{"id":62320,"date":"2025-05-16T09:31:38","date_gmt":"2025-05-16T07:31:38","guid":{"rendered":"https:\/\/www.inovex.de\/?p=62320"},"modified":"2025-05-16T09:31:38","modified_gmt":"2025-05-16T07:31:38","slug":"ai-cle-cancer-detection-head-neck","status":"publish","type":"post","link":"https:\/\/www.inovex.de\/de\/blog\/ai-cle-cancer-detection-head-neck\/","title":{"rendered":"AI-Based Diagnostics for Confocal Laser Endomicroscopy Images"},"content":{"rendered":"<p class=\"p1\"><i>(This article is an excerpt of the master\u2019s thesis of Stefanie Marx supervised by Department of Computer Science Faculty of Mathematics and Natural Sciences, University of Cologne, inovex GmbH and the Department of Otolaryngology, Head and Neck Surgery of Helios Dr. Horst Schmidt Kliniken Wiesbaden)<\/i><\/p>\n<p class=\"p1\">Detecting cancer early and precisely is critical for improving patient outcomes. Diagnosing and treating head and neck tumors are challenging<span class=\"Apple-converted-space\">\u00a0 <\/span>for surgeons<span class=\"Apple-converted-space\">\u00a0 <\/span>pathologists. Confocal Laser Endomicroscopy (CLE) is an emerging technology in this field that offers promising advantages. This high-resolution imaging technique allows clinicians to examine tissue at the cellular level in real-time \u2013 without the need for traditional biopsy followed by histopathological examination.<!--more--><\/p>\n<p class=\"p1\">Still, a critical problem remains: interpreting CLE images requires substantial expertise and extensive training for medical professionals. This high barrier to entry limits the widespread adoption of this valuable technology in clinical practice.<\/p>\n<p class=\"p1\">In this master&#8217;s thesis, I investigated how Deep Learning (DL) can be applied to automate the classification of CLE images, supporting the diagnosis of head and neck tumors. The primary objective was to develop an AI-based system capable of reliably distinguishing between healthy and neoplastic (tumorous) tissue.<\/p>\n<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_82_2 counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\"><p class=\"ez-toc-title\" style=\"cursor:inherit\"><\/p>\n<\/div><nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.inovex.de\/de\/blog\/ai-cle-cancer-detection-head-neck\/#Dataset-Methodology\" >Dataset &amp; Methodology:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.inovex.de\/de\/blog\/ai-cle-cancer-detection-head-neck\/#Preprocessing-and-Class-Balancing\" >Preprocessing and Class Balancing<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.inovex.de\/de\/blog\/ai-cle-cancer-detection-head-neck\/#Deep-Learning-Architectures\" >Deep Learning Architectures<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.inovex.de\/de\/blog\/ai-cle-cancer-detection-head-neck\/#Evaluation-Strategy\" >Evaluation Strategy<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.inovex.de\/de\/blog\/ai-cle-cancer-detection-head-neck\/#Results-and-Conclusion\" >Results and Conclusion:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.inovex.de\/de\/blog\/ai-cle-cancer-detection-head-neck\/#Transforming-CLE-into-a-Real-Time-Diagnostic-Tool\" >Transforming CLE into a Real-Time Diagnostic Tool<\/a><\/li><\/ul><\/nav><\/div>\n<h2 class=\"p1\"><span class=\"ez-toc-section\" id=\"Dataset-Methodology\"><\/span><b>Dataset &amp; Methodology:<\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"p2\">To train and evaluate the performance of deep learning models, I used a dataset of 27,413 CLE images collected from 25 patients with histologically confirmed malignancies. These samples span a variety of anatomical regions in the head and neck area, including:<\/p>\n<ul class=\"ul1\">\n<li class=\"li3\">Oral cavity<\/li>\n<li class=\"li3\">Oro- and hypopharynx<\/li>\n<li class=\"li4\">Sinunasal tumors<\/li>\n<\/ul>\n<p class=\"p4\">The inclusion of endonasal tumors is particularly noteworthy, as this region has rarely been considered in previous CLE classification research. Their presence significantly increases the complexity and diversity of the dataset, making it a more realistic and clinically relevant benchmark.