All original journal articles and conference papers that used ML algorithms in detecting and classifying leukemia were included. The study quality was assessed using the Qiao Quality Assessment tool.

RESULTS

From 1325 articles identified through a systematic search, 190 studies were eligible for this review. The mean validation accuracy (ACC) of the ML methods applied in the reviewed studies was 95.38%. Among different ML methods, modern techniques were mostly considered to detect and classify leukemia (60.53% of studies). Supervised learning was the dominant ML paradigm (79% of studies). Studies utilized common ML methodologies for leukemia detection and classification, including preprocessing, feature extraction, feature selection, and classification. Deep learning (DL) techniques, especially convolutional neural networks, were the most widely used modern algorithms in the mentioned methodologies. Most studies relied on internal validation (87%). Moreover, K-fold cross-validation and train/test split were the commonly employed validation strategies.

CONCLUSION

AI-based algorithms are widely used in detecting and classifying leukemia with remarkable performance. Future studies should prioritize rigorous external validation to evaluate generalizability.

Applications of Artificial Intelligence in Acute Promyelocytic Leukemia: An Avenue of Opportunities? A Systematic Review

Background. Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia defined by the presence of a genetic abnormality, namely the PML::RARA gene fusion, as the result of a reciprocal balanced translocation between chromosome 17 and chromosome 15. APL is a veritable emergency in hematology due to the risk of early death and coagulopathy if left untreated; thus, a rapid diagnosis is needed in this hematological malignancy. Needless to say, cytogenetic and molecular biology techniques, i.e., fluorescent in situ hybridization (FISH) and polymerase chain reaction (PCR), are essential in the diagnosis and management of patients diagnosed with APL. In recent years, the use of artificial intelligence (AI) and its brances, machine learning (ML), and deep learning (DL) in the field of medicine, including hematology, has brought to light new avenues for research in the fields of blood cancers. However, to our knowledge, there is no comprehensive evaluation of the potential applications of AI, ML, and DL in APL. Thus, the aim of the current publication was to evaluate the prospective uses of these novel technologies in APL. Methods. We conducted a comprehensive literature search in PubMed/MEDLINE, SCOPUS, and Web of Science and identified 20 manuscripts eligible for the qualitative analysis. Results. The included publications highlight the potential applications of ML, DL, and other AI branches in the diagnosis, evaluation, and management of APL. The examined AI models were based on the use of routine biological parameters, cytomorphology, flow-cytometry and/or OMICS, and demonstrated excellent performance metrics: sensitivity, specificity, accuracy, AUROC, and others. Conclusions. AI can emerge as a relevant tool in the evaluation of APL cases and potentially contribute to more rapid screening and identification of this hematological emergency.

Models for the marrow: A comprehensive review of AI-based cell classification methods and malignancy detection in bone marrow aspirate smears

Given the high prevalence of artificial intelligence (AI) research in medicine, the development of deep learning (DL) algorithms based on image recognition, such as the analysis of bone marrow aspirate (BMA) smears, is rapidly increasing in the field of hematology and oncology. The models are trained to identify the optimal regions of the BMA smear for differential cell count and subsequently detect and classify a number of cell types, which can ultimately be utilized for diagnostic purposes. Moreover, AI is capable of identifying genetic mutations phenotypically. This pipeline has the potential to offer an accurate and rapid preliminary analysis of the bone marrow in the clinical routine. However, the intrinsic complexity of hematological diseases presents several challenges for the automatic morphological assessment. To ensure general applicability across multiple medical centers and to deliver high accuracy on prospective clinical data, AI models would require highly heterogeneous training datasets. This review presents a systematic analysis of models for cell classification and detection of hematological malignancies published in the last 5 years (2019-2024). It provides insight into the challenges and opportunities of these DL-assisted tasks.

Optimization of diagnosis and treatment of hematological diseases via artificial intelligence

Background

Optimizing the diagnosis and treatment of hematological diseases is a challenging yet crucial research area. Effective treatment plans typically require the comprehensive integration of cell morphology, immunology, cytogenetics, and molecular biology. These plans also consider patient-specific factors such as disease stage, age, and genetic mutation status. With the advancement of artificial intelligence (AI), more "AI + medical" application models are emerging. In clinical practice, many AI-assisted systems have been successfully applied to the diagnosis and treatment of hematological diseases, enhancing precision and efficiency and offering valuable solutions for clinical practice.

