Artificial intelligence-based triage of large bowel biopsies can improve workflow

Background: Large bowel biopsies are one of the commonest types of biopsy specimen. We describe a service evaluation study to test the feasibility of using artificial intelligence (AI) to triage large bowel biopsies from a reporting backlog and prioritize those that require more urgent reporting. Methods: The pathway was developed in the UK by National Health Service (NHS) laboratory staff working in a medium-sized general hospital. The AI platform was interfaced with the slide scanner software and the reporting platform's software, so that pathologists could correct the AI label and reinforce the training set as they reported the cases. Results: he AI classifier achieved a sensitivity of 97.56% and specificity of 93.02% for the case-level-diagnosis of neoplasia (adenoma and adenocarcinoma) and for an AI diagnosis of any significant pathology (i.e., adenomas, adenocarcinomas, inflammation, hyperplastic polyps, and sessile serrated lesions) sensitivity was 95.65% and specificity 92.96%. The automated AI diagnostic classification pathway took approximately 175 s per slide to download and process the scanned whole slide image (WSI) and return an AI diagnostic classification. Biopsies with an AI diagnosis of neoplasia or inflammation were prioritized for reporting while the remainder followed the routine reporting pathway. The AI triaged pathway resulted in a significantly shorter reporting turnaround time for pathologist verified neoplastic cases (P < 0.001) and inflammation (P < 0.05). The project's costs amounted to £14800, excluding laboratory staff salaries. More time and resources were spent on developing the interface between the AI platform and laboratory IT systems than on the development of the AI platform itself. Conclusions: NHS laboratory staff were able to implement an AI solution to accurately triage large bowel biopsies into several diagnostic classes and this improved reporting turnaround times for cases with neoplasia or with inflammation.