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-62311\" src=\"https:\/\/www.inovex.de\/wp-content\/uploads\/EP-gesund_frame_0007-1-1-300x300.png\" alt=\"\" width=\"296\" height=\"296\" srcset=\"https:\/\/www.inovex.de\/wp-content\/uploads\/EP-gesund_frame_0007-1-1-300x300.png 300w, https:\/\/www.inovex.de\/wp-content\/uploads\/EP-gesund_frame_0007-1-1-1024x1020.png 1024w, https:\/\/www.inovex.de\/wp-content\/uploads\/EP-gesund_frame_0007-1-1-150x150.png 150w, https:\/\/www.inovex.de\/wp-content\/uploads\/EP-gesund_frame_0007-1-1-768x765.png 768w, https:\/\/www.inovex.de\/wp-content\/uploads\/EP-gesund_frame_0007-1-1-400x398.png 400w, https:\/\/www.inovex.de\/wp-content\/uploads\/EP-gesund_frame_0007-1-1-650x650.png 650w, https:\/\/www.inovex.de\/wp-content\/uploads\/EP-gesund_frame_0007-1-1.png 1404w\" sizes=\"auto, (max-width: 296px) 100vw, 296px\" \/> <img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-62313\" src=\"https:\/\/www.inovex.de\/wp-content\/uploads\/SS-Tumor-I_frame_0069-1-1-300x297.png\" alt=\"\" width=\"300\" height=\"297\" srcset=\"https:\/\/www.inovex.de\/wp-content\/uploads\/SS-Tumor-I_frame_0069-1-1-300x297.png 300w, https:\/\/www.inovex.de\/wp-content\/uploads\/SS-Tumor-I_frame_0069-1-1-1024x1013.png 1024w, https:\/\/www.inovex.de\/wp-content\/uploads\/SS-Tumor-I_frame_0069-1-1-150x150.png 150w, https:\/\/www.inovex.de\/wp-content\/uploads\/SS-Tumor-I_frame_0069-1-1-768x760.png 768w, https:\/\/www.inovex.de\/wp-content\/uploads\/SS-Tumor-I_frame_0069-1-1-1536x1520.png 1536w, https:\/\/www.inovex.de\/wp-content\/uploads\/SS-Tumor-I_frame_0069-1-1-400x396.png 400w, https:\/\/www.inovex.de\/wp-content\/uploads\/SS-Tumor-I_frame_0069-1-1-360x356.png 360w, https:\/\/www.inovex.de\/wp-content\/uploads\/SS-Tumor-I_frame_0069-1-1.png 1728w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><br \/>\n<i>CLE-Image of healthy (l) and malignant (r) tissue<\/i><\/p>\n<h2 class=\"p1\"><span class=\"ez-toc-section\" id=\"Preprocessing-and-Class-Balancing\"><\/span><b>Preprocessing and Class Balancing<\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"p1\">To improve data quality, I carefully processed the images by removing artifacts and low-quality samples and applied data augmentation to balance the classes. After this step, the final dataset was composed of 7,997 images labeled as neoplastic and 8,142 labeled as healthy tissue by a medical professional.<\/p>\n<h2 class=\"p2\"><span class=\"ez-toc-section\" id=\"Deep-Learning-Architectures\"><\/span><b>Deep Learning Architectures<\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"p1\">My research involved a comparative experimentation of five Convolutional Neural Network (CNN) architectures, ranging from basic to advanced, finetuned architectures.