• Stephen R Ali, Thomas D Dobbs, Adib Tarafdar, Huw Strafford, Beata Fonferko-Shadrach, Arron S Lacey, William Owen Pickrell, Hayley A Hutchings, and Iain S Whitaker.
• Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK.
• Br J Surg. 2024 Jan 3; 111 (1).

BackgroundCancer multidisciplinary team (MDT) meetings are under intense pressure to reform given the rapidly rising incidence of cancer and national mandates for protocolized streaming of cases. The aim of this study was to validate a natural language processing (NLP)-based web platform to automate evidence-based MDT decisions for skin cancer with basal cell carcinoma as a use case.MethodsA novel and validated NLP information extraction model was used to extract perioperative tumour and surgical factors from histopathology reports. A web application with a bespoke application programming interface used data from this model to provide an automated clinical decision support system, mapped to national guidelines and generating a patient letter to communicate ongoing management. Performance was assessed against retrospectively derived recommendations by two independent and blinded expert clinicians.ResultsThere were 893 patients (1045 lesions) used to internally validate the model. High accuracy was observed when compared against human predictions, with an overall value of 0.92. Across all classifiers the virtual skin MDT was highly specific (0.96), while sensitivity was lower (0.72).ConclusionThis study demonstrates the feasibility of a fully automated, virtual, web-based service model to host the skin MDT with good system performance. This platform could be used to support clinical decision-making during MDTs as 'human in the loop' approach to aid protocolized streaming. Future prospective studies are needed to validate the model in tumour types where guidelines are more complex.© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.

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