Real-time artificial intelligence-assisted detection and segmentation of nasopharyngeal carcinoma using multimodal endoscopic data: a multi-center, prospective study.

Background: Nasopharyngeal carcinoma (NPC) is a common malignancy in southern China, and often underdiagnosed due to reliance on physician expertise. Artificial intelligence (AI) can enhance diagnostic accuracy and efficiency using large datasets and advanced algorithms. Methods: Nasal endoscopy videos with white light imaging (WLI) and narrow-band imaging (NBI) modes from 707 patients treated at one center in China from June 2020 to December 2022 were prospectively collected. A total of 8816 frames were obtained through standardized data procedures. Nasopharyngeal Carcinoma Diagnosis Segmentation Network Framework (NPC-SDNet) was developed and internally tested based on these frames. Two hundred frames were randomly selected to compare the diagnostic performance between NPC-SDNet and rhinologists. Two external testing sets with 2818 images from other hospitals validated the robustness and generalizability of the model. This study was registered at clinicaltrials.gov (NCT04547673). Findings: The diagnostic accuracy, precision, recall, and specificity of NPC-SDNet using WLI were 95.0% (95% CI: 94.1%-96.2%), 93.5% (95% CI: 90.2%-95.2%), 97.2% (95% CI: 96.2%-98.3%), and 93.5% (95% CI: 91.7%-94.0%), respectively, and using NBI were 95.8% (95% CI: 94.0%-96,8%), 93.1% (95% CI: 91.0%-95.6%), 96.0% (95% CI: 95.7%-96.8%), and 97.2% (95% CI: 97.1%-97.4%), respectively. Segmentation performance was also robust, with mean Intersection over Union scores of 83.4% (95% CI: 81.8%-85.6%; NBI) and 83.7% (95% CI: 85.1%-90.1%; WLI). In head-to-head comparisons with rhinologists, NPC-SDNet achieved a diagnostic accuracy of 94.0% (95% CI: 91.5%-95.8%) and processed 1000 frames per minute, outperforming clinicians (68.9%-88.2%) across different expertise levels. External validation further supported the reliability of NPC-SDNet, with area under the receiver operating characteristic curve (AUC) values of 0.998 and 0.977 in NBI images, 0.977 and 0.970 in WLI images. Interpretation: NPC-SDNet demonstrates excellent real-time diagnostic and segmentation accuracy, offering a promising tool for enhancing the precision of NPC diagnosis. Funding: This work was supported by National Key R&D Program of China (2020YFC1316903), the National Natural Science Foundation of China (NSFC) grants (81900918, 82020108009), Natural Science Foundation of Guangdong Province (2022A1515010002), Key-Area Research and Development of Guangdong Province (2023B1111040004, 2020B1111190001), and Key Clinical Technique of Guangzhou (2023P-ZD06).