AI found hidden esophageal cancers in CT scans patients already had
A multicenter Nature Medicine study reports that an AI system called EAGLE can identify esophageal cancer and precancerous lesions in noncontrast chest CT scans that were not acquired specifically for the esophagus. The model was trained on 6,813 patients and validated across 12 centers in three countries involving 80,612 patients. In external cohorts totaling 11,466 people, it reached 90.0 percent sensitivity for cancer and 98.5 percent specificity, while sensitivity for precancerous lesions was lower at 52.5 percent. A calibration cohort of 35,402 patients reduced false positives by 72.7 percent while preserving sensitivity. In a prospective hospital cohort of 17,446 patients, 38 of 90 positive predictions were true positives, producing a 42.2 percent positive predictive value and 87.8 percent sensitivity for cancer. A real-world low-dose screening cohort of 10,959 people reported 99.94 percent specificity. The opportunity is unusually practical: use scans already being performed to identify people who should receive confirmatory endoscopy. But the strongest efficiency claims remain modeled. Simulations suggested triage could triple detection, reduce diagnostic time by 70.4 percent, and lower costs in seven of eight countries. Those are not randomized outcomes or evidence of reduced mortality. Most data came from China, follow-up was under two years, endoscopy adherence was limited, and broader validation is needed for different disease patterns. EAGLE may make existing imaging more valuable. It has not yet proved that population deployment improves survival or avoids harmful overdiagnosis.