Objective

This study summarizes the research progress of various AI-assisted systems applied in the clinical diagnosis and treatment of hematological diseases, with a focus on their application in morphology, immunology, cytogenetics, and molecular biology diagnosis, as well as prognosis prediction and treatment.

Methods

Using PubMed, Web of Science, and other network search engines, we conducted a literature search on studies from the past 5 years using the main keywords "artificial intelligence" and "hematological diseases." We classified the clinical applications of AI systems according to the diagnosis and treatment. We outline and summarize the current advancements in AI for optimizing the diagnosis and treatment of hematological diseases, as well as the difficulties and challenges in promoting the standardization of clinical diagnosis and treatment in this field.

Results

AI can significantly shorten turnaround times, reduce diagnostic costs, and accurately predict disease outcomes through applications in image-recognition technology, genomic data analysis, data mining, pattern recognition, and personalized medicine. However, several challenges remain, including the lack of AI product standards, standardized data, medical-industrial collaboration, and the complexity and non-interpretability of AI systems. In addition, regulatory gaps can lead to data privacy issues. Therefore, more research and improvements are needed to fully leverage the potential of AI to promote standardization of the clinical diagnosis and treatment of hematological diseases.

Conclusion

Our results serve as a reference point for the clinical diagnosis and treatment of hematological diseases and the development of AI-assisted clinical diagnosis and treatment systems. We offer suggestions for further development of AI in hematology and standardization of clinical diagnosis and treatment.

Digital Microscopy Augmented by Artificial Intelligence to Interpret Bone Marrow Samples for Hematological Diseases

Analysis of bone marrow aspirates (BMAs) is an essential step in the diagnosis of hematological disorders. This analysis is usually performed based on a visual examination of samples under a conventional optical microscope, which involves a labor-intensive process, limited by clinical experience and subject to high observer variability. In this work, we present a comprehensive digital microscopy system that enables BMA analysis for cell type counting and differentiation in an efficient and objective manner. This system not only provides an accessible and simple method to digitize, store, and analyze BMA samples remotely but is also supported by an Artificial Intelligence (AI) pipeline that accelerates the differential cell counting process and reduces interobserver variability. It has been designed to integrate AI algorithms with the daily clinical routine and can be used in any regular hospital workflow.

Deep learning enhances acute lymphoblastic leukemia diagnosis and classification using bone marrow images

Acute lymphoblastic leukemia (ALL) poses a significant health challenge, particularly in pediatric cases, requiring precise and rapid diagnostic approaches. This comprehensive review explores the transformative capacity of deep learning (DL) in enhancing ALL diagnosis and classification, focusing on bone marrow image analysis. Examining ten studies conducted between 2013 and 2023 across various countries, including India, China, KSA, and Mexico, the synthesis underscores the adaptability and proficiency of DL methodologies in detecting leukemia. Innovative DL models, notably Convolutional Neural Networks (CNNs) with Cat-Boosting, XG-Boosting, and Transfer Learning techniques, demonstrate notable approaches. Some models achieve outstanding accuracy, with one CNN reaching 100% in cancer cell classification. The incorporation of novel algorithms like Cat-Swarm Optimization and specialized CNN architectures contributes to superior classification accuracy. Performance metrics highlight these achievements, with models consistently outperforming traditional diagnostic methods. For instance, a CNN with Cat-Boosting attains 100% accuracy, while others hover around 99%, showcasing DL models' robustness in ALL diagnosis. Despite acknowledged challenges, such as the need for larger and more diverse datasets, these findings underscore DL's transformative potential in reshaping leukemia diagnostics. The high numerical accuracies accentuate a promising trajectory toward more efficient and accurate ALL diagnosis in clinical settings, prompting ongoing research to address challenges and refine DL models for optimal clinical integration.

