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Aim: The use of artificial intelligence represents an objective approach to increase endoscopist's adenoma detection rate (ADR) and limit interoperator variability. In this study, we evaluated a newly developed deep convolutional neural network (DCNN) for automated detection of colorectal polyps ex vivo as well as in a first in-human trial., Methods: For training of the DCNN, 116 529 colonoscopy images from 278 patients with 788 different polyps were collected. A subset of 10 467 images containing 504 different polyps were manually annotated and treated as the gold standard. An independent set of 45 videos consisting of 15 534 single frames was used for ex vivo performance testing. In vivo real-time detection of colorectal polyps during routine colonoscopy by the DCNN was tested in 42 patients in a back-to-back approach., Results: When analyzing the test set of 15 534 single frames, the DCNN's sensitivity and specificity for polyp detection and localization within the frame was 90% and 80%, respectively, with an area under the curve of 0.92. In vivo, baseline polyp detection rate and ADR were 38% and 26% and significantly increased to 50% (P = 0.023) and 36% (P = 0.044), respectively, with the use of the DCNN. Of the 13 additionally with the DCNN detected lesions, the majority were diminutive and flat, among them three sessile serrated adenomas., Conclusion: This newly developed DCNN enables highly sensitive automated detection of colorectal polyps both ex vivo and during first in-human clinical testing and could potentially increase the detection of colorectal polyps during colonoscopy., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

In this work we present a technique to deal with one of the biggest problems for the application of convolutional neural networks (CNNs) in the area of computer assisted endoscopic image diagnosis, the insufficient amount of training data. Based on patches from endoscopic images of colonic polyps with given label information, our proposed technique acquires additional (labeled) training data by tracking the area shown in the patches through the corresponding endoscopic videos and by extracting additional image patches from frames of these areas. So similar to the widely used augmentation strategies, additional training data is produced by adding images with different orientations, scales and points of view than the original images. However, contrary to augmentation techniques, we do not artificially produce image data but use real image data from videos under different image recording conditions (different viewpoints and image qualities). By means of our proposed method and by filtering out all extracted images with insufficient image quality, we are able to increase the amount of labeled image data by factor 39. We will show that our proposed method clearly and continuously improves the performance of CNNs., (Copyright © 2020. Published by Elsevier Ltd.)

Background: It was shown in previous studies that high definition endoscopy, high magnification endoscopy and image enhancement technologies, such as chromoendoscopy and digital chromoendoscopy [narrow-band imaging (NBI), i-Scan] facilitate the detection and classification of colonic polyps during endoscopic sessions. However, there are no comprehensive studies so far that analyze which endoscopic imaging modalities facilitate the automated classification of colonic polyps. In this work, we investigate the impact of endoscopic imaging modalities on the results of computer-assisted diagnosis systems for colonic polyp staging., Aim: To assess which endoscopic imaging modalities are best suited for the computer-assisted staging of colonic polyps., Methods: In our experiments, we apply twelve state-of-the-art feature extraction methods for the classification of colonic polyps to five endoscopic image databases of colonic lesions. For this purpose, we employ a specifically designed experimental setup to avoid biases in the outcomes caused by differing numbers of images per image database. The image databases were obtained using different imaging modalities. Two databases were obtained by high-definition endoscopy in combination with i-Scan technology (one with chromoendoscopy and one without chromoendoscopy). Three databases were obtained by high-magnification endoscopy (two databases using narrow band imaging and one using chromoendoscopy). The lesions are categorized into non-neoplastic and neoplastic according to the histological diagnosis., Results: Generally, it is feature-dependent which imaging modalities achieve high results and which do not. For the high-definition image databases, we achieved overall classification rates of up to 79.2% with chromoendoscopy and 88.9% without chromoendoscopy. In the case of the database obtained by high-magnification chromoendoscopy, the classification rates were up to 81.4%. For the combination of high-magnification endoscopy with NBI, results of up to 97.4% for one database and up to 84% for the other were achieved. Non-neoplastic lesions were classified more accurately in general than non-neoplastic lesions. It was shown that the image recording conditions highly affect the performance of automated diagnosis systems and partly contribute to a stronger effect on the staging results than the used imaging modality., Conclusion: Chromoendoscopy has a negative impact on the results of the methods. NBI is better suited than chromoendoscopy. High-definition and high-magnification endoscopy are equally suited., Competing Interests: Conflict-of-interest statement: There are no conflicts of interest.

