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Zhang H, Yang X, Tao Y, Zhang X, Huang X. Diagnostic accuracy of endocytoscopy via artificial intelligence in colorectal lesions: A systematic review and meta‑analysis. PLoS One 2023; 18:e0294930. [PMID: 38113199 PMCID: PMC10729963 DOI: 10.1371/journal.pone.0294930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 11/10/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Endocytoscopy (EC) is a nuclei and micro-vessels visualization in real-time and can facilitate "optical biopsy" and "virtual histology" of colorectal lesions. This study aimed to investigate the significance of employing artificial intelligence (AI) in the field of endoscopy, specifically in diagnosing colorectal lesions. The research was conducted under the supervision of experienced professionals and trainees. METHODS EMBASE, PubMed, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI) database, and other potential databases were surveyed for articles related to the EC with AI published before September 2023. RevMan (5.40), Stata (14.0), and R software (4.1.0) were used for statistical assessment. Studies that measured the accuracy of EC using AI for colorectal lesions were included. Two authors independently assessed the selected studies and their extracted data. This included information such as the country, literature, total study population, study design, characteristics of the fundamental study and control groups, sensitivity, number of samples, assay methodology, specificity, true positives or negatives, and false positives or negatives. The diagnostic accuracy of EC by AI was determined by a bivariate random-effects model, avoiding a high heterogeneity effect. The ANOVA model was employed to determine the more effective approach. RESULTS A total of 223 studies were reviewed; 8 articles were selected that included 2984 patients (4241 lesions) for systematic review and meta-analysis. AI assessed 4069 lesions; experts diagnosed 3165 and 5014 by trainees. AI demonstrated high accuracy, sensitivity, and specificity levels in detecting colorectal lesions, with values of 0.93 (95% CI: 0.90, 0.95) and 0.94 (95% CI: 0.73, 0.99). Expert diagnosis was 0.90 (95% CI: 0.85, 0.94), 0.87 (95% CI: 0.78, 0.93), and trainee diagnosis was 0.74 (95% CI: 0.67, 0.79), 0.72 (95% CI: 0.62, 0.80). With the EC by AI, the AUC from SROC was 0.95 (95% CI: 0.93, 0.97), therefore classified as excellent category, expert showed 0.95 (95% CI: 0.93, 0.97), and the trainee had 0.79 (95% CI: 0.75, 0.82). The superior index from the ANOVA model was 4.00 (1.15,5.00), 2.00 (1.15,5.00), and 0.20 (0.20,0.20), respectively. The examiners conducted meta-regression and subgroup analyses to evaluate the presence of heterogeneity. The findings of these investigations suggest that the utilization of NBI technology was correlated with variability in sensitivity and specificity. There was a lack of solid evidence indicating the presence of publishing bias. CONCLUSIONS The present findings indicate that using AI in EC can potentially enhance the efficiency of diagnosing colorectal abnormalities. As a valuable instrument, it can enhance prognostic outcomes in ordinary EC procedures, exhibiting superior diagnostic accuracy compared to trainee-level endoscopists and demonstrating comparability to expert endoscopists. The research is subject to certain constraints, namely a limited number of clinical investigations and variations in the methodologies used for identification. Consequently, it is imperative to conduct comprehensive and extensive research to enhance the precision of diagnostic procedures.
