• Vincenzo Venerito, Orazio Angelini, Gerardo Cazzato, Giuseppe Lopalco, Eugenio Maiorano, Antonietta Cimmino, and Florenzo Iannone.
• Department of Emergency and Organ Transplantations-Rheumatology Unit, University of Bari "Aldo Moro", Bari, Italy.
• Intern Emerg Med. 2021 Sep 1; 16 (6): 1457-1465.

AbstractUltrasound-guided synovial tissue biopsy (USSB) may allow personalizing the treatment for patients with inflammatory arthritis. To this end, the quantification of tissue inflammation in synovial specimens can be crucial to adopt proper therapeutic strategies. This study aimed at investigating whether computer vision may be of aid in discriminating the grade of synovitis in patients undergoing USSB. We used a database of 150 photomicrographs of synovium from patients who underwent USSB. For each hematoxylin and eosin (H&E)-stained slide, Krenn's score was calculated. After proper data pre-processing and fine-tuning, transfer learning on a ResNet34 convolutional neural network (CNN) was employed to discriminate between low and high-grade synovitis (Krenn's score < 5 or ≥ 5). We computed test phase metrics, accuracy, precision (true positive/actual results), and recall (true positive/predicted results). The Grad-Cam algorithm was used to highlight the regions in the image used by the model for prediction. We analyzed photomicrographs of specimens from 12 patients with arthritis. The training dataset included n.90 images (n.42 with high-grade synovitis). Validation and test datasets included n.30 (n.14 high-grade synovitis) and n.30 items (n.16 with high-grade synovitis). An accuracy of 100% (precision = 1, recall = 1) was scored in the test phase. Cellularity in the synovial lining and sublining layers was the salient determinant of CNN prediction. This study provides a proof of concept that computer vision with transfer learning is suitable for scoring synovitis. Integrating CNN-based approach into real-life patient management may improve the workflow between rheumatologists and pathologists.© 2021. Società Italiana di Medicina Interna (SIMI).

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