Development of an Image Analysis-Based Prognosis Score Using Google’s Teachable Machine in Melanoma

SIMPLE SUMMARY: The increase in adjuvant treatment of melanoma patients makes it necessary to provide the most accurate prognostic assessment possible, even at early stages of the disease. Although conventional risk stratification correctly identifies most patients in need of adjuvant treatment, there are some patients who, despite having a low tumor stage, have poor prognosis and could therefore benefit from early therapy. To close this gap in prognosis estimation, deep learning-based image analyses of histological sections could play a central role in the future. The aim of this study was to investigate whether such an analysis is possible only using basic image analysis of 831 H&E-stained melanoma sections using Google’s Teachable Machine. Although the classification obtained does not provide an additional prognostic estimate to conventional melanoma classification, this study shows that prognostic prediction is possible at the mere cellular image level. ABSTRACT: Background: The increasing number of melanoma patients makes it necessary to establish new strategies for prognosis assessment to ensure follow-up care. Deep-learning-based image analysis of primary melanoma could be a future component of risk stratification. Objectives: To develop a risk score for overall survival based on image analysis through artificial intelligence (AI) and validate it in a test cohort. Methods: Hematoxylin and eosin (H&E) stained sections of 831 melanomas, diagnosed from 2012–2015 were photographed and used to perform deep-learning-based group classification. For this purpose, the freely available software of Google’s teachable machine was used. Five hundred patient sections were used as the training cohort, and 331 sections served as the test cohort. Results: Using Google’s Teachable Machine, a prognosis score for overall survival could be developed that achieved a statistically significant prognosis estimate with an AUC of 0.694 in a ROC analysis based solely on image sections of approximately 250 × 250 µm. The prognosis group “low-risk” (n = 230) showed an overall survival rate of 93%, whereas the prognosis group “high-risk” (n = 101) showed an overall survival rate of 77.2%. Conclusions: The study supports the possibility of using deep learning-based classification systems for risk stratification in melanoma. The AI assessment used in this study provides a significant risk estimate in melanoma, but it does not considerably improve the existing risk classification based on the TNM classification.