1
|
Cheng Y, Li L, Bi Y, Su S, Zhang B, Feng X, Wang N, Zhang W, Yao Y, Ru N, Xiang J, Sun L, Hu K, Wen F, Wang Z, Bai L, Wang X, Wang R, Lv X, Wang P, Meng F, Xiao W, Linghu E, Chai N. Computer-aided diagnosis system for optical diagnosis of colorectal polyps under white light imaging. Dig Liver Dis 2024; 56:1738-1745. [PMID: 38744557 DOI: 10.1016/j.dld.2024.04.023] [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: 12/31/2023] [Revised: 03/21/2024] [Accepted: 04/23/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVES This study presents a novel computer-aided diagnosis (CADx) designed for optically diagnosing colorectal polyps using white light imaging (WLI).We aimed to evaluate the effectiveness of the CADx and its auxiliary role among endoscopists with different levels of expertise. METHODS We collected 2,324 neoplastic and 3,735 nonneoplastic polyp WLI images for model training, and 838 colorectal polyp images from 740 patients for model validation. We compared the diagnostic accuracy of the CADx with that of 15 endoscopists under WLI and narrow band imaging (NBI). The auxiliary benefits of CADx for endoscopists of different experience levels and for identifying different types of colorectal polyps was also evaluated. RESULTS The CADx demonstrated an optical diagnostic accuracy of 84.49%, showing considerable superiority over all endoscopists, irrespective of whether WLI or NBI was used (P < 0.001). Assistance from the CADx significantly improved the diagnostic accuracy of the endoscopists from 68.84% to 77.49% (P = 0.001), with the most significant impact observed among novice endoscopists. Notably, novices using CADx-assisted WLI outperform junior and expert endoscopists without such assistance. CONCLUSIONS The CADx demonstrated a crucial role in substantially enhancing the precision of optical diagnosis for colorectal polyps under WLI and showed the greatest auxiliary benefits for novice endoscopists.
Collapse
Affiliation(s)
- Yaxuan Cheng
- Chinese PLA Medical School, Beijing, 100853, PR China; Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Longsong Li
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Yawei Bi
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Song Su
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Bo Zhang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Xiuxue Feng
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Nanjun Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Wengang Zhang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Yi Yao
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Nan Ru
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Jingyuan Xiang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Lihua Sun
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Kang Hu
- Department of Gastroenterology, The 987 Hospital of PLA Joint Logistic Support Force, Baoji, 721004, PR China
| | - Feng Wen
- Department of Gastroenterology, General Hospital of Central Theater Command of PLA,Wuhan 430070, PR China
| | - Zixin Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Lu Bai
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Xueting Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Runzi Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Xingping Lv
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Pengju Wang
- Chinese PLA Medical School, Beijing, 100853, PR China; Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Fanqi Meng
- Medical Department, HighWise Medical Technology Co, Ltd, Changsha, 410000, PR China
| | - Wen Xiao
- Medical Department, HighWise Medical Technology Co, Ltd, Changsha, 410000, PR China
| | - Enqiang Linghu
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China.
| | - Ningli Chai
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China.
| |
Collapse
|
2
|
Norwood DA, Thakkar S, Cartee A, Sarkis F, Torres-Herman T, Montalvan-Sanchez EE, Russ K, Ajayi-Fox P, Hameed A, Mulki R, Sánchez-Luna SA, Morgan DR, Peter S. Performance of Computer-Aided Detection and Quality of Bowel Preparation: A Comprehensive Analysis of Colonoscopy Outcomes. Dig Dis Sci 2024; 69:3681-3689. [PMID: 39285090 PMCID: PMC11489221 DOI: 10.1007/s10620-024-08610-7] [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: 08/09/2024] [Accepted: 08/19/2024] [Indexed: 10/20/2024]
Abstract
BACKGROUND Artificial intelligence (AI) has emerged as a promising tool for detecting and characterizing colorectal polyps during colonoscopy, offering potential enhancements in traditional colonoscopy procedures to improve outcomes in patients with inadequate bowel preparation. AIMS This study aimed to assess the impact of an AI tool on computer-aided detection (CADe) assistance during colonoscopy in this population. METHODS This case-control study utilized propensity score matching (PSM) for age, sex, race, and colonoscopy indication to analyze a database of patients who underwent colonoscopy at a single tertiary referral center between 2017 and 2023. Patients were excluded if the procedure was incomplete or aborted owing to poor preparation. The patients were categorized based on the use of AI during colonoscopy. Data on patient demographics and colonoscopy performance metrics were collected. Univariate and multivariate logistic regression models were used to compare the groups. RESULTS After PSM patients with adequately prepped colonoscopies (n = 1466), the likelihood of detecting hyperplastic polyps (OR = 2.0, 95%CI 1.7-2.5, p < 0.001), adenomas (OR = 1.47, 95%CI 1.19-1.81, p < 0.001), and sessile serrated polyps (OR = 1.90, 95%CI 1.20-3.03, p = 0.007) significantly increased with the inclusion of CADe. In inadequately prepped patients (n = 160), CADe exhibited a more pronounced impact on the polyp detection rate (OR = 4.34, 95%CI 1.6-6.16, p = 0.049) and adenomas (OR = 2.9, 95%CI 2.20-8.57, p < 0.001), with a marginal increase in withdrawal and procedure times. CONCLUSION This study highlights the significant improvement in detecting diminutive polyps (< 5 mm) and sessile polyps using CADe, although notably, this benefit was only seen in patients with adequate bowel preparation. In conclusion, the integration of AI in colonoscopy, driven by artificial intelligence, promises to significantly enhance lesion detection and diagnosis, revolutionize the procedure's effectiveness, and improve patient outcomes.
