Artificial intelligence-assisted ganglion cell detection in Hirschsprung's disease: A comparative evaluation of two deep learning approaches

Background. Definitive diagnosis of Hirschsprung's disease (HD) requires pathological identification of enteric ganglion cells. This process is time-consuming and subject to inter-observer variability. Artificial intelligence (AI) tools have the potential to standardize and accelerate this workflow, but no study has determined which AI approach best serves intraoperative HD pathology diagnostics. Method. This study compared the U-Net and You Only Look Once version 26 (YOLO26) frameworks for ganglion cell detection using a single-centre retrospective dataset of 54 whole-slide images (WSIs) from rectal biopsies. WSIs were tiled into 397,731 image patches (128x128 pixels), further partitioned into training (70%), validation (15%), and testing (15%) sets. Models were evaluated on tile- and patient-level diagnostic metrics and processing latency. Results. The U-Net achieved a tile-level sensitivity of 82.9%, showing no statistically significant difference compared to YOLO26 (79.1%; p = 0.097). However, YOLO26 demonstrated a statistically significant advantage in tile-level specificity (96.1% vs. 93.9%; p < 0.001) and reduced mean inference latency (7.64 ms vs. 11.57 ms/tile). At the patient level, both models achieved 100% diagnostic sensitivity. Despite low patient-level specificity (0.0% U-Net; 11.8% YOLO26), the tissue-level diagnostic burden of false positives was 6.00% for U-Net and 3.50% for YOLO26. Conclusion. The U-Net is preferred when nominal gains in sensitivity are prioritized, while the YOLO26 is an alternative that optimizes efficiency and false positive suppression. Both models serve as robust screening filters to augment the pathologist's workflow and should be selected based on workflow requirements. Prospective validation on larger, multi-centre datasets is required before clinical implementation.