Background: In medical image data sets, the number of images is usually quite small. The small number of training samples does not allow to properly train classifiers which leads to massive overfitting to the training data. In this work, we investigate whether increasing the number of training samples by merging datasets from different imaging modalities can be effectively applied to improve predictive performance. Further, we investigate if the extracted features from the employed image representations differ between different imaging modalities and if domain adaption helps to overcome these differences., Method: We employ twelve feature extraction methods to differentiate between non-neoplastic and neoplastic lesions. Experiments are performed using four different classifier training strategies, each with a different combination of training data. The specifically designed setup for these experiments enables a fair comparison between the four training strategies., Results: Combining high definition with high magnification training data and chromoscopic with non-chromoscopic training data partly improved the results. The usage of domain adaptation has only a small effect on the results compared to just using non-adapted training data., Conclusion: Merging datasets from different imaging modalities turned out to be partially beneficial for the case of combining high definition endoscopic data with high magnification endoscopic data and for combining chromoscopic with non-chromoscopic data. NBI and chromoendoscopy on the other hand are mostly too different with respect to the extracted features to combine images of these two modalities for classifier training., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

In this work, various wavelet based methods like the discrete wavelet transform, the dual-tree complex wavelet transform, the Gabor wavelet transform, curvelets, contourlets and shearlets are applied for the automated classification of colonic polyps. The methods are tested on 8 HD-endoscopic image databases, where each database is acquired using different imaging modalities (Pentax's i-Scan technology combined with or without staining the mucosa), 2 NBI high-magnification databases and one database with chromoscopy high-magnification images. To evaluate the suitability of the wavelet based methods with respect to the classification of colonic polyps, the classification performances of 3 wavelet transforms and the more recent curvelets, contourlets and shearlets are compared using a common framework. Wavelet transforms were already often and successfully applied to the classification of colonic polyps, whereas curvelets, contourlets and shearlets have not been used for this purpose so far. We apply different feature extraction techniques to extract the information of the subbands of the wavelet based methods. Most of the in total 25 approaches were already published in different texture classification contexts. Thus, the aim is also to assess and compare their classification performance using a common framework. Three of the 25 approaches are novel. These three approaches extract Weibull features from the subbands of curvelets, contourlets and shearlets. Additionally, 5 state-of-the-art non wavelet based methods are applied to our databases so that we can compare their results with those of the wavelet based methods. It turned out that extracting Weibull distribution parameters from the subband coefficients generally leads to high classification results, especially for the dual-tree complex wavelet transform, the Gabor wavelet transform and the Shearlet transform. These three wavelet based transforms in combination with Weibull features even outperform the state-of-the-art methods on most of the databases. We will also show that the Weibull distribution is better suited to model the subband coefficient distribution than other commonly used probability distributions like the Gaussian distribution and the generalized Gaussian distribution. So this work gives a reasonable summary of wavelet based methods for colonic polyp classification and the huge amount of endoscopic polyp databases used for our experiments assures a high significance of the achieved results., (Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.)

Recently, Deep Learning, especially through Convolutional Neural Networks (CNNs) has been widely used to enable the extraction of highly representative features. This is done among the network layers by filtering, selecting, and using these features in the last fully connected layers for pattern classification. However, CNN training for automated endoscopic image classification still provides a challenge due to the lack of large and publicly available annotated databases. In this work we explore Deep Learning for the automated classification of colonic polyps using different configurations for training CNNs from scratch (or full training) and distinct architectures of pretrained CNNs tested on 8-HD-endoscopic image databases acquired using different modalities. We compare our results with some commonly used features for colonic polyp classification and the good results suggest that features learned by CNNs trained from scratch and the "off-the-shelf" CNNs features can be highly relevant for automated classification of colonic polyps. Moreover, we also show that the combination of classical features and "off-the-shelf" CNNs features can be a good approach to further improve the results.