The Application of Morphogo in the Detection of Megakaryocytes from Bone Marrow Digital Images with Convolutional Neural Networks

The evaluation of megakaryocytes is an important part of the work up on bone marrow smear examination. It has significance in the differential diagnosis, therapeutic efficacy assessment, and predication of prognosis of many hematologic diseases. The process of manual identification of megakaryocytes are tedious and lack of reproducibility; therefore, a reliable method of automated megakaryocytic identification is urgently needed. Three hundred and thirty-three bone marrow aspirate smears were digitized by Morphogo system. Pathologists annotated megakaryocytes on the digital images of marrow smears are applied to construct a large dataset for testing the system's predictive performance. Subsequently, we obtained megakaryocyte count and classification for each sample by different methods (system-automated analysis, system-assisted analysis, and microscopic examination) to study the correlation between different counting and classification methods. Morphogo system localized cells likely to be megakaryocytes on digital smears, which were later annotated by pathologists and the system, respectively. The system showed outstanding performance in identifying megakaryocytes in bone marrow smears with high sensitivity (96.57%) and specificity (89.71%). The overall correlation between the different methods was confirmed the high consistency (r ≥ 0.7218, R² ≥ 0.5211) with microscopic examination in classifying megakaryocytes. Morphogo system was proved as a reliable screen tool for analyzing megakaryocytes. The application of Morphogo system shows promises to advance the automation and standardization of bone marrow smear examination.

An AI-Aided Diagnostic Framework for Hematologic Neoplasms Based on Morphologic Features and Medical Expertise

A morphologic examination is essential for the diagnosis of hematological diseases. However, its conventional manual operation is time-consuming and laborious. Herein, we attempt to establish an artificial intelligence (AI)-aided diagnostic framework integrating medical expertise. This framework acts as a virtual hematological morphologist (VHM) for diagnosing hematological neoplasms. Two datasets were established as follows: An image dataset was used to train the Faster Region-based Convolutional Neural Network to develop an image-based morphologic feature extraction model. A case dataset containing retrospective morphologic diagnostic data was used to train a support vector machine algorithm to develop a feature-based case identification model based on diagnostic criteria. Integrating these 2 models established a whole-process AI-aided diagnostic framework, namely, VHM, and a 2-stage strategy was applied to practice case diagnosis. The recall and precision of VHM in bone marrow cell classification were 94.65% and 93.95%, respectively. The balanced accuracy, sensitivity, and specificity of VHM were 97.16%, 99.09%, and 92%, respectively, in the differential diagnosis of normal and abnormal cases, and 99.23%, 97.96%, and 100%, respectively, in the precise diagnosis of chronic myelogenous leukemia in chronic phase. This work represents the first attempt, to our knowledge, to extract multimodal morphologic features and to integrate a feature-based case diagnosis model for designing a comprehensive AI-aided morphologic diagnostic framework. The performance of our knowledge-based framework was superior to that of the widely used end-to-end AI-based diagnostic framework in terms of testing accuracy (96.88% vs 68.75%) or generalization ability (97.11% vs 68.75%) in differentiating normal and abnormal cases. The remarkable advantage of VHM is that it follows the logic of clinical diagnostic procedures, making it a reliable and interpretable hematological diagnostic tool.

Automatic identification of meibomian gland dysfunction with meibography images using deep learning

BACKGROUND

Artificial intelligence is developing rapidly, bringing increasing numbers of intelligent products into daily life. However, it has little progress in dry eye, which is a common disease and associated with meibomian gland dysfunction (MGD). Noninvasive infrared meibography, known as an effective diagnostic tool of MGD, allows for objective observation of meibomian glands. Thus, we discuss a deep learning method to measure and assess meibomian glands of meibography.

METHODS

We used Mask R-CNN deep learning (DL) framework. A total of 1878 meibography images were collected and manually annotated by two licensed eyelid specialists with two classes: conjunctiva and meibomian glands. The annotated pictures were used to establish a DL model. An independent test dataset that contained 58 images was used to compare the accuracy and efficiency of the deep learning model with specialists.

RESULTS

The DL model calculated the ratio of meibomian gland loss with precise values by achieving high accuracy in the identification of conjunctiva (validation loss < 0.35, mAP > 0.976) and meibomian glands (validation loss < 1.0, mAP > 0.92). The comparison between specialists' annotation and the DL model evaluation showed that there is little difference between the gold standard and the model. Each image takes 480 ms for the model to evaluate, almost 21 times faster than specialists.

CONCLUSIONS

The DL model can improve the accuracy of meibography image evaluation, help specialists to grade the meibomian glands and save their time to some extent.