<\/p>\n<p class=\"p1\">Basic architectures trained from scratch:<\/p>\n<ul class=\"ul1\">\n<li class=\"li3\"><b>LeNet-5:<\/b> A pioneering CNN architecture with a relatively simple structure<\/li>\n<li class=\"li4\"><b>AlexNet:<\/b> A deeper network that marked a significant advancement in CNN design<\/li>\n<\/ul>\n<p class=\"p1\">Advanced pre-trained architectures fine-tuned for CLE images:<\/p>\n<ul class=\"ul1\">\n<li class=\"li3\"><b>ResNet-34:<\/b> Incorporating residual connections to address the vanishing gradient problem<\/li>\n<li class=\"li3\"><b>InceptionV3:<\/b> Featuring multi-scale processing through parallel convolutional filters<\/li>\n<li class=\"li4\"><b>EfficientNetV2-S:<\/b> The cutting-edge model optimized for both accuracy and computational efficiency<\/li>\n<\/ul>\n<h2 class=\"p6\"><span class=\"ez-toc-section\" id=\"Evaluation-Strategy\"><\/span><b>Evaluation Strategy<\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"p1\">To ensure robust and clinically relevant evaluation, I implemented two complementary validation strategies:<\/p>\n<ul class=\"ul1\">\n<li class=\"li3\"><b>5-fold cross-validation<\/b> for comprehensive model assessment<\/li>\n<li class=\"li4\"><b>Leave-One-Patient-Out validatio<\/b>n to explore patient-specific challenges<\/li>\n<\/ul>\n<p class=\"p1\">Both evaluation approaches strictly separated patient data between training and test sets, preventing any data leakage that might artificially inflate performance metrics. The models were evaluated using a comprehensive set of performance metrics including accuracy, sensitivity, specificity, F1 score, and Area Under the Receiver Operating Characteristic curve (AUROC).<\/p>\n<p class=\"p1\">To address model interpretability, I employed Class Activation Maps (CAMs) to visualize the image regions that the model considered most relevant for its predictions. These heatmaps help validate whether the AI system is actually focusing on medically meaningful structures \u2014 rather than artifacts or noise. By surfacing the model\u2019s &#8222;thought process&#8220;, CAMs help transforming the system from a black box into a more transparent tool. This transparency is essential for building trust among clinicians and ultimately supporting adoption in real-world diagnostic workflows.<\/p>\n<h2 class=\"p6\"><span class=\"ez-toc-section\" id=\"Results-and-Conclusion\"><\/span><b>Results and Conclusion: <\/b><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"p4\">Among all tested models, EfficientNetV2-S delivered the strongest overall performance, achieving:<\/p>\n<ul class=\"ul1\">\n<li class=\"li3\">84.8% accuracy<\/li>\n<li class=\"li3\">87.0% sensitivity<\/li>\n<li class=\"li4\">83.6% specificity<\/li>\n<\/ul>\n<p class=\"p4\">These results were obtained through nested 5-fold cross-validation, ensuring a robust evaluation.<\/p>\n<figure id=\"attachment_62321\" aria-describedby=\"caption-attachment-62321\" style=\"width: 419px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-62321 \" src=\"https:\/\/www.inovex.de\/wp-content\/uploads\/ROC-Curve-Comparison.png\" alt=\"\" width=\"419\" height=\"314\" srcset=\"https:\/\/www.inovex.de\/wp-content\/uploads\/ROC-Curve-Comparison.png 2400w, https:\/\/www.inovex.de\/wp-content\/uploads\/ROC-Curve-Comparison-300x225.png 300w, https:\/\/www.inovex.de\/wp-content\/uploads\/ROC-Curve-Comparison-1024x768.png 1024w, https:\/\/www.inovex.de\/wp-content\/uploads\/ROC-Curve-Comparison-768x576.png 768w, https:\/\/www.inovex.de\/wp-content\/uploads\/ROC-Curve-Comparison-1536x1152.png 1536w, https:\/\/www.inovex.de\/wp-content\/uploads\/ROC-Curve-Comparison-2048x1536.png 2048w, https:\/\/www.inovex.de\/wp-content\/uploads\/ROC-Curve-Comparison-1920x1440.png 1920w, https:\/\/www.inovex.de\/wp-content\/uploads\/ROC-Curve-Comparison-400x300.png 400w, https:\/\/www.inovex.de\/wp-content\/uploads\/ROC-Curve-Comparison-360x270.png 360w\" sizes=\"auto, (max-width: 419px) 100vw, 419px\" \/><figcaption id=\"caption-attachment-62321\" class=\"wp-caption-text\">ROC curve comparison<\/figcaption><\/figure>\n<p class=\"p4\" style=\"text-align: center;\">Notably, all transfer learning approaches (EfficientNet, InceptionV3, ResNet-34) significantly outperformed models trained from scratch (LeNet-5, AlexNet). EfficientNet stood out for showing the highest consistency with the lowest standard deviation.