EndoFinder: Online Image Retrieval for Explainable Colorectal Polyp Diagnosis

Determining the necessity of resecting malignant polyps during colonoscopy screen is crucial for patient outcomes, yet challenging due to the time-consuming and costly nature of histopathology examination. While deep learning-based classification models have shown promise in achieving optical biopsy with endoscopic images, they often suffer from a lack of explainability. To overcome this limitation, we introduce EndoFinder, a content-based image retrieval framework to find the 'digital twin' polyp in the reference database given a newly detected polyp. The clinical semantics of the new polyp can be inferred referring to the matched ones. EndoFinder pioneers a polyp-aware image encoder that is pre-trained on a large polyp dataset in a self-supervised way, merging masked image modeling with contrastive learning. This results in a generic embedding space ready for different downstream clinical tasks based on image retrieval. We validate the framework on polyp re-identification and optical biopsy tasks, with extensive experiments demonstrating that EndoFinder not only achieves explainable diagnostics but also matches the performance of supervised classification models. EndoFinder's reliance on image retrieval has the potential to support diverse downstream decision-making tasks during real-time colonoscopy procedures.

Knowledge Extraction and Distillation from Large-Scale Image-Text Colonoscopy Records Leveraging Large Language and Vision Models

The development of artificial intelligence systems for colonoscopy analysis often necessitates expert-annotated image datasets. However, limitations in dataset size and diversity impede model performance and generalisation. Image-text colonoscopy records from routine clinical practice, comprising millions of images and text reports, serve as a valuable data source, though annotating them is labour-intensive. Here we leverage recent advancements in large language and vision models and propose EndoKED, a data mining paradigm for deep knowledge extraction and distillation. EndoKED automates the transformation of raw colonoscopy records into image datasets with pixel-level annotation. We validate EndoKED using multi-centre datasets of raw colonoscopy records (~1 million images), demonstrating its superior performance in training polyp detection and segmentation models. Furthermore, the EndoKED pre-trained vision backbone enables data-efficient and generalisable learning for optical biopsy, achieving expert-level performance in both retrospective and prospective validation.

EndoBoost: a plug-and-play module for false positive suppression during computer-aided polyp detection in real-world colonoscopy

The advance of computer-aided detection systems using deep learning opened a new scope in endoscopic image analysis. However, the learning-based models developed on closed datasets are susceptible to unknown anomalies in complex clinical environments. In particular, the high false positive rate of polyp detection remains a major challenge in clinical practice. In this work, we release the FPPD-13 dataset, which provides a taxonomy and real-world cases of typical false positives during computer-aided polyp detection in real-world colonoscopy. We further propose a post-hoc module EndoBoost, which can be plugged into generic polyp detection models to filter out false positive predictions. This is realized by generative learning of the polyp manifold with normalizing flows and rejecting false positives through density estimation. Compared to supervised classification, this anomaly detection paradigm achieves better data efficiency and robustness in open-world settings. Extensive experiments demonstrate a promising false positive suppression in both retrospective and prospective validation. In addition, the released dataset can be used to perform 'stress' tests on established detection systems and encourages further research toward robust and reliable computer-aided endoscopic image analysis. The dataset and code will be publicly available at http://endoboost.miccai.cloud.