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Background  The objective was to build a novel method for automated image analysis to locate and quantify the number of cytokeratin 7 (K7)-positive hepatocytes reflecting cholestasis by applying deep learning neural networks (AI model) in a cohort of 210 liver specimens. We aimed to study the correlation between the AI model’s results and disease progression. The cohort of liver biopsies which served as a model of chronic cholestatic liver disease comprised of patients diagnosed with primary sclerosing cholangitis (PSC).    Methods  In a cohort of patients with PSC identified from the PSC registry of the University Hospital of Helsinki, their K7-stained liver biopsy specimens were scored by a pathologist (human K7 score) and then digitally analyzed for K7-positive hepatocytes (K7%area). The digital analysis was by a K7-AI model created in an Aiforia Technologies cloud platform. For validation, values were human K7 score, stage of disease (Metavir and Nakunuma fibrosis score), and plasma liver enzymes indicating clinical cholestasis, all subjected to correlation analysis.    Results  The K7-AI model results (K7%area) correlated with the human K7 score (0.896;  p  < 2.2e − 16 ). In addition, K7%area correlated with stage of PSC (Metavir 0.446;  p  < 1.849e − 10  and Nakanuma 0.424;  p  < 4.23e − 10 ) and with plasma alkaline phosphatase (P-ALP) levels (0.369,  p  < 5.749e − 5 ).    Conclusions  The accuracy of the AI-based analysis was comparable to that of the human K7 score. Automated quantitative image analysis correlated with stage of PSC and with P-ALP. Based on the results of the K7-AI model, we recommend K7 staining in the assessment of cholestasis by means of automated methods that provide fast (9.75 s/specimen) quantitative analysis.    Supplementary Information  The online version contains supplementary material available at 10.1186/s13000-021-01102-6.

Chronic cholestasis detection by a novel tool: automated analysis of cytokeratin 7-stained liver specimens