Artificial Intelligence-Assisted Colonoscopy for Polyp Detection : A Systematic Review and Meta-analysis.

IF 19.6 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

Annals of Internal Medicine Pub Date : 2024-12-01 Epub Date: 2024-10-22 DOI:10.7326/ANNALS-24-00981

Saeed Soleymanjahi, Jack Huebner, Lina Elmansy, Niroop Rajashekar, Nando Lüdtke, Rumzah Paracha, Rachel Thompson, Alyssa A Grimshaw, Farid Foroutan, Shahnaz Sultan, Dennis L Shung

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引用次数: 0

Abstract

Background: Randomized clinical trials (RCTs) of computer-aided detection (CADe) system-enhanced colonoscopy compared with conventional colonoscopy suggest increased adenoma detection rate (ADR) and decreased adenoma miss rate (AMR), but the effect on detection of advanced colorectal neoplasia (ACN) is unclear.

Purpose: To conduct a systematic review to compare performance of CADe-enhanced and conventional colonoscopy.

Data sources: Cochrane Library, Google Scholar, Ovid EMBASE, Ovid MEDLINE, PubMed, Scopus, and Web of Science Core Collection databases were searched through February 2024.

Study selection: Published RCTs comparing CADe-enhanced and conventional colonoscopy.

Data extraction: Average adenoma per colonoscopy (APC) and ACN per colonoscopy were primary outcomes. Adenoma detection rate, AMR, and ACN detection rate (ACN DR) were secondary outcomes. Balancing outcomes included withdrawal time and resection of nonneoplastic polyps (NNPs). Subgroup analyses were done by neural network architecture.

Data synthesis: Forty-four RCTs with 36 201 cases were included. Computer-aided detection-enhanced colonoscopies have higher average APC (12 090 of 12 279 [0.98] vs. 9690 of 12 292 [0.78], incidence rate difference [IRD] = 0.22 [95% CI, 0.16 to 0.28]) and higher ADR (7098 of 16 253 [44.7%] vs. 5825 of 15 855 [36.7%], rate ratio [RR] = 1.21 [CI, 1.15 to 1.28]). Average ACN per colonoscopy was similar (1512 of 9296 [0.16] vs. 1392 of 9121 [0.15], IRD = 0.01 [CI, -0.01 to 0.02]), but ACN DR was higher with CADe system use (1260 of 9899 [12.7%] vs. 1119 of 9746 [11.5%], RR = 1.16 [CI, 1.02 to 1.32]). Using CADe systems resulted in resection of almost 2 extra NNPs per 10 colonoscopies and longer total withdrawal time (0.53 minutes [CI, 0.30 to 0.77]).

Limitation: Statistically significant heterogeneity in quality and sample size and inability to blind endoscopists to the intervention in included studies may affect the performance estimates.

Conclusion: Computer-aided detection-enhanced colonoscopies have increased APC and detection rate but no difference in ACN per colonoscopy and a small increase in ACN DR. There is minimal increase in procedure time and no difference in performance across neural network architectures.

Primary funding source: None. (PROSPERO: CRD42023422835).

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用于息肉检测的人工智能辅助结肠镜检查：系统综述与 Meta 分析。

背景：计算机辅助检测（CADe）系统增强型结肠镜检查与传统结肠镜检查相比，随机临床试验（RCT）表明腺瘤检出率（ADR）提高，腺瘤漏检率（AMR）降低，但对晚期结直肠肿瘤（ACN）检出的影响尚不清楚。目的：进行一项系统综述，比较CADe增强型结肠镜检查与传统结肠镜检查的性能：数据来源：检索了 Cochrane Library、Google Scholar、Ovid EMBASE、Ovid MEDLINE、PubMed、Scopus 和 Web of Science Core Collection 数据库，检索期至 2024 年 2 月：已发表的比较 CADe 增强型结肠镜检查和传统结肠镜检查的 RCT：数据提取：每次结肠镜检查的平均腺瘤数（APC）和ACN是主要结果。腺瘤检出率、AMR和ACN检出率（ACN DR）是次要结果。平衡结果包括退出时间和非肿瘤性息肉（NNPs）切除率。通过神经网络架构进行亚组分析：数据综述：共纳入 44 项 RCT，36 201 个病例。计算机辅助检测增强型结肠镜检查的平均 APC 较高（12 279 例中的 12 090 例 [0.98] 对 12 292 例中的 9690 例 [0.78]，发病率差异 [IRD] = 0.22 [95% CI, 0.16 to 0.28]），ADR 较高（16 253 例中的 7098 例 [44.7%] 对 15 855 例中的 5825 例 [36.7%]，比率比 [RR] = 1.21 [CI, 1.15 to 1.28]）。每次结肠镜检查的平均 ACN 相似（9296 例中的 1512 例 [0.16] 与 9121 例中的 1392 例 [0.15]，IRD = 0.01 [CI, -0.01 to 0.02]），但使用 CADe 系统的 ACN DR 较高（9899 例中的 1260 例 [12.7%] 与 9746 例中的 1119 例 [11.5%]，RR = 1.16 [CI, 1.02 to 1.32]）。使用 CADe 系统会导致每 10 次结肠镜检查多切除近 2 个 NNPs，总退出时间延长（0.53 分钟 [CI, 0.30 至 0.77]）：局限性：在质量和样本量方面存在统计学意义上的明显异质性，且所纳入的研究无法使内镜医师对干预措施视而不见，这些因素都可能会影响性能估计值：结论：计算机辅助检测增强型结肠镜检查提高了APC和检出率，但每次结肠镜检查的ACN没有差异，ACN DR略有增加。手术时间的增加极少，不同神经网络架构的性能也无差异：主要资金来源：无。(PROCEMO：CRD42023422835）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Internal Medicine 医学-医学：内科

CiteScore

23.90

自引率

1.80%

发文量

1136

审稿时长

3-8 weeks

期刊介绍： Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.