Deep learning outperformed 136 of 157 dermatologists in a head-to-head dermoscopic melanoma image classification task

• Published in: European journal of cancer (1990) Vol. 113; pp. 47 - 54
• Main Authors: Brinker, Titus J., Hekler, Achim, Enk, Alexander H., Klode, Joachim, Hauschild, Axel, Berking, Carola, Schilling, Bastian, Haferkamp, Sebastian, Schadendorf, Dirk, Holland-Letz, Tim, von Kalle, Christof, Sirokay, Judith, Albrecht, Magarete, Chorti, Eleftheria, Dith, Anna, Drusio, Christina, Giese, Nina, Griewank, Klaus, Hallasch, Sandra, Hanhart, Zdenka, Herz, Saskia, Hohaus, Katja, Jansen, Philipp, Jockenhöfer, Finja, Kanaki, Theodora, Leonhard, Katja, Matei, Liliana, Olischewski, Alexandra, Placke, Jan-Malte, Raub, Simon, Salva, Katrin, Sody, Elsa, Steingrube, Nadine, Ugurel, Selma, Zaremba, Anne, Gebhardt, Christoffer, Booken, Nina, Buder-Bakhaya, Kristina, Bokor-Billmann, Therezia, Enk, Alexander, Hänßle, Holger, Salzmann, Martin, Schank, Timo, Bohne, Ann-Sophie, Egberts, Friederike, Ewald, Benjamin, Falkvoll, Sandra, Gerdes, Sascha, Harde, Viola, Jost, Marion, Kosova, Katja, Messinger, Laetitia, Metzner, Malte, Scheller, Natalie, Schwarz, Thomas, Stölzl, Dora, Thielking, Federieke, Tomaschewski, Elena, Wehkamp, Ulrike, Wiedow, Oliver, Bender-Säbelkampf, Sophia, Horbrügger, Marc, Karoglan, Ante, Kraas, Luise, Geraud, Cyrill, Koch, Philipp, Linke, Miriam, Maurier, Nolwenn, Müller, Verena, Thomas, Benjamin, Utikal, Jochen Sven, Alamri, Ali Saeed M., Baczako, Andrea, Betke, Matthias, Haas, Carolin, Hartmann, Daniela, Kilian, Katharina, Krammer, Sebastian, Lapczynski, Natalie Lidia, Nasifoglu, Suzan, Ruini, Cristel, Wolff, Hans, Achatz, Birgit, Bergbreiter, Astrid, Drexler, Konstantin, Halupczok, Anna, Hegemann, Marie, Dinauer, Verena, Maagk, Maria, Mickler, Marion, Philipp, Biance, Wittmann, Constanze, Gesierich, Anja, Glutsch, Valerie, Kahlert, Katrin, Kerstan, Andreas, Schrüfer, Philipp
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-05-2019; Elsevier Science Ltd
• Subjects: Algorithms; Artificial intelligence; Artificial neural networks; Classification; Colleges & universities; Deep Learning; Dermatologists; Dermatology; Dermoscopy; Germany; Hospitals, University; Humans; Image classification; Learning algorithms; Lesions; Levels; Medical personnel; Melanoma; Melanoma - diagnosis; Melanoma - pathology; Neural networks; Nevus - diagnosis; Nevus - pathology; Physicians; Sensitivity; Sensitivity and Specificity; Skin cancer; Skin Neoplasms - diagnosis; Skin Neoplasms - pathology; Germany; Artificial intelligence; Melanoma; Skin cancer
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2019.04.001

Recent studies have successfully demonstrated the use of deep-learning algorithms for dermatologist-level classification of suspicious lesions by the use of excessive proprietary image databases and limited numbers of dermatologists. For the first time, the performance of a deep-learning algorithm trained by open-source images exclusively is compared to a large number of dermatologists covering all levels within the clinical hierarchy.
We used methods from enhanced deep learning to train a convolutional neural network (CNN) with 12,378 open-source dermoscopic images. We used 100 images to compare the performance of the CNN to that of the 157 dermatologists from 12 university hospitals in Germany. Outperformance of dermatologists by the deep neural network was measured in terms of sensitivity, specificity and receiver operating characteristics.
The mean sensitivity and specificity achieved by the dermatologists with dermoscopic images was 74.1% (range 40.0%–100%) and 60% (range 21.3%–91.3%), respectively. At a mean sensitivity of 74.1%, the CNN exhibited a mean specificity of 86.5% (range 70.8%–91.3%). At a mean specificity of 60%, a mean sensitivity of 87.5% (range 80%–95%) was achieved by our algorithm. Among the dermatologists, the chief physicians showed the highest mean specificity of 69.2% at a mean sensitivity of 73.3%. With the same high specificity of 69.2%, the CNN had a mean sensitivity of 84.5%.
A CNN trained by open-source images exclusively outperformed 136 of the 157 dermatologists and all the different levels of experience (from junior to chief physicians) in terms of average specificity and sensitivity.
•A convolutional neural network (CNN) received enhanced training with 12,378 open-source dermoscopic images.•In a head-to-head comparison, the CNN outperformed 136 of 157 participating dermatologists.•The CNN was capable to outperform dermatologists of all hierarchical subgroups (from junior to chief physicians) in dermoscopic melanoma image classification.