Deep learning based identification of pituitary adenoma on surgical endoscopic images: a pilot study

Accurate tumor identification during surgical excision is necessary for neurosurgeons to determine the extent of resection without damaging the surrounding tissues. No conventional technologies have achieved reliable performance for pituitary adenomas. This study proposes a deep learning approach using intraoperative endoscopic images to discriminate pituitary adenomas from non-tumorous tissue inside the sella turcica. Static images were extracted from 50 intraoperative videos of patients with pituitary adenomas. All patients underwent endoscopic transsphenoidal surgery with a 4 K ultrahigh-definition endoscope. The tumor and non-tumorous tissue within the sella turcica were delineated on static images. Using intraoperative images, we developed and validated deep learning models to identify tumorous tissue. Model performance was evaluated using a fivefold per-patient methodology. As a proof-of-concept, the model's predictions were pathologically cross-referenced with a medical professional's diagnosis using the intraoperative images of a prospectively enrolled patient. In total, 605 static images were obtained. Among the cropped 117,223 patches, 58,088 were labeled as tumors, while the remaining 59,135 were labeled as non-tumorous tissues. The evaluation of the image dataset revealed that the wide-ResNet model had the highest accuracy of 0.768, with an F1 score of 0.766. A preliminary evaluation on one patient indicated alignment between the ground truth set by neurosurgeons, the model's predictions, and histopathological findings. Our deep learning algorithm has a positive tumor discrimination performance in intraoperative 4-K endoscopic images in patients with pituitary adenomas.