Evaluation of a Deep Learning Approach to Differentiate Bowen's Disease and Seborrheic Keratosis

Simple Summary Bowen's disease (malignant) and seborrheic keratosis (benign) are frequent cutaneous neoplasms. Our study assessed the potential of artificial intelligence to distinguish these entities histologically. A dermatopathologist trained deep learning network diagnosed Bowen's disease and seborrheic keratosis with AUCs of 0.9858 and 0.9764 and sensitivities of 0.9511 and 0.9394, respectively. The algorithm proved robust to slides prepared in three different labs and two different scanner models. Nevertheless, challenges, such as distinguishing irritated seborrheic keratosis from Bowen's disease remained. We believe our findings demonstrate that deep learning algorithms can aid in clinical routine; however, results should be confirmed by qualified histopathologists. Background: Some of the most common cutaneous neoplasms are Bowen's disease and seborrheic keratosis, a malignant and a benign proliferation, respectively. These entities represent a significant fraction of a dermatopathologists' workload, and in some cases, histological differentiation may be challenging. The potential of deep learning networks to distinguish these diseases is assessed. Methods: In total, 1935 whole-slide images from three institutions were scanned on two different slide scanners. A U-Net-based segmentation deep learning algorithm was trained on data from one of the centers to differentiate Bowen's disease, seborrheic keratosis, and normal tissue, learning from annotations performed by dermatopathologists. Optimal thresholds for the class distinction of diagnoses were extracted and assessed on a test set with data from all three institutions. Results: We aimed to diagnose Bowen's diseases with the highest sensitivity. A good performance was observed across all three centers, underlining the model's robustness. In one of the centers, the distinction between Bowen's disease and all other diagnoses was achieved with an AUC of 0.9858 and a sensitivity of 0.9511. Seborrheic keratosis was detected with an AUC of 0.9764 and a sensitivity of 0.9394. Nevertheless, distinguishing irritated seborrheic keratosis from Bowen's disease remained challenging. Conclusions: Bowen's disease and seborrheic keratosis could be correctly identified by the evaluated deep learning model on test sets from three different centers, two of which were not involved in training, and AUC scores > 0.97 were obtained. The method proved robust to changes in the staining solution and scanner model. We believe this demonstrates that deep learning algorithms can aid in clinical routine; however, the results should be confirmed by qualified histopathologists.