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Affiliation(s)
- Hangbin Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xinyu Yang
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Ye Tao
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xinyi Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xuan Huang
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Li G, Lee M, Chang TS, Yu J, Li H, Duan X, Wu X, Jaiswal S, Feng S, Oldham KR, Wang TD. Wide-field endoscope accessory for multiplexed fluorescence imaging. Sci Rep 2023; 13:19527. [PMID: 37945660 PMCID: PMC10636199 DOI: 10.1038/s41598-023-45955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
A wide-field endoscope that is sensitive to fluorescence can be used as an adjunct to conventional white light endoscopy by detecting multiple molecular targets concurrently. We aim to demonstrate a flexible fiber-coupled accessory that can pass forward through the instrument channel of standard medical endoscopes for clinical use to collect fluorescence images. A miniature scan mirror with reflector dimensions of 1.30 × 0.45 mm2 was designed, fabricated, and placed distal to collimated excitation beams at λex = 488, 660, and 785 nm. The mirror was driven at resonance for wide angular deflections in the X and Y-axes. A large image field-of-view (FOV) was generated in real time. The optomechanical components were packaged in a rigid distal tip with dimensions of 2.6 mm diameter and 12 mm length. The scan mirror was driven at 27.6 and 9.04 kHz in the fast (X) and slow (Y) axes, respectively, using a square wave with 50% duty cycle at 60 Vpp to collect fluorescence images at 10 frames per sec. Maximum total divergence angles of ± 27.4° and ± 22.8° were generated to achieve a FOV of 10.4 and 8.4 mm, respectively, at a working distance of 10 mm. Multiplexed fluorescence images were collected in vivo from the rectum of live mice using 3 fluorescently-labeled peptides that bind to unique cell surface targets. The fluorescence images collected were separated into 3 channels. Target-to-background ratios of 2.6, 3.1, and 3.9 were measured. This instrument demonstrates potential for broad clinical use to detect heterogeneous diseases in hollow organs.
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Affiliation(s)
- Gaoming Li
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 109 Zina Pitcher Pl. BSRB 1522, Ann Arbor, MI, 48109-2200, USA
| | - Miki Lee
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 109 Zina Pitcher Pl. BSRB 1522, Ann Arbor, MI, 48109-2200, USA
| | - Tse-Shao Chang
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Joonyoung Yu
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Haijun Li
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 109 Zina Pitcher Pl. BSRB 1522, Ann Arbor, MI, 48109-2200, USA
| | - Xiyu Duan
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 109 Zina Pitcher Pl. BSRB 1522, Ann Arbor, MI, 48109-2200, USA
| | - Xiaoli Wu
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 109 Zina Pitcher Pl. BSRB 1522, Ann Arbor, MI, 48109-2200, USA
| | - Sangeeta Jaiswal
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 109 Zina Pitcher Pl. BSRB 1522, Ann Arbor, MI, 48109-2200, USA
| | - Shuo Feng
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 109 Zina Pitcher Pl. BSRB 1522, Ann Arbor, MI, 48109-2200, USA
| | - Kenn R Oldham
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Thomas D Wang
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 109 Zina Pitcher Pl. BSRB 1522, Ann Arbor, MI, 48109-2200, USA.
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA.
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El Zoghbi M, Shaukat A, Hassan C, Anderson JC, Repici A, Gross SA. Artificial Intelligence-Assisted Optical Diagnosis: A Comprehensive Review of Its Role in Leave-In-Situ and Resect-and-Discard Strategies in Colonoscopy. Clin Transl Gastroenterol 2023; 14:e00640. [PMID: 37747097 PMCID: PMC10584286 DOI: 10.14309/ctg.0000000000000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023] Open
Abstract
Colorectal cancer screening plays a vital role in early detection and removal of precancerous adenomas, contributing to decreased mortality rates. Most polyps found during colonoscopies are small and unlikely to harbor advanced neoplasia or invasive cancer, leading to the development of "leave-in-situ" and "resect-and-discard" approaches. These strategies could lead to significant cost savings and efficiencies, but their implementation has been hampered by concerns around financial incentives, medical-legal risks, and local rules for tissue handling. This article reviews the potential of artificial intelligence to enhance the accuracy of polyp diagnosis through computer-aided diagnosis (CADx). While the adoption of CADx in optical biopsy has shown mixed results, it has the potential to significantly improve the management of colorectal polyps. Several studies reviewed in this article highlight the varied results of CADx in optical biopsy for colorectal polyps. Although artificial intelligence does not consistently outperform expert endoscopists, it has the potential to serve as a beneficial secondary reader, aiding in accurate optical diagnosis and increasing the confidence of the endoscopist. These studies indicate that although CADx holds great potential, it is yet to fully meet the performance thresholds necessary for clinical implementation.