Development and Validation of a Model for Laparoscopic Colorectal Surgical Instrument Recognition Using Convolutional Neural Network-Based Instance Segmentation and Videos of Laparoscopic Procedures

IMPORTANCE

Deep learning-based automatic surgical instrument recognition is an indispensable technology for surgical research and development. However, pixel-level recognition with high accuracy is required to make it suitable for surgical automation.

OBJECTIVE

To develop a deep learning model that can simultaneously recognize 8 types of surgical instruments frequently used in laparoscopic colorectal operations and evaluate its recognition performance.

DESIGN, SETTING, AND PARTICIPANTS

This quality improvement study was conducted at a single institution with a multi-institutional data set. Laparoscopic colorectal surgical videos recorded between April 1, 2009, and December 31, 2021, were included in the video data set. Deep learning-based instance segmentation, an image recognition approach that recognizes each object individually and pixel by pixel instead of roughly enclosing with a bounding box, was performed for 8 types of surgical instruments.

MAIN OUTCOMES AND MEASURES

Average precision, calculated from the area under the precision-recall curve, was used as an evaluation metric. The average precision represents the number of instances of true-positive, false-positive, and false-negative results, and the mean average precision value for 8 types of surgical instruments was calculated. Five-fold cross-validation was used as the validation method. The annotation data set was split into 5 segments, of which 4 were used for training and the remainder for validation. The data set was split at the per-case level instead of the per-frame level; thus, the images extracted from an intraoperative video in the training set never appeared in the validation set. Validation was performed for all 5 validation sets, and the average mean average precision was calculated.

RESULTS

In total, 337 laparoscopic colorectal surgical videos were used. Pixel-by-pixel annotation was manually performed for 81 760 labels on 38 628 static images, constituting the annotation data set. The mean average precisions of the instance segmentation for surgical instruments were 90.9% for 3 instruments, 90.3% for 4 instruments, 91.6% for 6 instruments, and 91.8% for 8 instruments.

CONCLUSIONS AND RELEVANCE

A deep learning-based instance segmentation model that simultaneously recognizes 8 types of surgical instruments with high accuracy was successfully developed. The accuracy was maintained even when the number of types of surgical instruments increased. This model can be applied to surgical innovations, such as intraoperative navigation and surgical automation.

BO-ALLCNN: Bayesian-Based Optimized CNN for Acute Lymphoblastic Leukemia Detection in Microscopic Blood Smear Images

Acute lymphoblastic leukemia (ALL) is a deadly cancer characterized by aberrant accumulation of immature lymphocytes in the blood or bone marrow. Effective treatment of ALL is strongly associated with the early diagnosis of the disease. Current practice for initial ALL diagnosis is performed through manual evaluation of stained blood smear microscopy images, which is a time-consuming and error-prone process. Deep learning-based human-centric biomedical diagnosis has recently emerged as a powerful tool for assisting physicians in making medical decisions. Therefore, numerous computer-aided diagnostic systems have been developed to autonomously identify ALL in blood images. In this study, a new Bayesian-based optimized convolutional neural network (CNN) is introduced for the detection of ALL in microscopic smear images. To promote classification performance, the architecture of the proposed CNN and its hyperparameters are customized to input data through the Bayesian optimization approach. The Bayesian optimization technique adopts an informed iterative procedure to search the hyperparameter space for the optimal set of network hyperparameters that minimizes an objective error function. The proposed CNN is trained and validated using a hybrid dataset which is formed by integrating two public ALL datasets. Data augmentation has been adopted to further supplement the hybrid image set to boost classification performance. The Bayesian search-derived optimal CNN model recorded an improved performance of image-based ALL classification on test set. The findings of this study reveal the superiority of the proposed Bayesian-optimized CNN over other optimized deep learning ALL classification models.

Classification of acute myeloid leukemia M1 and M2 subtypes using machine learning

BACKGROUND

Classification of acute myeloid leukemia (AML) relies on manual analysis of bone marrow or peripheral blood smear images. We aimed to construct a machine learning model for automatic classification of AML-M1 and M2 subtypes in bone marrow smear images.