<\/p>\n<p class=\"p1\">To assess generalization across patients, I applied a Leave-One-Patient-Out (LOPO) cross-validation using EfficientNet. The results revealed substantial performance differences between individual patients \u2013 13 patients achieved over 90% accuracy, while 6 patients fell below 70%.<\/p>\n<figure id=\"attachment_62323\" aria-describedby=\"caption-attachment-62323\" style=\"width: 482px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-62323 \" src=\"https:\/\/www.inovex.de\/wp-content\/uploads\/LOPO-Cross-Validation-scaled.png\" alt=\"\" width=\"482\" height=\"314\" srcset=\"https:\/\/www.inovex.de\/wp-content\/uploads\/LOPO-Cross-Validation-scaled.png 2560w, https:\/\/www.inovex.de\/wp-content\/uploads\/LOPO-Cross-Validation-300x196.png 300w, https:\/\/www.inovex.de\/wp-content\/uploads\/LOPO-Cross-Validation-1024x668.png 1024w, https:\/\/www.inovex.de\/wp-content\/uploads\/LOPO-Cross-Validation-768x501.png 768w, https:\/\/www.inovex.de\/wp-content\/uploads\/LOPO-Cross-Validation-1536x1002.png 1536w, https:\/\/www.inovex.de\/wp-content\/uploads\/LOPO-Cross-Validation-2048x1336.png 2048w, https:\/\/www.inovex.de\/wp-content\/uploads\/LOPO-Cross-Validation-1920x1253.png 1920w, https:\/\/www.inovex.de\/wp-content\/uploads\/LOPO-Cross-Validation-400x261.png 400w, https:\/\/www.inovex.de\/wp-content\/uploads\/LOPO-Cross-Validation-360x235.png 360w\" sizes=\"auto, (max-width: 482px) 100vw, 482px\" \/><figcaption id=\"caption-attachment-62323\" class=\"wp-caption-text\">Test accuracy distribution across individual patients in LOPO cross-validation<\/figcaption><\/figure>\n<p class=\"p1\">Further interpretability analysis with Class Activation Maps (CAMs) confirmed that the model consistently identified clinically relevant tumorous regions. A confidence analysis of the model outputs revealed the model mostly makes high-confidence predictions, clustering at both ends of the probability spectrum.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-62327\" src=\"https:\/\/www.inovex.de\/wp-content\/uploads\/CAM_original-300x300.png\" alt=\"\" width=\"300\" height=\"300\" srcset=\"https:\/\/www.inovex.de\/wp-content\/uploads\/CAM_original-300x300.png 300w, https:\/\/www.inovex.de\/wp-content\/uploads\/CAM_original-1020x1024.png 1020w, https:\/\/www.inovex.de\/wp-content\/uploads\/CAM_original-150x150.png 150w, https:\/\/www.inovex.de\/wp-content\/uploads\/CAM_original-768x771.png 768w, https:\/\/www.inovex.de\/wp-content\/uploads\/CAM_original-1530x1536.png 1530w, https:\/\/www.inovex.de\/wp-content\/uploads\/CAM_original-650x650.png 650w, https:\/\/www.inovex.de\/wp-content\/uploads\/CAM_original-360x361.png 360w, https:\/\/www.inovex.de\/wp-content\/uploads\/CAM_original.png 1536w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/> <img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-62325\" src=\"https:\/\/www.inovex.de\/wp-content\/uploads\/CAM-Overlay-300x300.png\" alt=\"\" width=\"300\" height=\"300\" srcset=\"https:\/\/www.inovex.de\/wp-content\/uploads\/CAM-Overlay-300x300.png 300w, https:\/\/www.inovex.de\/wp-content\/uploads\/CAM-Overlay-1024x1024.png 1024w, https:\/\/www.inovex.de\/wp-content\/uploads\/CAM-Overlay-150x150.png 150w, https:\/\/www.inovex.de\/wp-content\/uploads\/CAM-Overlay-768x768.png 768w, https:\/\/www.inovex.de\/wp-content\/uploads\/CAM-Overlay-1536x1536.png 1536w, https:\/\/www.inovex.de\/wp-content\/uploads\/CAM-Overlay-400x400.png 400w, https:\/\/www.inovex.de\/wp-content\/uploads\/CAM-Overlay-650x650.png 650w, https:\/\/www.inovex.de\/wp-content\/uploads\/CAM-Overlay-360x360.png 360w, https:\/\/www.inovex.de\/wp-content\/uploads\/CAM-Overlay.png 1542w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><br \/>\n<i>CLE-Image (l) with CAM overlay (r)<\/i><\/p>\n<h2 class=\"p1\"><span class=\"ez-toc-section\" id=\"Transforming-CLE-into-a-Real-Time-Diagnostic-Tool\"><\/span>Transforming CLE into a Real-Time Diagnostic Tool<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"p2\">This study demonstrates that established deep learning-based classification methods can be effectively applied to a novel, previously unexamined dataset from diverse anatomical regions within the head and neck.