Skin cancer classification via convolutional neural networks: systematic review of studies involving human experts.

Abstract

BACKGROUND:

Multiple studies have compared the performance of artificial intelligence (AI)-based models for automated skin cancer classification to human experts, thus setting the cornerstone for a successful translation of AI-based tools into clinicopathological practice.

OBJECTIVE:

The objective of the study was to systematically analyse the current state of research on reader studies involving melanoma and to assess their potential clinical relevance by evaluating three main aspects: test set characteristics (holdout/out-of-distribution data set, composition), test setting (experimental/clinical, inclusion of metadata) and representativeness of participating clinicians.

METHODS:

PubMed, Medline and ScienceDirect were screened for peer-reviewed studies published between 2017 and 2021 and dealing with AI-based skin cancer classification involving melanoma. The search terms skin cancer classification, deep learning, convolutional neural network (CNN), melanoma (detection), digital biomarkers, histopathology and whole slide imaging were combined. Based on the search results, only studies that considered direct comparison of AI results with clinicians and had a diagnostic classification as their main objective were included.

RESULTS:

A total of 19 reader studies fulfilled the inclusion criteria. Of these, 11 CNN-based approaches addressed the classification of dermoscopic images; 6 concentrated on the classification of clinical images, whereas 2 dermatopathological studies utilised digitised histopathological whole slide images.

CONCLUSIONS:

All 19 included studies demonstrated superior or at least equivalent performance of CNN-based classifiers compared with clinicians. However, almost all studies were conducted in highly artificial settings based exclusively on single images of the suspicious lesions. Moreover, test sets mainly consisted of holdout images and did not represent the full range of patient populations and melanoma subtypes encountered in clinical practice.

• Authors: Sarah Haggenmüller, Roman C Maron, Achim Hekler, Jochen S Utikal, Catarina Barata, Raymond L Barnhill, Helmut Beltraminelli, Carola Berking, Brigid Betz-Stablein, Andreas Blum, Stephan A Braun, Richard Carr, Marc Combalia, Maria-Teresa Fernandez-Figueras, Gerardo Ferrara, Sylvie Fraitag, Lars E French, Frank F Gellrich, Kamran Ghoreschi, Matthias Goebeler, Pascale Guitera, Holger A Haenssle, Sebastian Haferkamp, Lucie Heinzerling, Markus V Heppt, Franz J Hilke, Sarah Hobelsberger, Dieter Krahl, Heinz Kutzner, Aimilios Lallas, Konstantinos Liopyris, Mar Llamas-Velasco, Josep Malvehy, Friedegund Meier, Cornelia S L Müller, Alexander A Navarini, Cristián Navarrete-Dechent, Antonio Perasole, Gabriela Poch, Sebastian Podlipnik, Luis Requena, Veronica M Rotemberg, Andrea Saggini, Omar P Sangueza, Carlos Santonja, Dirk Schadendorf, Bastian Schilling, Max Schlaak, Justin G Schlager, Mildred Sergon, Wiebke Sondermann, H Peter Soyer, Hans Starz, Wilhelm Stolz, Esmeralda Vale, Wolfgang Weyers, Alexander Zink, Eva Krieghoff-Henning, Jakob N Kather, Christof von Kalle, Daniel B Lipka, Stefan Fröhling, Axel Hauschild, Harald Kittler, Titus J Brinker
• Journal: European journal of cancer (Oxford, England : 1990) (Eur J Cancer) Vol. 156 Pg. 202-216 (10 2021) ISSN: 1879-0852 [Electronic] England
• PMID: 34509059 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Systematic Review)
• Copyright: Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Topics

• Automation
• Biopsy
• Clinical Competence
• Deep Learning
• Dermatologists
• Dermoscopy
• Diagnosis, Computer-Assisted
• Humans
• Image Interpretation, Computer-Assisted
• Melanoma (classification, pathology)
• Microscopy
• Neural Networks, Computer
• Pathologists
• Predictive Value of Tests
• Reproducibility of Results
• Skin Neoplasms (classification, pathology)