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Affiliation(s)
- Maysaa El Zoghbi
- NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Aasma Shaukat
- NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Endoscopy Unit, Milan, Italy
| | - Joseph C. Anderson
- White River Junction VAMC, University of Connecticut School of Medicine, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Endoscopy Unit, Milan, Italy
| | - Seth A. Gross
- NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
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Mori Y, Kudo SE, Misawa M, Saito Y, Ikematsu H, Hotta K, Ohtsuka K, Urushibara F, Kataoka S, Ogawa Y, Maeda Y, Takeda K, Nakamura H, Ichimasa K, Kudo T, Hayashi T, Wakamura K, Ishida F, Inoue H, Itoh H, Oda M, Mori K. Real-Time Use of Artificial Intelligence in Identification of Diminutive Polyps During Colonoscopy: A Prospective Study. Ann Intern Med 2018; 169:357-366. [PMID: 30105375 DOI: 10.7326/m18-0249] [Citation(s) in RCA: 308] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Computer-aided diagnosis (CAD) for colonoscopy may help endoscopists distinguish neoplastic polyps (adenomas) requiring resection from nonneoplastic polyps not requiring resection, potentially reducing cost. OBJECTIVE To evaluate the performance of real-time CAD with endocytoscopes (×520 ultramagnifying colonoscopes providing microvascular and cellular visualization of colorectal polyps after application of the narrow-band imaging [NBI] and methylene blue staining modes, respectively). DESIGN Single-group, open-label, prospective study. (UMIN [University hospital Medical Information Network] Clinical Trial Registry: UMIN000027360). SETTING University hospital. PARTICIPANTS 791 consecutive patients undergoing colonoscopy and 23 endoscopists. INTERVENTION Real-time use of CAD during colonoscopy. MEASUREMENTS CAD-predicted pathology (neoplastic or nonneoplastic) of detected diminutive polyps (≤5 mm) on the basis of real-time outputs compared with pathologic diagnosis of the resected specimen (gold standard). The primary end point was whether CAD with the stained mode produced a negative predictive value (NPV) of 90% or greater for identifying diminutive rectosigmoid adenomas, the threshold required to "diagnose-and-leave" nonneoplastic polyps. Best- and worst-case scenarios assumed that polyps lacking either CAD diagnosis or pathology were true- or false-positive or true- or false-negative, respectively. RESULTS Overall, 466 diminutive (including 250 rectosigmoid) polyps from 325 patients were assessed by CAD, with a pathologic prediction rate of 98.1% (457 of 466). The NPVs of CAD for diminutive rectosigmoid adenomas were 96.4% (95% CI, 91.8% to 98.8%) (best-case scenario) and 93.7% (CI, 88.3% to 97.1%) (worst-case scenario) with stained mode and 96.5% (CI, 92.1% to 98.9%) (best-case scenario) and 95.2% (CI, 90.3% to 98.0%) (worst-case scenario) with NBI. LIMITATION Two thirds of the colonoscopies were conducted by experts who had each experienced more than 200 endocytoscopies; 186 polyps not assessed by CAD were excluded. CONCLUSION Real-time CAD can achieve the performance level required for a diagnose-and-leave strategy for diminutive, nonneoplastic rectosigmoid polyps. PRIMARY FUNDING SOURCE Japan Society for the Promotion of Science.
