Image Analysis Using Machine Learning for Automated Detection of Hemoglobin H Inclusions in Blood Smears - A Method for Morphologic Detection of Rare Cells

Background: Morphologic rare cell detection is a laborious, operator-dependent process which has the potential to be improved by the use of image analysis using artificial intelligence. Detection of rare hemoglobin H (HbH) inclusions in red cells in the peripheral blood is a common screening method...

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Bibliographic Details
Published in:	Journal of pathology informatics Vol. 12; no. 1; p. 18
Main Authors:	Lee, Shir Ying, Chen, Crystal M.E., Lim, Elaine Y.P., Shen, Liang, Sathe, Aneesh, Singh, Aahan, Sauer, Jan, Taghipour, Kaveh, Yip, Christina Y.C.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-01-2021 Wolters Kluwer - Medknow Elsevier
Subjects:	Blood smear convolutional neural network hemoglobin H machine learning rare event detection Technical Note rare event detection Blood smear machine learning hemoglobin H convolutional neural network
Online Access:	Get full text
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Summary:	Background: Morphologic rare cell detection is a laborious, operator-dependent process which has the potential to be improved by the use of image analysis using artificial intelligence. Detection of rare hemoglobin H (HbH) inclusions in red cells in the peripheral blood is a common screening method for alpha-thalassemia. This study aims to develop a convolutional neural network-based algorithm for the detection of HbH inclusions. Methods: Digital images of HbH-positive and HbH-negative blood smears were used to train and test the software. The software performance was tested on images obtained at various magnifications and on different scanning platforms. Another model was developed for total red cell counting and was used to confirm HbH cell frequency in alpha-thalassemia trait. The threshold minimum red cells to image for analysis was determined by Poisson modeling and validated on image sets. Results: The sensitivity and specificity of the software for HbH+ cells on images obtained at ×100, ×60, and ×40 objectives were close to 91% and 99%, respectively. When an AI-aided diagnostic model was tested on a pilot of 40 whole slide images (WSIs), good inter-rater reliability and high sensitivity and specificity of slide-level classification were obtained. Using the lowest frequency of HbH+ cells (1 in 100,000) observed in our study, we estimated that a minimum of 2.4 × 106 red cells would need to be analyzed to reduce misclassification at the slide level. The minimum required smear size was validated on 78 image sets which confirmed its validity. Conclusions: WSI image analysis can be utilized effectively for morphologic rare cell detection. The software can be further developed on WISs and evaluated in future clinical validation studies comparing AI-aided diagnosis with the routine diagnostic method.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2153-3539 2229-5089 2153-3539
DOI:	10.4103/jpi.jpi_110_20