Computer-Aided Diagnosis for Leaving Colorectal Polyps In Situ : A Systematic Review and Meta-analysis.

Cesare Hassan, Loredana Correale, Gloria M Fernandez, James Weiquan Li, Masashi Misawa, Shahnaz Sultan, Antonio Facciorusso, Alessandro Repici, Marco Spadaccini, Yuichi Mori, Per Olav Vandvik, Farid Foroutan, Pradeep Bhandari, Tommy Rizkala, Kareem Khalaf, Harsh Patel, Evelien Dekker, Prateek Sharma, Emanuele Rondonotti, Douglas K Rex, Shin-Ei Kudo, Seth Gross, Tyler Berzin, Giulio Antonelli, Britt B S L Houwen

Journal: Annals of internal medicine 2024;177(7):919-928

PMID: 38768453

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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).

Address: 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.).; Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan (M.M., S.K.).; Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Rozzano, Italy (T.R., L.C.).; 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.).; Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, and VA Health Care System, Minneapolis, Minnesota (S.S.).; University of Foggia, Department of Medical Sciences, Section of Gastroenterology, Foggia, Italy (A.F.).; 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.).; Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands (B.B.S.L.H.).; Gastroenterology Unit, Valduce Hospital, Como, Italy (E.R.).; Kansas City VA Medical Center, Gastroenterology and Hepatology, Kansas City, Missouri (H.P., P.S.).; Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (K.K.).; Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, and Duke-NUS Academic Medicine Centre, Singapore Health Services, Singapore (J.W.L.).; Endoscopy Unit, Gastroenterology Department, Clinical Institute of Digestive and Metabolic Disease, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain (G.M.F.).; Queen Alexandra Hospital, Department of Gastroenterology, Portsmouth, United Kingdom (P.B.).; Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, and Bergman Clinics Maag and Darm Amsterdam, Amsterdam, the Netherlands (E.D.).; Department of Gastroenterology, Tisch Hospital, New York University Langone Medical Center, New York, New York (S.G.).; Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (T.B.).; Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway (P.O.V.).; Indiana University School of Medicine, Division of Gastroenterology, Indianapolis, Indiana (D.K.R.).; Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada (F.F.).

DOI: 10.7326/M23-2865

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MeSH Terms: Humans, Colonic Polyps, Colonoscopy, Diagnosis, Computer-Assisted, Colorectal Neoplasms