Journal of the anus, rectum and colon · 2026
Development and Validation of a Computer-Aided Diagnostic System for Colorectal Lesions Based on the JNET Classification: Supporting the "Resect and Discard" Strategy.
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Morimoto Shin, Yoshida Shigeto, Wu Yongfei, Koide Tetsushi, Tamaki Toru, Takehara Yudai, Kamigaichi Yuki, Tanaka Hidenori, Yamashita Ken, Kishida Yoshihiro, Kuwai Toshio, Oka Shiro
Аннотация
OBJECTIVES: Although the Japan NBI Expert Team (JNET) classification for colorectal lesions is clinically useful, standardization remains challenging owing to endoscopist variabilities. Therefore, we developed a computer-aided diagnosis (CADx) system to support JNET diagnoses, potentially facilitating a "Resect and Discard" strategy. The CADx system's diagnostic performance and its potential to support the "Resect and Discard" strategy were compared with those of endoscopists of varying experience.
METHODS: Forty-three patients (60 lesions) who underwent CADx system colonoscopies at Hiroshima University Hospital between September 2022 and July 2024 were evaluated. Endoscopists were grouped by experience: beginners (100-500 cases, n=4), intermediates (1,000-2,000 cases, n=5), and experts (>2,000 cases, n=3). In Study 1, JNET classification concordance between the CADx system and beginner/intermediate endoscopists was compared, using expert diagnosis as the gold standard. Study 2 included 38 <10 mm lesions, with histopathology as the gold standard. Lesions excluding advanced neoplasia were classified as "Resect and Discard". The CADx system and endoscopists were evaluated for identifying JNET Type 1 and 2A lesions as non-advanced neoplasia.
RESULTS: In Study 1, CADx-expert concordance was 83.3% (Kappa=0.75)-significantly higher than beginners (66.7%) and outperforming intermediates (78.0%). In Study 2, the CADx system's accuracy was 92.1%-significantly higher than beginners (70.4%) and outperforming intermediates (82.6%) and experts (78.9%). The CADx system's advanced neoplasia negative predictive value was 100%.
CONCLUSIONS: The CADx system showed high concordance with expert diagnoses. For lesions <10 mm, its high advanced neoplasia diagnostic accuracy indicates its potential utility in supporting the "Resect and Discard" strategy.
METHODS: Forty-three patients (60 lesions) who underwent CADx system colonoscopies at Hiroshima University Hospital between September 2022 and July 2024 were evaluated. Endoscopists were grouped by experience: beginners (100-500 cases, n=4), intermediates (1,000-2,000 cases, n=5), and experts (>2,000 cases, n=3). In Study 1, JNET classification concordance between the CADx system and beginner/intermediate endoscopists was compared, using expert diagnosis as the gold standard. Study 2 included 38 <10 mm lesions, with histopathology as the gold standard. Lesions excluding advanced neoplasia were classified as "Resect and Discard". The CADx system and endoscopists were evaluated for identifying JNET Type 1 and 2A lesions as non-advanced neoplasia.
RESULTS: In Study 1, CADx-expert concordance was 83.3% (Kappa=0.75)-significantly higher than beginners (66.7%) and outperforming intermediates (78.0%). In Study 2, the CADx system's accuracy was 92.1%-significantly higher than beginners (70.4%) and outperforming intermediates (82.6%) and experts (78.9%). The CADx system's advanced neoplasia negative predictive value was 100%.
CONCLUSIONS: The CADx system showed high concordance with expert diagnoses. For lesions <10 mm, its high advanced neoplasia diagnostic accuracy indicates its potential utility in supporting the "Resect and Discard" strategy.