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  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>TRANSFER LEARNING FOR ENDOSCOPY DISEASE DETECTION AND SEGMENTATION WITH MASK-RCNN BENCHMARK ARCHITECTURE</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Shahadate Rezvy</string-name>
          <xref ref-type="aff" rid="aff2">2</xref>
          <xref ref-type="aff" rid="aff3">3</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Tahmina Zebin</string-name>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Barbara Braden</string-name>
          <xref ref-type="aff" rid="aff4">4</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Wei Pang</string-name>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Stephen Taylor</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Xiaohong W Gao</string-name>
          <xref ref-type="aff" rid="aff3">3</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>MRC Weatherall Institute of Molecular Medicine, University of Oxford</institution>
          ,
          <country country="UK">UK</country>
        </aff>
        <aff id="aff1">
          <label>1</label>
          <institution>School of Computing Sciences, University of East Anglia</institution>
          ,
          <country country="UK">UK</country>
        </aff>
        <aff id="aff2">
          <label>2</label>
          <institution>School of Mathematical &amp; Computer Sciences, Heriot-Watt University</institution>
          ,
          <country country="UK">UK</country>
        </aff>
        <aff id="aff3">
          <label>3</label>
          <institution>School of Science and Technology, Middlesex University London</institution>
          ,
          <country country="UK">UK</country>
        </aff>
        <aff id="aff4">
          <label>4</label>
          <institution>Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford</institution>
          ,
          <country country="UK">UK</country>
        </aff>
      </contrib-group>
      <abstract>
        <p>We proposed and implemented a disease detection and semantic segmentation pipeline using a modified mask-RCNN infrastructure model on the EDD2020 dataset1. On the images provided for the phase-I test dataset, for 'BE', we achieved an average precision of 51.14%, for 'HGD' and 'polyp' it is 50%. However, the detection score for 'suspicious' and 'cancer' were low. For phase-I, we achieved a dice coefficient of 0.4562 and an F2 score of 0.4508. We noticed the missed and mis-classification was due to the imbalance between classes. Hence, we applied a selective and balanced augmentation stage in our architecture to provide more accurate detection and segmentation. We observed an increase in detection score to 0.29 on phase -II images after balancing the dataset from our phase-I detection score of 0.24. We achieved an improved semantic segmentation score of 0.62 from our phase-I score of 0.52.</p>
      </abstract>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>1. INTRODUCTION</title>
      <p>
        Endoscopy is an extensively used clinical procedure for the
early detection of cancers in various organs such as
esophagus, stomach, colon, and bladder [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ]. In recent years, deep
learning methods were used in various endoscopic
imaging tasks including esophago-gastro-duodenoscopy (EGD),
colonoscopy, and capsule endoscopy (CE) [
        <xref ref-type="bibr" rid="ref2">2</xref>
        ]. Most of these
were inspired by artificial neural network-based solutions
for accurate and consistent localization and segmentation of
diseased region-of-interests enable precise quantification and
mapping of lesions from clinical endoscopy videos. This
enables critical and useful detection techniques for monitoring
and surgical planning.
      </p>
      <p>
        For oesophageal cancer detection, Mendel et al. [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ]
proposed an automatic approach for early detection of
adenocar1https://edd2020.grand-challenge.org
      </p>
      <p>
        Copyright c 2020 for this paper by its authors. Use permitted under
Creative Commons License Attribution 4.0 International (CC BY 4.0).
cinoma in the esophagus by using high-definition endoscopic
images (50 cancer, 50 Barrett). They adapted and fed the data
set to a deep Convolutional Neural Network (CNN) using a
transfer learning approach. The model was evaluated to leave
one patient out cross-validation. With sensitivity and
specificity of 0.94 and 0.88, respectively. Horie et al. [
        <xref ref-type="bibr" rid="ref4">4</xref>
        ] reported
AI diagnoses of esophageal cancer including squamous cell
carcinoma (ESCC) and adenocarcinoma (EAC) using CNNs.
The CNN correctly detected esophageal cancer cases with a
sensitivity of 98%. CNN could detect all small cancer lesions
less than 10 mm in size. It has reportedly distinguished
superficial esophageal cancer from advanced cancer with an
accuracy of 98%. Very recently, Gao et al. [
        <xref ref-type="bibr" rid="ref5">5</xref>
        ] investigated the
feasibility of mask-RCNN (Region-based convolutional neural
network) and YOLOv3 architectures to detect various stages
of squamous cell carcinoma (SCC) cancer in real-time to
detect subtle appearance changes. For the detection of SCC, the
reported average accuracy for classification and detection was
85% and 74% respectively.