METHODS

Bone marrow smear images of AML patients were extracted from the Cancer Imaging Archive (TCIA) open database. Classification criteria of AML subtypes were based on the French-American-British (FAB) classification system. Random forest method and broad learning system (BLS) were used to develop the classification model. Morphological features, radiomics features, and clinical features were extracted. The performance of the classification model was evaluated by calculating accuracy, precision, recall, F1-score, and area under the curve (AUC). A total of 50 bone marrow smear images (AML-M1, 31 cases; AML-M2, 19 cases) with 500 slices were included in this study.

RESULTS

A total of 43 morphological features, 276 radiomics features, and 1 clinical feature were extracted. Finally, 9 variables including 2 morphological features, 6 radiomics features, and 1 clinical feature were selected into the classification model. The best classification performance was observed in the random forest model with 9 variables, with the average accuracy, AUC, F1-score, recall, and precision of the model being 0.998 ± 0.003, 0.998 ± 0.004, 0.998 ± 0.004, 0.996 ± 0.009, and 1 ± 0, respectively.

CONCLUSION

The random forest model performed well for the classification of AML-M1 and M2, which may provide a tool for clinicians to classify AML-M1 and M2.

Deep learning identifies Acute Promyelocytic Leukemia in bone marrow smears

BACKGROUND

Acute promyelocytic leukemia (APL) is considered a hematologic emergency due to high risk of bleeding and fatal hemorrhages being a major cause of death. Despite lower death rates reported from clinical trials, patient registry data suggest an early death rate of 20%, especially for elderly and frail patients. Therefore, reliable diagnosis is required as treatment with differentiation-inducing agents leads to cure in the majority of patients. However, diagnosis commonly relies on cytomorphology and genetic confirmation of the pathognomonic t(15;17). Yet, the latter is more time consuming and in some regions unavailable.

METHODS

In recent years, deep learning (DL) has been evaluated for medical image recognition showing outstanding capabilities in analyzing large amounts of image data and provides reliable classification results. We developed a multi-stage DL platform that automatically reads images of bone marrow smears, accurately segments cells, and subsequently predicts APL using image data only. We retrospectively identified 51 APL patients from previous multicenter trials and compared them to 1048 non-APL acute myeloid leukemia (AML) patients and 236 healthy bone marrow donor samples, respectively.

RESULTS

Our DL platform segments bone marrow cells with a mean average precision and a mean average recall of both 0.97. Further, it achieves high accuracy in detecting APL by distinguishing between APL and non-APL AML as well as APL and healthy donors with an area under the receiver operating characteristic of 0.8575 and 0.9585, respectively, using visual image data only.

CONCLUSIONS

Our study underlines not only the feasibility of DL to detect distinct morphologies that accompany a cytogenetic aberration like t(15;17) in APL, but also shows the capability of DL to abstract information from a small medical data set, i. e. 51 APL patients, and infer correct predictions. This demonstrates the suitability of DL to assist in the diagnosis of rare cancer entities. As our DL platform predicts APL from bone marrow smear images alone, this may be used to diagnose APL in regions were molecular or cytogenetic subtyping is not routinely available and raise attention to suspected cases of APL for expert evaluation.

A deep learning method and device for bone marrow imaging cell detection

BACKGROUND

Morphological analysis of bone marrow cells is considered as the gold standard for the diagnosis of leukemia. However, due to the diverse morphology of bone marrow cells, extensive experience and patience are needed for morphological examination. automatic diagnosis system through the comprehensive application of image analysis and pattern recognition technology is urgently needed to reduce work intensity, error probability and improves work efficiency.

METHODS

In this article, we establish a new morphological diagnosis system for bone marrow cell detection based on the deep learning object detection framework. The model is based on the Faster Region-Convolutional Neural Network (R-CNN), a classical object detection model. The system automatically detects bone marrow cells and determines their types. As specimens have severe long-tail distribution, i.e., the frequency of different types of cells varies dramatically, we proposed a general score ranking loss to solve such a problem. The general score ranking loss considers the ranking relationship between positive and negative samples and optimizes the positive sample with a higher classification probability value.

RESULTS

We verified this system with 70 bone marrow specimens of leukemia patients, which proved that it can realize intelligent recognition with high efficiency. The software is finally integrated into the microscope system to build an augmented reality system.

CONCLUSIONS

Clinical tests show that the response speed of the newly developed diagnostic system is faster than that of trained diagnostic experts.