Collapse
Affiliation(s)
- Dalton A Norwood
- Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, 35205, USA
| | - Shyam Thakkar
- Department of Medicine, Section of Gastroenterology and Hepatology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Amanda Cartee
- Division of Gastroenterology and Hepatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, 35205, USA
| | - Fayez Sarkis
- Division of Gastroenterology and Hepatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, 35205, USA
| | - Tatiana Torres-Herman
- Division of Gastroenterology and Hepatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, 35205, USA
| | | | - Kirk Russ
- Division of Gastroenterology and Hepatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, 35205, USA
| | - Patricia Ajayi-Fox
- Division of Gastroenterology and Hepatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, 35205, USA
| | - Anam Hameed
- Division of Gastroenterology and Hepatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, 35205, USA
| | - Ramzi Mulki
- Division of Gastroenterology and Hepatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, 35205, USA
| | - Sergio A Sánchez-Luna
- Division of Gastroenterology and Hepatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, 35205, USA
| | - Douglas R Morgan
- Division of Gastroenterology and Hepatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, 35205, USA
| | - Shajan Peter
- Division of Gastroenterology and Hepatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, 35205, USA.
| |
Collapse
|
4
|
Rex DK, Bhavsar-Burke I, Buckles D, Burton J, Cartee A, Comar K, Edwards A, Fennimore B, Fischer M, Gerich M, Gilmore A, Hamdeh S, Hoffman J, Ibach M, Jackson M, James-Stevenson T, Kaltenbach T, Kaplan J, Kapur S, Kohm D, Kriss M, Kundumadam S, Kyanam Kabir Baig KR, Menard-Katcher P, Kraft C, Langworthy J, Misra B, Molloy E, Munoz JC, Norvell J, Nowak T, Obaitan I, Patel S, Patel M, Peter S, Reid BM, Rogers N, Ross J, Ryan J, Sagi S, Saito A, Samo S, Sarkis F, Scott FI, Siwiec R, Sullivan S, Wieland A, Zhang J, Repici A, Hassan C, Byrne MF, Rastogi A. Artificial Intelligence for Real-Time Prediction of the Histology of Colorectal Polyps by General Endoscopists. Ann Intern Med 2024; 177:911-918. [PMID: 38768450 DOI: 10.7326/m24-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Real-time prediction of histologic features of small colorectal polyps may prevent resection and/or pathologic evaluation and therefore decrease colonoscopy costs. Previous studies showed that computer-aided diagnosis (CADx) was highly accurate, though it did not outperform expert endoscopists. OBJECTIVE To assess the diagnostic performance of histologic predictions by general endoscopists before and after assistance from CADx in a real-life setting. DESIGN Prospective, multicenter, single-group study. (ClinicalTrials.gov: NCT04437615). SETTING 6 centers across the United States. PARTICIPANTS 1252 consecutive patients undergoing colonoscopy and 49 general endoscopists with variable experience in real-time prediction of polyp histologic features. INTERVENTION Real-time use of CADx during routine colonoscopy. MEASUREMENTS The primary end points were the sensitivity and specificity of CADx-unassisted and CADx-assisted histologic predictions for adenomas measuring 5 mm or less. For clinical purposes, additional estimates according to location and confidence level were provided. RESULTS The CADx device made a diagnosis for 2695 polyps measuring 5 mm or less (96%) in 1252 patients. There was no difference in sensitivity between the unassisted and assisted groups (90.7% vs. 90.8%; P = 0.52). Specificity was higher in the CADx-assisted group (59.5% vs. 64.7%; P < 0.001). Among all 2695 polyps measuring 5 mm or less, 88.2% and 86.1% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be resected and discarded without pathologic evaluation. Among 743 rectosigmoid polyps measuring 5 mm or less, 49.5% and 47.9% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be left in situ without resection. LIMITATION Decision making based on CADx might differ outside a clinical trial. CONCLUSION CADx assistance did not result in increased sensitivity of optical diagnosis. Despite a slight increase, the specificity of CADx-assisted diagnosis remained suboptimal. PRIMARY FUNDING SOURCE Olympus America Corporation served as the clinical study sponsor.