This work introduces texture analysis methods that are based on computing the local fractal dimension (LFD; or also called the local density function) and applies them for colonic polyp classification. The methods are tested on 8 HD-endoscopic image databases, where each database is acquired using different imaging modalities (Pentax's i-Scan technology combined with or without staining the mucosa) and on a zoom-endoscopic image database using narrow band imaging. In this paper, we present three novel extensions to a LFD based approach. These extensions additionally extract shape and/or gradient information of the image to enhance the discriminativity of the original approach. To compare the results of the LFD based approaches with the results of other approaches, five state of the art approaches for colonic polyp classification are applied to the employed databases. Experiments show that LFD based approaches are well suited for colonic polyp classification, especially the three proposed extensions. The three proposed extensions are the best performing methods or at least among the best performing methods for each of the employed databases. The methods are additionally tested by means of a public texture image database, the UIUCtex database. With this database, the viewpoint invariance of the methods is assessed, an important features for the employed endoscopic image databases. Results imply that most of the LFD based methods are more viewpoint invariant than the other methods. However, the shape, size and orientation adapted LFD approaches (which are especially designed to enhance the viewpoint invariance) are in general not more viewpoint invariant than the other LFD based approaches., (Copyright © 2015 Elsevier B.V. All rights reserved.)

In this work we propose a method to extract shape-based features from endoscopic images for an automated classification of colonic polyps. This method is based on the density of pits as used in the pit pattern classification scheme which is commonly used for the classification of colonic polyps. For the detection of pits we employ a noise-robust variant of the LBP operator. To be able to be robust against local texture variations we extend this operator by an adaptive thresholding. Based on the detected pit candidates we compute a Delaunay triangulation and use the edge lengths of the resulting triangles to construct histograms. These are then used in conjunction with the k-NN classifier to classify images. We show that, compared to a previously developed method, we are not only able to almost always get higher classification results in our application scenario, but that the proposed method is also able to significantly outperform the previously developed method in terms of the computational demand., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

In this work we propose a novel method to describe local texture properties within color images with the aim of automated classification of endoscopic images. In contrast to comparable Local Binary Patterns operator approaches, where the respective texture operator is almost always applied to each color channel separately, we construct a color vector field from an image. Based on this field the proposed operator computes the similarity between neighboring pixels. The resulting image descriptor is a compact 1D-histogram which we use for a classification using the k-nearest neighbors classifier. To show the usability of this operator we use it to classify magnification-endoscopic images according to the pit pattern classification scheme. Apart from that, we also show that compared to previously proposed operators we are not only able to get competitive classification results in our application scenario, but that the proposed operator is also able to outperform the other methods either in terms of speed, feature compactness, or both., (Copyright © 2011 Elsevier B.V. All rights reserved.)

The diagnosis of colorectal cancer is usually supported by a staging system, such as the Duke or TNM system. In this work we discuss computer-aided pit-pattern classification of surface structures observed during high-magnification colonoscopy in order to support dignity assessment of colonic polyps. This is considered a quite promising approach because it allows in vivo staging of colorectal lesions. Since recent research work has shown that the characteristic surface structures of the colon mucosa exhibit texture characteristics, we employ a set of texture image features in the wavelet-domain and propose a novel classifier combination approach which is similar to a combination of experts. The experimental results of our work show superior classification performance compared to previous approaches on both a two-class (non-neoplastic vs. neoplastic) and a more complicated six-class (pit-pattern) classification problem.

In the last 40 years colonoscopy has been the gold standard in diagnosis of conditions affecting the large intestine. We see its main disadvantages in the necessity for intestinal preparation and in the pain not infrequently experienced by patients who are not sedated. Widespread use of sedation has made it possible to improve patient acceptance in recent years. Complications of colonoscopy are rare, and even the removal of large polyps is regarded as a safe procedure. One of the main problems of colonoscopy is that a large number of far from trivial polyps--up to 20% in the literature--are overlooked. New developments, such as higher resolution videochips and chromoendoscopy, lead to a better diagnostic yield, especially of flat lesions. The rapidly developing sector of interventional colonoscopy in particular will ensure that colonoscopy continues to have an important place in the management of illnesses affecting the large intestine.

Colonoscopy has long been the gold standard for the diagnosis of colonic diseases. Recently, with the advent of CT colonografy, new alternatives seem to appear on the horizon, which seem to finally overcome some of colonoscopy's drawbacks like procedure related pain and discomfort during the examination. Polyp miss rate and the fact that not always the caecum can be reached are also the basis of debate. This article gives an overview about current technique, indications and limitations of diagnostic colonoscopy as well as a potential prospect for the future, discussing novel imaging technologies ranging from magnification endoscopy to virtual histopathology.