      </p>
      <p>
        For colonoscopy, deep neural networks based solutions
were implemented to detect and classify colorectal polyps
in research presented by the authors in reference [
        <xref ref-type="bibr" rid="ref6 ref7 ref8">6, 7, 8</xref>
        ].
For gastric cancer, Wu et al. [
        <xref ref-type="bibr" rid="ref9">9</xref>
        ] identified EGC from
nonmalignancy with an accuracy of 92.5%, a sensitivity of
94.0%, a specificity of 91.0%, a positive predictive value
of 91.3%, and a negative predictive value of 93.8%,
outperforming all levels of endoscopists. In real-time unprocessed
EGD videos, the DCNN achieved automated performance for
detecting EGC and monitoring blind spots. Mori et al. [
        <xref ref-type="bibr" rid="ref10">10</xref>
        ]
and Min et al. [
        <xref ref-type="bibr" rid="ref2">2</xref>
        ] provided a comprehensive review of some
recent literature in this field.
      </p>
      <p>For Endoscopy Disease Detection and Segmentation
Grand Challenge, we proposed and implemented a disease
detection and semantic segmentation pipeline using a
modified mask-RCNN architecture. The rest of the paper is
organized as follows. Section 2 introduces the dataset for
the task. Section 3 presents our proposed architecture with
various settings and procedural stages, with results presented
and discussed in Section 4. Finally, conclusions are drawn in
Section 5.</p>
    </sec>
    <sec id="sec-2">
      <title>2. DATASET DESCRIPTION AND IMAGE</title>
    </sec>
    <sec id="sec-3">
      <title>AUGMENTATION</title>
      <p>
        The annotated dataset provided for the competition contained
388 frames from 5 different international centers and 3 organs
(colon, esophagus, and stomach) targeting multiple
populations and varied endoscopy video modalities associated with
pre-malignant and diseased regions. The dataset is labeled by
medical experts and experienced post-doctoral researchers. It
came with object-wise binary masks and bounding box
annotation. The class-wise object distribution in the dataset is
shown in Table 1. A detailed description of the dataset can be
found at [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ].
      </p>
      <p>We separated a small subset from the original training set
with various class labels as our external validation set. This
subset had 25 images, and was programmatically chosen to
have similar size and resolution as the images in phase-I test
dataset of 24 images. This set with ground truth labels served
as a checkpoint for us to the trained model’s performance.</p>
      <p>
        We applied image augmentation techniques [
        <xref ref-type="bibr" rid="ref11">11</xref>
        ] on the
rest of the images with their associated masks. Our
observation of the dataset revealed a co-location of ’BE’ regions
with ’suspicious, cancer and HGD’ area. We also noticed an
imbalance between classes and images coming from various
organs. Hence, we opted for an instance cropping stage in our
pipeline that produced multiple images from these co-located
images, each with one target object and other objects are
removed by a selective cropping mechanism (example shown
on Figure 1). We kept 10% padding around the ground truth
bounding box provided for the instance. This isolated the
instances of ’cancer’, ’suspicious’ and ’HGD’ regions from
colocalized ’BE’ regions. We applied transformations such as
rotation, flip and crop on the individual classes and instances
to increase our training data. We then used the
’WeightedRandomSampler’ from the PyTorch data loader to form the
final balanced training set of almost equal class representation.
This set included 1670 instances in total. Figure 1 illustrates
some of the augmentation methods we applied in our pipeline.
      </p>
    </sec>
    <sec id="sec-4">
      <title>3. METHODS</title>
      <p>
        We implemented the Endoscopic disease detection and
semantic segmentation pipeline for the EDD2020 challenge
using a modified mask-RCNN [
        <xref ref-type="bibr" rid="ref12">12</xref>
        ] architecture trained in the
feature-representation transfer learning mode. Mask-RCNN
was proposed as an extension of Faster R-CNN and the
architecture has reportedly outperformed all the previous
stateof-the-art models used for the instance segmentation task on
various image datasets. We used PyTorch, torchvision,
imgaug, pycoco-creator, maskrcnn-benchmark [
        <xref ref-type="bibr" rid="ref13">13</xref>
        ], apex, and
OpenCV libraries in python for generating various functions
of the pipeline.
      </p>
    </sec>
    <sec id="sec-5">
      <title>3.1. Pre-trained model backbone and network head removal</title>
      <p>
        We removed the network head or the final layers of the
pretrained model with a Resnet-101 backbone [
        <xref ref-type="bibr" rid="ref12">12</xref>
        ] that was
initially trained on the COCO dataset. This stage is crucial as
the pre-trained model was trained for a different classification
task. The removal of network head removed weights and bias
associated to class score, bounding box predictor and mask
predictor layers. It is then replaced with new untrained layers
with desired number of classes for the new data. We adjusted
a six-class network head for the EDD2020 dataset (five
assigned classes+ Background). We fed the augmented dataset
and and the associated masks into the mask-RCNN model
architecture as illustrated in figure 2.
