Development of a Deep Learning System for Intra-Operative Identification of Cancer Metastases

Abstract: For several cancer patients, operative resection with curative intent can end up in early recurrence of the cancer. Current limitations in peri-operative cancer staging and especially intra-operative misidentification of visible metastases is likely the main reason leading to unnecessary operative interventions in the affected individuals. Here, we evaluate whether an AI system can improve recognition of peritoneal surface metastases on routine staging laparoscopy images from patients with gastrointestinal malignancies. In a simulated setting evaluating biopsied peritoneal lesions, a prototype deep learning surgical guidance system outperformed oncologic surgeons in identifying peritoneal surface metastases. In this environment the developed AI model would have improved the identification of metastases by 5% while reducing the number of unnecessary biopsies by 28% compared to current standard practice. Evaluating non-biopsied peritoneal lesions, the findings support the possibility that the AI system could identify peritoneal surface metastases that were falsely deemed benign in clinical practice. Our findings demonstrate the technical feasibility of an AI system for intra-operative identification of peritoneal surface metastases, but require future assessment in a multi-institutional clinical setting.