Real-World Insights in Designing SteatoStat: An End-to-End Deep Learning Pipeline for Hepatic Steatosis...

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a significant and escalating global health concern, with an estimated prevalence of 30%. Current assessments of hepatic steatosis, a hallmark of MASLD, rely on semi-quantitative grading by pathologists, which is inherently limited by inter-observer variability. Objective: To address this limitation, we developed a novel deep learning pipeline, named SteatoStat, to standardize and enhance the quantification of hepatic steatosis in patients with MASLD. Method: The SteatoStat pipeline employs and integrates multiple components such as file format standardization, rule-based cell filtering, and multiple segmentation models across various liver structures, resulting in an output of a continuous quantitative measure of steatosis percentage and translated into steatosis grades. Results: We report a high degree of accuracy and reliability with SteatoStat achieving the following performance metrics (DICE score = 0.8955, AUROC = 0.9928, F1 score = 0.8990). When benchmarked against expert pathologists, the weighted Kappa coefficient is 0.837. Furthermore, in comparison with an existing, well-established model, SteatoStat demonstrated a weighted Kappa coefficient = 0.765. Conclusions: These robust findings underscore its potential clinical utility in providing a standardized objective quantification of hepatic steatosis. Future directions include enhancing the model's generalizability and its clinical integration through validation on independent, multi-institutional datasets.