Introduction
The screening of prostate biopsies in UK histopathology departments commonly involves examining up to 10–12 cores per case [1]. Biopsy rates have increased compared to numbers of qualified pathologists; overburdened services may have an increased potential for human error identifying small foci of cancers [2, 3]. A financially viable and dependable aid for pathologists was sought to rebalance this supply-demand mismatch. The study primarily aimed to validate the use of artificial intelligence (AI) as an assistance tool for the diagnosis of prostate biopsies in clinical practice. Additionally, AI was viewed as a potential for increasing accuracy and reliability of pathologists in this field.
Challenges of AI involve potentially introducing human bias from the resources they learn from and public concern over future obsolescence of humans within diagnostics. Concerns regarding reliability, failsafe measures should AI fail, data protection and workflow issues required addressing before progress towards AI dependent diagnosis can begin.
Method
The study involved digitally scanning 3975 slides from 860 patients biopsied in North Wales. Digital images were reported by the AI and by a consultant histopathologist. Slides were classified based on the AI diagnosis as either likely-benign, uncertain, or likely-malignant prior to examination by pathologists in Betsi Cadwaladr University Health Board. An AI-Model (IBEX, Tel Aviv, Israel) would then highlight points of interest to the pathologist alongside the proposed AI diagnosis. Pathologists would then formulate their diagnosis based on their findings and categorise the case as either benign, uncertain, or malignant.
Parallel to this, numbers regarding the Glan Clwyd histopathology department’s workload; namely caseload, specimens per case, immunohistochemistry requests and final diagnoses comparing cases from 2019 to cases 2022.
Results
Procedures in 2022 were deemed comparable to those carried out in 2019 with 81:19 being biopsy and template biopsy respectively in 2022 compared to a ratio of 86:14 in 2019. Numbers of prostate biopsy cases decreased in this period from 708 cases to 467 cases with number of specimens also decreasing from 2184 to 1632 (Figure 1).
Cases in 2022 had a slightly higher average number of specimens compared to 2019 from 3.08 specimens per case to 3.49.
From 2019 to 2022 the proportion of cancer diagnoses increased from 55 % of cases to 68 % – with a corresponding decrease in the percentage of benign specimens from 43 % to 29 %. Percentages of the intermediate; atypical small acinar proliferation diagnoses remained roughly similar throughout the study (Figure 2).
