Endoscopy · 2025
Computer-assisted optical diagnosis of colorectal polyps up to 10 mm.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Oleksiw Megan, Taghiakbari Mahsa, Djinbachian Roupen, Pohl Heiko, Barkun Alan, Rex Douglas K, Panzini Benoit, Bouchard Simon, Lasfar Dina, Amani Bilal, Dubois Delphine, Jalal Yousr, Bouin Mikael, von Renteln Daniel
Аннотация
BACKGROUND: Computer-aided diagnosis (CADx) of colorectal polyps during colonoscopy could replace pathology for certain polyps. This study aimed to evaluate CADx-assisted optical diagnosis for polyps of ≤10 mm in the context of established quality benchmarks.
METHODS: We performed a post-hoc analysis of a randomized controlled trial evaluating assistive versus autonomous computer-aided optical diagnosis. Our primary outcome was achievement of the American Society for Gastrointestinal Endoscopy PIVI1 threshold for resect-and-discard implementation when CADx was used for polyps ≤3 mm. Secondary outcomes included PIVI1 threshold achievement when using CADx with a size cutoff of ≤5 mm and ≤10 mm, as well as diagnostic performance and prevalence of advanced histology across the polyp size groups.
RESULTS: We included 313 patients with a total of 463 polyps of ≤10 mm undergoing optical diagnosis with CADx assistance. Compared with pathology-based intervals, surveillance interval agreement was 94.6% (95%CI 91.3%–96.7%), 89.5% (95%CI 85.4%–92.5%), and 85.9% (95%CI 81.5%–89.5%) when CADx was used with size cutoffs ≤3 mm, ≤5 mm, and ≤10 mm, respectively. The diagnostic accuracy of CADx-assisted optical diagnosis was 76.2%, 76.6%, and 72.5% for polyps sized ≤3 mm, >3 to ≤5 mm, and >5 to ≤10 mm, respectively. The negative predictive value for rectosigmoid adenomas was >90% for all size groups (PIVI2). The prevalence of advanced or serrated pathology was higher in polyps >3 mm, which resulted in a higher number of incorrectly assigned surveillances intervals.
CONCLUSIONS: In our study, CADx-assisted optical diagnosis met the resect-and-discard PIVI1 threshold only with a size cutoff of ≤3 mm, and the diagnose-and-leave PIVI2 threshold for polyps ≤10 mm.
METHODS: We performed a post-hoc analysis of a randomized controlled trial evaluating assistive versus autonomous computer-aided optical diagnosis. Our primary outcome was achievement of the American Society for Gastrointestinal Endoscopy PIVI1 threshold for resect-and-discard implementation when CADx was used for polyps ≤3 mm. Secondary outcomes included PIVI1 threshold achievement when using CADx with a size cutoff of ≤5 mm and ≤10 mm, as well as diagnostic performance and prevalence of advanced histology across the polyp size groups.
RESULTS: We included 313 patients with a total of 463 polyps of ≤10 mm undergoing optical diagnosis with CADx assistance. Compared with pathology-based intervals, surveillance interval agreement was 94.6% (95%CI 91.3%–96.7%), 89.5% (95%CI 85.4%–92.5%), and 85.9% (95%CI 81.5%–89.5%) when CADx was used with size cutoffs ≤3 mm, ≤5 mm, and ≤10 mm, respectively. The diagnostic accuracy of CADx-assisted optical diagnosis was 76.2%, 76.6%, and 72.5% for polyps sized ≤3 mm, >3 to ≤5 mm, and >5 to ≤10 mm, respectively. The negative predictive value for rectosigmoid adenomas was >90% for all size groups (PIVI2). The prevalence of advanced or serrated pathology was higher in polyps >3 mm, which resulted in a higher number of incorrectly assigned surveillances intervals.
CONCLUSIONS: In our study, CADx-assisted optical diagnosis met the resect-and-discard PIVI1 threshold only with a size cutoff of ≤3 mm, and the diagnose-and-leave PIVI2 threshold for polyps ≤10 mm.