Deep learning using nasal endoscopy and T2-weighted MRI for prediction of sinonasal inverted papilloma-associated squamous cell carcinoma: an exploratory study

BACKGROUND: Detecting malignant transformation of sinonasal inverted papilloma (SIP) into squamous cell carcinoma (SIP-SCC) before surgery is a clinical need. We aimed to explore the value of deep learning (DL) that leverages nasal endoscopy and T2-weighted magnetic resonance imaging (T2W-MRI) for automated tumor segmentation and differentiation between SIP and SIP-SCC. METHODS: We conducted a retrospective analysis of 174 patients diagnosed with SIPs, who were divided into a training cohort (n = 121) and a testing cohort (n = 53). Three DL architectures were utilized to train automated segmentation models for endoscopic and T2W-MRI images. DL scores predicting SIP-SCC were generated using DenseNet121 from both modalities and combined to create a dual-modality DL nomogram. The diagnostic performance of the DL models was assessed alongside two radiologists, evaluated through the area under the receiver operating characteristic curve (AUROC), with comparisons made using the Delong method. RESULTS: In the testing cohort, the FCNResNet101 and VNet exhibited superior performance in automated segmentation, achieving mean dice similarity coefficients of 0. 95 ± 0. 03 for endoscopy and 0. 93 ± 0. 02 for T2W-MRI, respectively. The dual-modality DL nomogram based on automated segmentation demonstrated the highest predictive performance for SIP-SCC (AUROC 0. 865), outperforming the radiology resident (AUROC 0. 672, p = 0. 071) and the attending radiologist (AUROC 0. 707, p = 0. 066), with a trend toward significance. Notably, both radiologists improved their diagnostic performance with the assistance of the DL nomogram (AUROCs 0. 734 and 0. 834). CONCLUSION: The DL framework integrating endoscopy and T2W-MRI offers a fully automated predictive tool for SIP-SCC. RELEVANCE STATEMENT: The integration of endoscopy and T2W-MRI within a well-established DL framework enables fully automated prediction of SIP-SSC, potentially improving decision-making for patients with suspicious SIP. KEY POINTS: Detecting the transformation of SIP into SIP-SCC before surgery is both critical and challenging. Endoscopy and T2W-MRI were integrated using DL for predicting SIP-SCC. The dual-modality DL nomogram outperformed two radiologists. The nomogram may improve decision-making for patients with suspicious SIP.