Collapse
Affiliation(s)
- Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Indira Bhavsar-Burke
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Daniel Buckles
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - James Burton
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Amanda Cartee
- University of Alabama at Birmingham, Birmingham, Alabama (A.C., A.E., K.R.K.K.B., S.P., F.S.)
| | - Kevin Comar
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - Adam Edwards
- University of Alabama at Birmingham, Birmingham, Alabama (A.C., A.E., K.R.K.K.B., S.P., F.S.)
| | - Blair Fennimore
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Monika Fischer
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Mark Gerich
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Ashley Gilmore
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Shadi Hamdeh
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - Jeffrey Hoffman
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - Michael Ibach
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - Mollie Jackson
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - Toyia James-Stevenson
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Tonya Kaltenbach
- San Francisco VA Medical Center, San Francisco, California (T.K., C.K., J.R.)
| | - Jeffrey Kaplan
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Saurabh Kapur
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - Daniel Kohm
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - Michael Kriss
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Shanker Kundumadam
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | | | - Paul Menard-Katcher
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Cary Kraft
- San Francisco VA Medical Center, San Francisco, California (T.K., C.K., J.R.)
| | - James Langworthy
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - Bharat Misra
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - Eric Molloy
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - Juan Carlos Munoz
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - John Norvell
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Thomas Nowak
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Itegbemie Obaitan
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Swati Patel
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Mitesh Patel
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - Shajan Peter
- University of Alabama at Birmingham, Birmingham, Alabama (A.C., A.E., K.R.K.K.B., S.P., F.S.)
| | - B Marie Reid
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - Nicholas Rogers
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Jason Ross
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - James Ryan
- San Francisco VA Medical Center, San Francisco, California (T.K., C.K., J.R.)
| | - Sashidhar Sagi
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Akira Saito
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Salih Samo
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - Fayez Sarkis
- University of Alabama at Birmingham, Birmingham, Alabama (A.C., A.E., K.R.K.K.B., S.P., F.S.)
| | - Frank I Scott
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Robert Siwiec
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Shelby Sullivan
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Amanda Wieland
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Jianying Zhang
- Department of Statistics, Olympus America Corporation, Center Valley, Pennsylvania (J.Z.)
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy, and Endoscopy Unit and Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Italy (A.R., C.H.)
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy, and Endoscopy Unit and Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Italy (A.R., C.H.)
| | - Michael F Byrne
- Division of Gastroenterology, Vancouver General Hospital; University of British Columbia; and Satisfai Health, Vancouver, British Columbia, Canada (M.F.B.)