      </p>
    </sec>
    <sec id="sec-6">
      <title>3.2. Transfer learning stages</title>
      <p>At the initial stage, we froze the weights of the earlier layers
of the pre-trained ResNet-101 backbone to help us extract the
generic low-level descriptors or patterns from the endoscopy
image data. Later layers of the CNN become progressively
more specific to the details of the output classes of the new
data-set. Then a newly added network head is trained for
adapting the weights according to the patterns and
distribution of the new dataset. The network head is updated and fine
tuned during model training. The training of the model has
been done offline on an Ubuntu machine with Intel(R) Core
i9-9900X CPU @ 3.50GHz, 62GB memory and a GeForce
RTX 2060 GPU. The final model was fine- tuned with an
Adam optimizer with a learning rate of 0.0001 and a
categorical cross-entropy for 50000 epochs. To be noted, the dataset
after augmentation is still quite small, so we employed a
fivefold cross-validation during training to avoid the over-fitting
of the model.</p>
    </sec>
    <sec id="sec-7">
      <title>4. RESULTS AND EVALUATION SCORE</title>
      <p>
        Equations (1) to (3) in this section summarises the detection
and segmentation matrices we are using to evaluate the
performance of a model trained on this dataset [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ]. The metric,
For the detection task, the competition uses a a final mean
score (scored), which is a weighted score of mAP and IoU
and formula is presented in Equation (2). Here, IoU -
intersection over union measures the overlap between the ground
truth and predicted bounding boxes. For scoring of the
semantic segmentation task, an average measure (scores) is
calculated as per Equation (3), which is the average score of
F1score (Dice Coefficient), F2-score, precision and recall. A
detail description of these matrices can be found in [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ].
mAP =
Table 2 summarises average precision performances on the
isolated validation dataset (25 images with ground-truth
masks) to get an estimate of the test set performance.
Classwise precision values were presented for two IoU thresholds.
For AP (50), only candidates over 50% region comparing
ground truth were counted and we achieved about 36.1%
average precision for bounding box detection and 34.7%
average precision for pixel-to-pixel segmentation. For AP (75),
only the candidates over 75% IoU value are counted.
Average precision values were counted for large (AP (l)) and
medium-sized (AP (m)) objects in the images and the
accuracy ranged from 32.27% to 45% respectively. To be noted,
we omitted AP (s) for small object (area &lt; 32pixel2) due to
the absence of such small objects in the test dataset. However,
such low values are indicative of the model being overfit and
we applied parameter-tuning to the fully connected network
layers along with realistic and balanced augmentation. This
significantly improved the mAP for for both bounding box
and segmentation mask to 47.9% and 51.3% respectively
(shown in row 3 and 4 on Table 2).
      </p>
      <p>For phase-I, we received 24 images and Figure 3 shows
detection and segmentation output from some of the images from
this test set. From the scores available on the leaderboard,
for ’BE’, we achieved average precision value of 51.14%, for
’HGD’ and ’polyp’ it is 50%. However, the score for
’suspicious’ and ’cancer’ areas were very low. We attained a dice
coefficient of 0.4562 and an F2 score of 0.4508. We noticed
the missed and mis-classification was due to the imbalance
between classes. Hence, before phase-II submission, we
retrained the model after applying a
’WeightedRandomSampler’ for selective and balanced sampling of the augmented
dataset. During phase-II, we received 43 images and we
retrained the model with a balanced augmentation dataset.
From the leader-board scores available at this stage, the
final detection score scored and semantic segmentation score
scores is listed in Table 3. In the table, we observed an
increase in detection score to 0.29 when a class balancing and
instance cropping is applied on the training dataset. We had
a score of 0.24 on phase-I which we obtained with generic
augmentation techniques applied on the data. We achieved an
improved semantic segmentation score of 0.62 as well from
our phase-I score 0f 0.52. The final model had an standard
deviation of 0.082 in the mAPd value and deviation was 0.33
in the semantic score.</p>
    </sec>
    <sec id="sec-8">
      <title>5. DISCUSSION &amp; CONCLUSION</title>
      <p>As balanced augmentation has improved both detection and
segmentation score in this task, application of generative
adversarial network-based augmentation techniques in future
can contribute to a more generalised and robust model.
Additionally, we assumed that the detected object was spread
uniformly across a detected region as the patch was
classified as a specific disease type (cancer, polyp) depending on
the patch-specific feature. However, the idea of one uniform</p>
    </sec>
    <sec id="sec-9">
      <title>6. REFERENCES</title>
    </sec>
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</article>