Predicting Generalization of AI Colonoscopy Models to Unseen Data

$\textbf{Background}$: Generalizability of AI colonoscopy algorithms is important for wider adoption in clinical practice. However, current techniques for evaluating performance on unseen data require expensive and time-intensive labels. $\textbf{Methods}$: We use a "Masked Siamese Network" (MSN) to identify novel phenomena in unseen data and predict polyp detector performance. MSN is trained to predict masked out regions of polyp images, without any labels. We test MSN's ability to be trained on data only from Israel and detect unseen techniques, narrow-band imaging (NBI) and chromendoscoy (CE), on colonoscopes from Japan (354 videos, 128 hours). We also test MSN's ability to predict performance of Computer Aided Detection (CADe) of polyps on colonoscopies from both countries, even though MSN is not trained on data from Japan. $\textbf{Results}$: MSN correctly identifies NBI and CE as less similar to Israel whitelight than Japan whitelight (bootstrapped z-test, |z| > 496, p < 10^-8 for both) using the label-free Frechet distance. MSN detects NBI with 99% accuracy, predicts CE better than our heuristic (90% vs 79% accuracy) despite being trained only on whitelight, and is the only method that is robust to noisy labels. MSN predicts CADe polyp detector performance on in-domain Israel and out-of-domain Japan colonoscopies (r=0.79, 0.37 respectively). With few examples of Japan detector performance to train on, MSN prediction of Japan performance improves (r=0.56). $\textbf{Conclusion}$: Our technique can identify distribution shifts in clinical data and can predict CADe detector performance on unseen data, without labels. Our self-supervised approach can aid in detecting when data in practice is different from training, such as between hospitals or data has meaningfully shifted from training. MSN has potential for application to medical image domains beyond colonoscopy.