Does sex matter?: Analysis of sex-related differences in the diagnostic performance of a market-approved convolutional neural network for skin cancer detection
Background - Advances in biomedical artificial intelligence may introduce or perpetuate sex and gender discriminations. Convolutional neural networks (CNN) have proven a dermatologist-level performance in image classification tasks but have not been assessed for sex and gender biases that may affect...
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| Main Authors: | , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
16 February 2022
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| In: |
European journal of cancer
Year: 2022, Volume: 164, Pages: 88-94 |
| ISSN: | 1879-0852 |
| DOI: | 10.1016/j.ejca.2021.12.034 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.ejca.2021.12.034 Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S095980492200020X 
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| Author Notes: | Katharina Sies, Julia K. Winkler, Christine Fink, Felicitas Bardehle, Ferdinand Toberer, Timo Buhl, Alexander Enk, Andreas Blum, Wilhelm Stolz, Albert Rosenberger, Holger A. Haenssle |
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| 245 | 1 | 0 | |a Does sex matter? |b Analysis of sex-related differences in the diagnostic performance of a market-approved convolutional neural network for skin cancer detection |c Katharina Sies, Julia K. Winkler, Christine Fink, Felicitas Bardehle, Ferdinand Toberer, Timo Buhl, Alexander Enk, Andreas Blum, Wilhelm Stolz, Albert Rosenberger, Holger A. Haenssle |
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| 520 | |a Background - Advances in biomedical artificial intelligence may introduce or perpetuate sex and gender discriminations. Convolutional neural networks (CNN) have proven a dermatologist-level performance in image classification tasks but have not been assessed for sex and gender biases that may affect training data and diagnostic performance. In this study, we investigated sex-related imbalances in training data and diagnostic performance of a market-approved CNN for skin cancer classification (Moleanalyzer Pro®, Fotofinder Systems GmbH, Bad Birnbach, Germany). - Methods - We screened open-access dermoscopic image repositories widely used for CNN training for distribution of sex. Moreover, the sex-related diagnostic performance of the market-approved CNN was tested in 1549 dermoscopic images stratified by sex (female n = 773; male n = 776). - Results - Most open-access repositories showed a marked under-representation of images originating from female (40%) versus male (60%) patients. Despite these imbalances and well-known sex-related differences in skin anatomy or skin-directed behaviour, the tested CNN achieved a comparable sensitivity of 87.0% [80.9%-91.3%] versus 87.1% [81.1%-91.4%], specificity of 98.7% [97.4%-99.3%] versus 96.9% [95.2%-98.0%] and ROC-AUC of 0.984 [0.975-0.993] versus 0.979 [0.969-0.988] in dermoscopic images of female versus male origin, respectively. In the sample at hand, sex-related differences in ROC-AUCs were not statistically significant in the per-image analysis nor in an additional per-individual analysis (p ≥ 0.59). - Conclusion - Design and training of artificial intelligence algorithms for medical applications should generally acknowledge sex and gender dimensions. Despite sex-related imbalances in open-access training data, the diagnostic performance of the tested CNN showed no sex-related bias in the classification of skin lesions. | ||
| 650 | 4 | |a Automated melanoma detection | |
| 650 | 4 | |a Bias | |
| 650 | 4 | |a Computer-assisted diagnostics | |
| 650 | 4 | |a Convolutional neural network | |
| 650 | 4 | |a Deep learning | |
| 650 | 4 | |a Dermoscopy | |
| 650 | 4 | |a Melanoma | |
| 650 | 4 | |a Nevi | |
| 650 | 4 | |a Pigmented skin lesions | |
| 650 | 4 | |a Sex | |
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