Integrating Whole Slide Imaging and Artificial Intelligence Provides Higher Accuracy in Thyroid Cytology

Abstract Introduction/Objective The aim of the study is to evaluate the potential advantages of integrating Whole Slide Imaging (WSI) and Artificial Intelligence (AI) to increase efficiency and diagnostic accuracy in thyroid cytology, especially in indeterminate lesions. Methods/Case Report A retrospective database search from 2000-2023 was performed, and the concordance with the pathologists was evaluated based on the manual or AI-based Region of Interest (ROI) identification, the best- suited AI, algorithm design, color enhancement, and combination of AI and Electronic Medical Records (EMR). Results (if a Case Study enter NA) The cohort included 3285 WSI and 121,384 ROI. In 109 WSI with manually diagnosed ROI, Deep learning successfully predicted benign and malignant cases, including 11 indeterminate cases, with zero false positives or negatives for 35% of cases. In the second study with 908 WSI, 4494 ROI were identified with Convolutional Neural Network (CNN). A higher area under the curve (AUC) resulted when EMR and Machine Learning algorithm (MLA) were integrated: EMR: 0.931, MLA: 0932, EMR+ MLA; 0.962, Sensitivity: 92.0%, Specificity 90.5%. In the next study with 145 WSI, the CNN-identified ROI was presented to the same pathologist after 117 days. Perfect concordance was seen between the two methods (K score 0.924, time to diagnosis;81.59 Second). In 360 WSI, YOLOV4 algorithm was trained to detect the ROI, and detection and classification rates were used to evaluate the accuracy. It had a precision of 81.84% (3.16% more than the single detection networks of 78.68%). In the last study with 964 WSI, color augmentation improved the AUC for indeterminate cases from 88.3% to 96.2%. Conclusion CNN is a better-suited AI for whole slide imaging due to its compatibility with image data and ability to automatically detect important features without human supervision. It also removes the component of subjective bias in interpretation. Color augmentation and integration of EMR can overcome the unique challenges in thyroid indeterminate cytology.