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Affiliation(s)
- Yuichi Mori
- Showa University Northern Yokohama Hospital, Yokohama, Japan (Y.M., S.K., M.M., F.U., S.K., Y.O., Y.M., K.T., H.N., K.I., T.K., T.H., K.W., F.I.)
| | - Shin-Ei Kudo
- Showa University Northern Yokohama Hospital, Yokohama, Japan (Y.M., S.K., M.M., F.U., S.K., Y.O., Y.M., K.T., H.N., K.I., T.K., T.H., K.W., F.I.)
| | - Masashi Misawa
- Showa University Northern Yokohama Hospital, Yokohama, Japan (Y.M., S.K., M.M., F.U., S.K., Y.O., Y.M., K.T., H.N., K.I., T.K., T.H., K.W., F.I.)
| | - Yutaka Saito
- National Cancer Center Hospital, Tokyo, Japan (Y.S.)
| | | | | | - Kazuo Ohtsuka
- Tokyo Medical and Dental University, Tokyo, Japan (K.O.)
| | - Fumihiko Urushibara
- Showa University Northern Yokohama Hospital, Yokohama, Japan (Y.M., S.K., M.M., F.U., S.K., Y.O., Y.M., K.T., H.N., K.I., T.K., T.H., K.W., F.I.)
| | - Shinichi Kataoka
- Showa University Northern Yokohama Hospital, Yokohama, Japan (Y.M., S.K., M.M., F.U., S.K., Y.O., Y.M., K.T., H.N., K.I., T.K., T.H., K.W., F.I.)
| | - Yushi Ogawa
- Showa University Northern Yokohama Hospital, Yokohama, Japan (Y.M., S.K., M.M., F.U., S.K., Y.O., Y.M., K.T., H.N., K.I., T.K., T.H., K.W., F.I.)
| | - Yasuharu Maeda
- Showa University Northern Yokohama Hospital, Yokohama, Japan (Y.M., S.K., M.M., F.U., S.K., Y.O., Y.M., K.T., H.N., K.I., T.K., T.H., K.W., F.I.)
| | - Kenichi Takeda
- Showa University Northern Yokohama Hospital, Yokohama, Japan (Y.M., S.K., M.M., F.U., S.K., Y.O., Y.M., K.T., H.N., K.I., T.K., T.H., K.W., F.I.)
| | - Hiroki Nakamura
- Showa University Northern Yokohama Hospital, Yokohama, Japan (Y.M., S.K., M.M., F.U., S.K., Y.O., Y.M., K.T., H.N., K.I., T.K., T.H., K.W., F.I.)
| | - Katsuro Ichimasa
- Showa University Northern Yokohama Hospital, Yokohama, Japan (Y.M., S.K., M.M., F.U., S.K., Y.O., Y.M., K.T., H.N., K.I., T.K., T.H., K.W., F.I.)
| | - Toyoki Kudo
- Showa University Northern Yokohama Hospital, Yokohama, Japan (Y.M., S.K., M.M., F.U., S.K., Y.O., Y.M., K.T., H.N., K.I., T.K., T.H., K.W., F.I.)
| | - Takemasa Hayashi
- Showa University Northern Yokohama Hospital, Yokohama, Japan (Y.M., S.K., M.M., F.U., S.K., Y.O., Y.M., K.T., H.N., K.I., T.K., T.H., K.W., F.I.)
| | - Kunihiko Wakamura
- Showa University Northern Yokohama Hospital, Yokohama, Japan (Y.M., S.K., M.M., F.U., S.K., Y.O., Y.M., K.T., H.N., K.I., T.K., T.H., K.W., F.I.)
| | - Fumio Ishida
- Showa University Northern Yokohama Hospital, Yokohama, Japan (Y.M., S.K., M.M., F.U., S.K., Y.O., Y.M., K.T., H.N., K.I., T.K., T.H., K.W., F.I.)
| | - Haruhiro Inoue
- Showa University Koto-Toyosu Hospital, Tokyo, Japan (H.I.)
| | - Hayato Itoh
- Nagoya University, Nagoya, Japan (H.I., M.O., K.M.)
| | - Masahiro Oda
- Nagoya University, Nagoya, Japan (H.I., M.O., K.M.)
| | - Kensaku Mori
- Nagoya University, Nagoya, Japan (H.I., M.O., K.M.)
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