Abstract 1394: Diagnosis of thyroid cancer using deep convolutional neural network models applied to sonographic images from clinical ultrasound exams
Authors: Li Xiangchun , Zhang Sheng , Zhang Qiang , Wei Xi , Pan Yi , Zhao Jing , Xin Xiaojie , Wang Xiaoqing , Yang Fan , Li Jianxin , Yang Meng , Wang Qinghua , Zheng Xiangqian , Zhao Yanhui , Zhang Lun , Wang Xudong , Zheng Zhimin , Whitlow Christopher T. , Gurcan Metin N. , Pasche Boris , Gao Ming , Zhang Wei , Chen Kexin 
Published: August 2019

Abstract
Background Incidence rate of thyroid cancer is steadily increasing due to overdiagnosis and overtreatment. Thyroid ultrasound is commonly used to diagnose thyroid cancer. The aim of this study is to examine the accuracy of using deep convolutional neural network (DCNN) models to improve diagnosis of thyroid cancer by analyzing sonographic imaging data from clinical thyroid ultrasound.
Methods A total of 131,731 sonographic images from 17,627 thyroid cancer patients and 180,668 sonographic images from 25,325 controls used as training set were obtained from Tianjin Cancer Hospital. Images from anatomical sites that did not have cancer according to location sign on the image were not included. All thyroid cancer patients and 13·2% of controls (51,255 images) were confirmed by pathological reports. DCNN is a specific type of neural network optimized for image recognition. We trained two DCNN models on the training set and subsequently evaluated the performance on one independent internal (Tianjin, 1,118 individuals) and two external (Jilin,154 individuals; Weihai, 1,420 individuals) validation sets. Individuals in the validation sets all have pathological examinations. We compared the specificity/sensitivity of DCNN models with the performance of six thyroid ultrasound radiologists on these three validation sets.
Findings DCNN model achieved high performance in identifying thyroid cancer patients versus six experience radiologists: for Tianjin validation set, sensitivity was 92·2% versus 96·9% (95% CI 89·7% - 94·3% vs. 93·9% - 98·6%; p = 0·003), and specificity was 85·6% versus 59·4% (95% CI 82·4% - 88·4% vs. 53% - 65·6%; p &lt; 0·0001); for Jilin validation set, sensitivity was 84·3% versus 92·9% (95% CI 73·6% - 91·9% vs. 84·1% - 97·6%; p = 0·05), and specificity was 86·9% versus 57·1% (95% CI 77·8% - 93·3% vs. 45·9% - 67·9%; p &lt; 0·0001); for Weihai validation set, sensitivity was 84·5% versus 89% (95% CI 81·2% - 87·4% vs. 81·9% - 94%; p = 0·2), and specificity was 87·5% versus 68·6% (95% CI 85·1% - 89·6% vs. 60·7% - 75·8%; p &lt; 0·0001).
Interpretation DCNN models exhibited high accuracy, sensitivity, and specificity in identifying thyroid cancer patients at levels comparable to or higher than six experienced radiologists. Conferred by the high specificity of DCNN models, the rate of overdiagnosis and overtreatment of patients with thyroid cancer is expected to decrease. This supports future application of the deep learning models to clinical practice for thyroid cancer diagnosis. However, further validation of these DCNN models in prospective clinical trials is warranted.
Funding The Program for Changjiang Scholars and Innovative Research Team in University in China (IRT_14R40), National Natural Science Foundation of China (31801117).
Citation Format: Xiangchun Li, Sheng Zhang, Qiang Zhang, Xi Wei, Yi Pan, Jing Zhao, Xiaojie Xin, Xiaoqing Wang, Fan Yang, Jianxin Li, Meng Yang, Qinghua Wang, Xiangqian Zheng, Yanhui Zhao, Lun Zhang, Xudong Wang, Zhimin Zheng, Christopher T. Whitlow, Metin N. Gurcan, Boris Pasche, Ming Gao, Wei Zhang, Kexin Chen. Diagnosis of thyroid cancer using deep convolutional neural network models applied to sonographic images from clinical ultrasound exams [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1394.