Performance of the Techcyte AI-based image analysis system for coproparasitological diagnosis in clinical stool specimens: a retrospective evaluation study

Coproparasitological stool analysis based on microscopic examination is the reference diagnostic technique routinely performed in clinical microbiology laboratories. Automated image analysis systems could offer a suitable solution, reducing technologist workload and improving screening efficiency. The Human Fecal Ova & Parasite (O&P) Detection Solution (Techcyte) is an artificial intelligence (AI) software employing imaging-based algorithms to provide screening presumptive diagnostic results. This study aimed to validate the Wet Mount Iodine Solution software for detecting and diagnosing protozoan and helminthic infections in stool specimens. A total of 178 clinical stool specimens were retrospectively analyzed between July and October 2024 for comparative evaluation of the AI-based system. Positive specimens with confirmed mono ( n = 116) and mixed ( n = 31) protozoa and helminth infections, as well as negative specimens ( n = 31), were included. Conventional microscopy results were compared with AI presumptive detection and identification outcomes. In addition, operator-reviewed AI results were evaluated against the reference diagnosis. The system achieved 96.62% positive percent agreement (PPA) and 93.33% negative percent agreement (NPA) for overall detection considering operator-reviewed interpretation. The kappa coefficient was 0.865, indicating strong agreement with conventional microscopy. The AI system detected additional parasites in 74/178 (41.57%) specimens, providing a diagnostic improvement compared to traditional microscopy. AI-assisted microscopy enhances intestinal parasite diagnosis, providing reliable results when combined with operator review. Despite limitations such as specimen low volume analysis and artifact detection, the system shows strong potential for improving diagnostic workflows in clinical microbiology laboratories.

IMPORTANCE

Microscopic examination of stool specimens remains the reference technique for diagnosing intestinal parasitic infections although it is labor-intensive and operator-dependent methodology. The implementation of artificial intelligence-assisted microscopy offers a promising approach to streamline diagnostic workflows, improve consistency, and enhance traditional methods. Our evaluation study provides valuable clinical evaluation data of the Human Fecal Ova & Parasite (O&P) Detection Wet Mount Iodine Solution (Techcyte), demonstrating high sensitivity, specificity, and agreement with conventional microscopy. Importantly, AI-assisted review yielded diagnostic gains in a substantial proportion of specimens, underscoring its value as a screening and complementary tool for routine parasitological diagnostics. These findings highlight the potential of AI-powered image analysis to improve the accuracy and efficiency of coproparasitological testing, thereby supporting clinical decision-making and optimizing resource utilization in microbiology laboratories.