| | - Amit Rastogi
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| |
Collapse
|
5
|
Hassan C, Misawa M, Rizkala T, Mori Y, Sultan S, Facciorusso A, Antonelli G, Spadaccini M, Houwen BBSL, Rondonotti E, Patel H, Khalaf K, Li JW, Fernandez GM, Bhandari P, Dekker E, Gross S, Berzin T, Vandvik PO, Correale L, Kudo SE, Sharma P, Rex DK, Repici A, Foroutan F. Computer-Aided Diagnosis for Leaving Colorectal Polyps In Situ : A Systematic Review and Meta-analysis. Ann Intern Med 2024; 177:919-928. [PMID: 38768453 DOI: 10.7326/m23-2865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Computer-aided diagnosis (CADx) allows prediction of polyp histology during colonoscopy, which may reduce unnecessary removal of nonneoplastic polyps. However, the potential benefits and harms of CADx are still unclear. PURPOSE To quantify the benefit and harm of using CADx in colonoscopy for the optical diagnosis of small (≤5-mm) rectosigmoid polyps. DATA SOURCES Medline, Embase, and Scopus were searched for articles published before 22 December 2023. STUDY SELECTION Histologically verified diagnostic accuracy studies that evaluated the real-time performance of physicians in predicting neoplastic change of small rectosigmoid polyps without or with CADx assistance during colonoscopy. DATA EXTRACTION The clinical benefit and harm were estimated on the basis of accuracy values of the endoscopist before and after CADx assistance. The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. The outcome measure for benefit was the proportion of polyps predicted to be nonneoplastic that would avoid removal with the use of CADx. The outcome measure for harm was the proportion of neoplastic polyps that would be not resected and left in situ due to an incorrect diagnosis with the use of CADx. Histology served as the reference standard for both outcomes. DATA SYNTHESIS Ten studies, including 3620 patients with 4103 small rectosigmoid polyps, were analyzed. The studies that assessed the performance of CADx alone (9 studies; 3237 polyps) showed a sensitivity of 87.3% (95% CI, 79.2% to 92.5%) and specificity of 88.9% (CI, 81.7% to 93.5%) in predicting neoplastic change. In the studies that compared histology prediction performance before versus after CADx assistance (4 studies; 2503 polyps), there was no difference in the proportion of polyps predicted to be nonneoplastic that would avoid removal (55.4% vs. 58.4%; risk ratio [RR], 1.06 [CI, 0.96 to 1.17]; moderate-certainty evidence) or in the proportion of neoplastic polyps that would be erroneously left in situ (8.2% vs. 7.5%; RR, 0.95 [CI, 0.69 to 1.33]; moderate-certainty evidence). LIMITATION The application of optical diagnosis was only simulated, potentially altering the decision-making process of the operator. CONCLUSION Computer-aided diagnosis provided no incremental benefit or harm in the management of small rectosigmoid polyps during colonoscopy. PRIMARY FUNDING SOURCE European Commission. (PROSPERO: CRD42023402197).
Collapse
Affiliation(s)
- Cesare Hassan
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, and Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Rozzano, Italy (C.H., M.S., A.R.)
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan (M.M., S.K.)
| | - Tommy Rizkala
- Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Rozzano, Italy (T.R., L.C.)
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan; University of Oslo, Clinical Effectiveness Research Group, and Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway (Y.M.)
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, and VA Health Care System, Minneapolis, Minnesota (S.S.)
| | - Antonio Facciorusso
- University of Foggia, Department of Medical Sciences, Section of Gastroenterology, Foggia, Italy (A.F.)
| | - Giulio Antonelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Ariccia, and Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy (G.A.)
| | - Marco Spadaccini
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, and Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Rozzano, Italy (C.H., M.S., A.R.)
| | - Britt B S L Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands (B.B.S.L.H.)
| | | | - Harsh Patel
- Kansas City VA Medical Center, Gastroenterology and Hepatology, Kansas City, Missouri (H.P., P.S.)
| | - Kareem Khalaf
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (K.K.)
| | - James Weiquan Li
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, and Duke-NUS Academic Medicine Centre, Singapore Health Services, Singapore (J.W.L.)
| | - Gloria M Fernandez
- Endoscopy Unit, Gastroenterology Department, Clinical Institute of Digestive and Metabolic Disease, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain (G.M.F.)
| | - Pradeep Bhandari
- Queen Alexandra Hospital, Department of Gastroenterology, Portsmouth, United Kingdom (P.B.)
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, and Bergman Clinics Maag and Darm Amsterdam, Amsterdam, the Netherlands (E.D.)
| | - Seth Gross
- Department of Gastroenterology, Tisch Hospital, New York University Langone Medical Center, New York, New York (S.G.)
| | - Tyler Berzin
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (T.B.)
| | - Per Olav Vandvik
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway (P.O.V.)
| | - Loredana Correale
- Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Rozzano, Italy (T.R., L.C.)
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan (M.M., S.K.)
| | - Prateek Sharma
- Kansas City VA Medical Center, Gastroenterology and Hepatology, Kansas City, Missouri (H.P., P.S.)
| | - Douglas K Rex
- Indiana University School of Medicine, Division of Gastroenterology, Indianapolis, Indiana (D.K.R.)
| | - Alessandro Repici
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, and Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Rozzano, Italy (C.H., M.S., A.R.)
| | - Farid Foroutan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada (F.F.)
| |
Collapse
|