AI可自动评估卵巢癌腹腔镜手术中肿瘤负荷,提升判断准确性。
Artificial Intelligence for the Assessment of Peritoneal Carcinosis during Diagnostic Laparoscopy for Advanced Ovarian Cancer
- 用深度学习分析腹腔镜视频,自动识别病灶并评分
- 在独立测试集上手术可行性预测准确率达80%
- 为医生提供标准化参考,适合临床辅助决策
晚期卵巢癌常伴腹膜转移(PC),术前腹腔镜检查时的法吉蒂评分(FS)用于判断手术可切除性,但主观性强、依赖操作者。研究回顾性收集了某中心患者的腹腔镜视频,分为训练与独立测试集。基于7311帧数据训练深度学习模型,实现关键帧识别、解剖结构与病灶分割,并预测视频级FS及手术指征(ItS)。在训练集(n=101)和独立测试集(n=50)中,结构分割Dice得分分别为70±3%和56±3%,解剖站分类F1得分74±3%和73±4%,FS预测归一化RMSE为1.39±0.18和1.15±0.08,手术指征预测F1达80±8%和80±2%。这是首个基于腹腔镜视频自动预测减瘤手术可行性的AI模型,其跨数据集稳定表现表明该技术可支持术中肿瘤负荷评估与决策。
原文摘要 · Abstract (English)
Advanced Ovarian Cancer (AOC) is often diagnosed at an advanced stage with peritoneal carcinosis (PC). Fagotti score (FS) assessment at diagnostic laparoscopy (DL) guides treatment planning by estimating surgical resectability, but its subjective and operator-dependent nature limits reproducibility and widespread use. Videos of patients undergoing DL with concomitant FS assessments at a referral center were retrospectively collected and divided into a development dataset, for data annotation, AI training and evaluation, and an independent test dataset, for internal validation. In the development dataset, FS-relevant frames were manually annotated for anatomical structures and PC. Deep learning models were trained to automatically identify FS-relevant frames, segment structures and PC, and predict video-level FS and indication to surgery (ItS). AI performance was evaluated using Dice score for segmentation, F1-scores for anatomical stations (AS) and ItS prediction, and root mean square error (RMSE) for final FS estimation. In the development dataset, the segmentation model trained on 7,311 frames, achieved Dice scores of 70$\pm$3% for anatomical structures and 56$\pm$3% for PC. Video-level AS classification achieved F1-scores of 74$\pm$3% and 73$\pm$4%, FS prediction showed normalized RMSE values of 1.39$\pm$0.18 and 1.15$\pm$0.08, and ItS reached F1-scores of 80$\pm$8% and 80$\pm$2% in the development (n=101) and independent test datasets (n=50), respectively. This is the first AI model to predict the feasibility of cytoreductive surgery providing automated FS estimation from DL videos. Its reproducible and reliable performance across datasets suggests that AI can support surgeons through standardized intraoperative tumor burden assessment and clinical decision-making in AOC.
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