AI triage of duodenal biopsies improves workflow

Aims To develop, deploy and evaluate artificial intelligence (AI) for triaging duodenal biopsies within a National Health Service (NHS) histopathology laboratory, with the aim of improving reporting turnaround times for clinically significant diagnoses. Methods The pathway was developed in the UK in an NHS laboratory. Rule-based automation software was used to find all newly scanned duodenal biopsy slides. Those with case numbers ending in an odd number were exported for AI triage and if they had significant AI predicted abnormalities they were prioritised for reporting. The cases with even numbers followed the routine reporting pathway. Results 313 cases (517 duodenal slides) were processed by the routine pathway, and 329 cases (533 duodenal slides) were processed by the AI triage pathway. AI processing took about 70 s per slide. The AI classifier had a sensitivity and positive predictive value (PPV) as follows: normal small bowel: 99.6%, 95.7%; coeliac disease: 86.7%, 100%; gastric heterotopia: 84.6%, 95.7%; adenoma: 88.9%, 88.9%; adenocarcinoma: 50.0%, 100%. In the AI triage workstream coeliac disease, and non-neoplastic abnormalities as a group, were reported quicker than in the standard workstream (6 days vs 10 days and 7 days vs 10 days, respectively, both p<0.005), but neoplastic lesions were not reported quicker. The cost of deployment and operation was reasonable. Conclusions An NHS histopathology laboratory successfully developed and implemented an AI-based triage system for duodenal biopsies, achieving high diagnostic accuracy and significantly improving turnaround times for coeliac disease and non-neoplastic abnormalities as a group. This study demonstrates the feasibility and clinical value of locally developed AI tools within routine diagnostic practice.