Artificial Intelligence and Hysteroscopy: A Multicentric Study on Automated Classification of Pleomorphic Lesions

<b>Background/Objectives</b>: The integration of artificial intelligence (AI) in medical imaging is rapidly advancing, yet its application in gynecologic use remains limited. This proof-of-concept study presents the development and validation of a convolutional neural network (CNN) designed to automatically detect and classify endometrial polyps. <b>Methods</b>: A multicenter dataset (n = 3) comprising 65 hysteroscopies was used, yielding 33,239 frames and 37,512 annotated objects. Still frames were extracted from full-length videos and annotated for the presence of histologically confirmed polyps. A YOLOv1-based object detection model was used with a 70-20-10 split for training, validation, and testing. Primary performance metrics included recall, precision, and mean average precision at an intersection over union (IoU) ≥ 0.50 (mAP50). Frame-level classification metrics were also computed to evaluate clinical applicability. <b>Results</b>: The model achieved a recall of 0.96 and precision of 0.95 for polyp detection, with a mAP50 of 0.98. At the frame level, mean recall was 0.75, precision 0.98, and F1 score 0.82, confirming high detection and classification performance. <b>Conclusions</b>: This study presents a CNN trained on multicenter, real-world data that detects and classifies polyps simultaneously with high diagnostic and localization performance, supported by explainable AI features that enhance its clinical integration and technological readiness. Although currently limited to binary classification, this study demonstrates the feasibility and potential of AI to reduce diagnostic subjectivity and inter-observer variability in hysteroscopy. Future work will focus on expanding the model's capabilities to classify a broader range of endometrial pathologies, enhance generalizability, and validate performance in real-time clinical settings.