Publication: Longitudinal Screening for Diabetic Retinopathy in a Nationwide Screening Program: Comparing Deep Learning and Human Graders
Issued Date
2020-01-01
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23146753
23146745
23146745
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2-s2.0-85098557969
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of Diabetes Research. Vol.2020, (2020)
Suggested Citation
Jirawut Limwattanayingyong, Variya Nganthavee, Kasem Seresirikachorn, Tassapol Singalavanija, Ngamphol Soonthornworasiri, Varis Ruamviboonsuk, Chetan Rao, Rajiv Raman, Andrzej Grzybowski, Mike Schaekermann, Lily H. Peng, Dale R. Webster, Christopher Semturs, Jonathan Krause, Rory Sayres, Fred Hersch, Richa Tiwari, Yun Liu, Paisan Ruamviboonsuk Longitudinal Screening for Diabetic Retinopathy in a Nationwide Screening Program: Comparing Deep Learning and Human Graders. Journal of Diabetes Research. Vol.2020, (2020). doi:10.1155/2020/8839376 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/60886
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Title
Longitudinal Screening for Diabetic Retinopathy in a Nationwide Screening Program: Comparing Deep Learning and Human Graders
Author(s)
Jirawut Limwattanayingyong
Variya Nganthavee
Kasem Seresirikachorn
Tassapol Singalavanija
Ngamphol Soonthornworasiri
Varis Ruamviboonsuk
Chetan Rao
Rajiv Raman
Andrzej Grzybowski
Mike Schaekermann
Lily H. Peng
Dale R. Webster
Christopher Semturs
Jonathan Krause
Rory Sayres
Fred Hersch
Richa Tiwari
Yun Liu
Paisan Ruamviboonsuk
Variya Nganthavee
Kasem Seresirikachorn
Tassapol Singalavanija
Ngamphol Soonthornworasiri
Varis Ruamviboonsuk
Chetan Rao
Rajiv Raman
Andrzej Grzybowski
Mike Schaekermann
Lily H. Peng
Dale R. Webster
Christopher Semturs
Jonathan Krause
Rory Sayres
Fred Hersch
Richa Tiwari
Yun Liu
Paisan Ruamviboonsuk
Abstract
© 2020 Jirawut Limwattanayingyong et al. Objective. To evaluate diabetic retinopathy (DR) screening via deep learning (DL) and trained human graders (HG) in a longitudinal cohort, as case spectrum shifts based on treatment referral and new-onset DR. Methods. We randomly selected patients with diabetes screened twice, two years apart within a nationwide screening program. The reference standard was established via adjudication by retina specialists. Each patient's color fundus photographs were graded, and a patient was considered as having sight-threatening DR (STDR) if the worse eye had severe nonproliferative DR, proliferative DR, or diabetic macular edema. We compared DR screening via two modalities: DL and HG. For each modality, we simulated treatment referral by excluding patients with detected STDR from the second screening using that modality. Results. There were 5,738 patients (12.3% STDR) in the first screening. DL and HG captured different numbers of STDR cases, and after simulated referral and excluding ungradable cases, 4,148 and 4,263 patients remained in the second screening, respectively. The STDR prevalence at the second screening was 5.1% and 6.8% for DL- and HG-based screening, respectively. Along with the prevalence decrease, the sensitivity for both modalities decreased from the first to the second screening (DL: from 95% to 90%, p=0.008; HG: from 74% to 57%, p<0.001). At both the first and second screenings, the rate of false negatives for the DL was a fifth that of HG (0.5-0.6% vs. 2.9-3.2%). Conclusion. On 2-year longitudinal follow-up of a DR screening cohort, STDR prevalence decreased for both DL- and HG-based screening. Follow-up screenings in longitudinal DR screening can be more difficult and induce lower sensitivity for both DL and HG, though the false negative rate was substantially lower for DL. Our data may be useful for health-economics analyses of longitudinal screening settings.