<\/p>\n<p class=\"p2\">The successful adaptation of these techniques confirms their viability in a new data context and substantiates the proof of concept.<\/p>\n<p class=\"p2\">By assisting the interpretation of these complex images, AI transforms CLE from a pure image acquisition device requiring expert interpretation into a diagnostic tool capable of providing real-time support. This advancement could significantly enhance the utility of CLE in clinical practice enabling:<\/p>\n<ul class=\"ul1\">\n<li class=\"li3\">Assistance for novice endoscopists in interpreting morphological structures<\/li>\n<li class=\"li3\">Acceleration of analysis time<\/li>\n<li class=\"li3\">Visual guidance via CAM, making model decisions more transparent<\/li>\n<li class=\"li4\">Guiding surgeons during the procedure<\/li>\n<\/ul>\n<p class=\"p2\">Looking ahead, several promising research avenues emerge:<\/p>\n<ol class=\"ol1\">\n<li class=\"li3\"><b>Two-stage model<\/b>: first filtering out non-diagnostic images, then classifying the diagnostic images into healthy and neoplastic categories<\/li>\n<li class=\"li3\"><b>Advanced techniques<\/b>: Tumor margin segmentation and the integration of temporal image sequences<\/li>\n<li class=\"li4\"><b>Human-AI collaboration<\/b>: Deeper exploration of Human-AI Collaboration, including the design of interaction paradigms and the evaluation of explainability features in clinical decision-making<\/li>\n<\/ol>\n<p class=\"p2\">Recent studies suggest that AI assistance can significantly improve diagnostic accuracy and inter-observer agreement among clinicians, highlighting the potential synergistic benefits of integrating AI into clinical practice.<\/p>\n<p class=\"p2\">While the findings are promising, larger-scale validation studies with diverse datasets will be critical for clinical adoption of AI-based CLE diagnostics. Continued research should further investigate transparency and usability, ensuring that AI systems in the operating room are trustworthy and usable in real-world conditions to significantly improve head and neck cancer diagnosis.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>(This article is an excerpt of the master\u2019s thesis of Stefanie Marx supervised by Department of Computer Science Faculty of Mathematics and Natural Sciences, University of Cologne, inovex GmbH and the Department of Otolaryngology, Head and Neck Surgery of Helios Dr. Horst Schmidt Kliniken Wiesbaden) Detecting cancer early and precisely is critical for improving patient [&hellip;]<\/p>\n","protected":false},"author":433,"featured_media":62351,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"ep_exclude_from_search":false,"footnotes":""},"tags":[],"service":[76,958],"coauthors":[{"id":433,"display_name":"Stefanie Marx","user_nicename":"stephanie-marx"}],"class_list":["post-62320","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","service-artificial-intelligence","service-ehealth"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>AI-Based Diagnostics for Confocal Laser Endomicroscopy Images<\/title>\n<meta name=\"description\" content=\"AI transforms CLE into a diagnostic tool for head and neck cancer. 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