{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T23:07:35Z","timestamp":1773788855838,"version":"3.50.1"},"reference-count":30,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,5,17]],"date-time":"2024-05-17T00:00:00Z","timestamp":1715904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Cancers"],"abstract":"<jats:p>High-resolution anoscopy (HRA) plays a central role in the detection and treatment of precursors of anal squamous cell carcinoma (ASCC). Artificial intelligence (AI) algorithms have shown high levels of efficiency in detecting and differentiating HSIL from low-grade squamous intraepithelial lesions (LSIL) in HRA images. Our aim was to develop a deep learning system for the automatic detection and differentiation of HSIL versus LSIL using HRA images from both conventional and digital proctoscopes. A convolutional neural network (CNN) was developed based on 151 HRA exams performed at two volume centers using conventional and digital HRA systems. A total of 57,822 images were included, 28,874 images containing HSIL and 28,948 LSIL. Partial subanalyses were performed to evaluate the performance of the CNN in the subset of images acetic acid and lugol iodine staining and after treatment of the anal canal. The overall accuracy of the CNN in distinguishing HSIL from LSIL during the testing stage was 94.6%. The algorithm had an overall sensitivity and specificity of 93.6% and 95.7%, respectively (AUC 0.97). For staining with acetic acid, HSIL was differentiated from LSIL with an overall accuracy of 96.4%, while for lugol and after therapeutic manipulation, these values were 96.6% and 99.3%, respectively. The introduction of AI algorithms to HRA may enhance the early diagnosis of ASCC precursors, and this system was shown to perform adequately across conventional and digital HRA interfaces.<\/jats:p>","DOI":"10.3390\/cancers16101909","type":"journal-article","created":{"date-parts":[[2024,5,17]],"date-time":"2024-05-17T04:26:29Z","timestamp":1715919989000},"page":"1909","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Deep Learning and High-Resolution Anoscopy: Development of an Interoperable Algorithm for the Detection and Differentiation of Anal Squamous Cell Carcinoma Precursors\u2014A Multicentric Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0340-0830","authenticated-orcid":false,"given":"Miguel Mascarenhas","family":"Saraiva","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, S\u00e3o Jo\u00e3o University Hospital, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"},{"name":"WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal"},{"name":"Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"}]},{"given":"Lucas","family":"Spindler","sequence":"additional","affiliation":[{"name":"Department of Proctology, GH Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014 Paris, France"}]},{"given":"Thiago","family":"Manzione","sequence":"additional","affiliation":[{"name":"Department of Surgery, Instituto de Infectologia Em\u00edlio Ribas, S\u00e3o Paulo 01246-900, Brazil"}]},{"given":"Tiago","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, S\u00e3o Jo\u00e3o University Hospital, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"},{"name":"WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal"},{"name":"Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"}]},{"given":"Nadia","family":"Fathallah","sequence":"additional","affiliation":[{"name":"Department of Proctology, GH Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014 Paris, France"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0484-4804","authenticated-orcid":false,"given":"Miguel","family":"Martins","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, S\u00e3o Jo\u00e3o University Hospital, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"},{"name":"WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9427-5635","authenticated-orcid":false,"given":"Pedro","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, S\u00e3o Jo\u00e3o University Hospital, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"},{"name":"WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal"},{"name":"Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5890-7049","authenticated-orcid":false,"given":"Francisco","family":"Mendes","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, S\u00e3o Jo\u00e3o University Hospital, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"},{"name":"WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8523-874X","authenticated-orcid":false,"given":"Joana","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal"},{"name":"DigestAID\u2014Artificial Intelligence Development, Rua Alfredo Allen, 4200-135 Porto, Portugal"}]},{"given":"Jo\u00e3o","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal"},{"name":"DigestAID\u2014Artificial Intelligence Development, Rua Alfredo Allen, 4200-135 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9387-9872","authenticated-orcid":false,"given":"Guilherme","family":"Macedo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, S\u00e3o Jo\u00e3o University Hospital, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"},{"name":"WGO Gastroenterology and Hepatology Training Center, 4200-427 Porto, Portugal"},{"name":"Faculty of Medicine, University of Porto, Alameda Professor Hern\u00e2ni Monteiro, 4200-427 Porto, Portugal"}]},{"given":"Sidney","family":"Nadal","sequence":"additional","affiliation":[{"name":"Department of Surgery, Instituto de Infectologia Em\u00edlio Ribas, S\u00e3o Paulo 01246-900, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1498-9089","authenticated-orcid":false,"given":"Vincent","family":"de Parades","sequence":"additional","affiliation":[{"name":"Department of Proctology, GH Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014 Paris, France"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1097\/LGT.0000000000000256","article-title":"2016 IANS International Guidelines for Practice Standards in the Detection of Anal Cancer Precursors","volume":"20","author":"Hillman","year":"2016","journal-title":"J. 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