Artificial Intelligence System to Determine Risk of T1 Colorectal Cancer Metastasis to Lymph Node

Gastroenterology. 2021 Mar;160(4):1075-1084.e2. doi: 10.1053/j.gastro.2020.09.027. Epub 2020 Sep 24.


Background & aims: In accordance with guidelines, most patients with T1 colorectal cancers (CRC) undergo surgical resection with lymph node dissection, despite the low incidence (∼10%) of metastasis to lymph nodes. To reduce unnecessary surgical resections, we used artificial intelligence to build a model to identify T1 colorectal tumors at risk for metastasis to lymph node and validated the model in a separate set of patients.

Methods: We collected data from 3134 patients with T1 CRC treated at 6 hospitals in Japan from April 1997 through September 2017 (training cohort). We developed a machine-learning artificial neural network (ANN) using data on patients' age and sex, as well as tumor size, location, morphology, lymphatic and vascular invasion, and histologic grade. We then conducted the external validation on the ANN model using independent 939 patients at another hospital during the same period (validation cohort). We calculated areas under the receiver operator characteristics curves (AUCs) for the ability of the model and US guidelines to identify patients with lymph node metastases.

Results: Lymph node metastases were found in 319 (10.2%) of 3134 patients in the training cohort and 79 (8.4%) of /939 patients in the validation cohort. In the validation cohort, the ANN model identified patients with lymph node metastases with an AUC of 0.83, whereas the guidelines identified patients with lymph node metastases with an AUC of 0.73 (P < .001). When the analysis was limited to patients with initial endoscopic resection (n = 517), the ANN model identified patients with lymph node metastases with an AUC of 0.84 and the guidelines identified these patients with an AUC of 0.77 (P = .005).

Conclusions: The ANN model outperformed guidelines in identifying patients with T1 CRCs who had lymph node metastases. This model might be used to determine which patients require additional surgery after endoscopic resection of T1 CRCs. UMIN Clinical Trials Registry no: UMIN000038609.

Keywords: AI; Algorithm; LNM; Machine Learning; Management.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Age Factors
  • Aged
  • Colectomy / statistics & numerical data
  • Colon / diagnostic imaging
  • Colon / pathology
  • Colon / surgery
  • Colonoscopy / statistics & numerical data
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / pathology*
  • Colorectal Neoplasms / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Japan / epidemiology
  • Lymph Node Excision / statistics & numerical data*
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / pathology
  • Lymph Nodes / surgery
  • Lymphatic Metastasis / diagnosis*
  • Lymphatic Metastasis / therapy
  • Machine Learning*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • ROC Curve
  • Retrospective Studies
  • Risk Assessment / methods
  • Risk Factors

Associated data

  • JPRN/UMIN000038609