Accurate classification of cells in bronchoalveolar lavage (BAL) fluid is essential for the assessment of lung disease in pneumology and critical care medicine. However, the effectiveness of BAL fluid analysis is highly dependent on individual expertise. Our research is focused on improving the accuracy and efficiency of BAL cell classification using the "You Only Look Once" (YOLO) algorithm to reduce variability and increase the accuracy of cell detection in BALF analysis. We assess various YOLOv7 iterations, including YOLOv7, YOLOv7 with Adam and label smoothing, YOLOv7-E6E, and YOLOv7-E6E with Adam and label smoothing focusing on the detection of four key cell types of diagnostic importance in BAL fluid: macrophages, lymphocytes, neutrophils, and eosinophils. This study utilised cytospin preparations of BAL fluid, employing May-Grunwald-Giemsa staining, and analysed a dataset comprising 2032 images with 42,221 annotations. Classification performance was evaluated using recall, precision, F1 score, mAP@.5, and mAP@.5;.95 along with a confusion matrix. The comparison of four algorithmic approaches revealed minor distinctions in mean results, falling short of statistical significance (p < 0.01; p < 0.05). YOLOv7, with an inference time of 13.5 ms for 640 × 640 px images, achieved commendable performance across all cell types, boasting an average F1 metric of 0.922, precision of 0.916, recall of 0.928, and mAP@.5 of 0.966. Remarkably, all four cell types were classified consistently with high-performance metrics. Notably, YOLOv7 demonstrated marginally superior class value dispersion when compared to YOLOv7-adam-label-smoothing, YOLOv7-E6E, and YOLOv7-E6E-adam-label-smoothing, albeit without statistical significance. Consequently, there is limited justification for deploying the more computationally intensive YOLOv7-E6E and YOLOv7-E6E-adam-label-smoothing models. This investigation indicates that the default YOLOv7 variant is the preferred choice for differential cytology due to its accessibility, lower computational demands, and overall more consistent results than more complex models.
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