Department of Gastroenterology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.
Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
Gastroenterology. 2020 Oct;159(4):1252-1261.e5. doi: 10.1053/j.gastro.2020.06.023. Epub 2020 Jun 17.
BACKGROUND AND AIMS: Up to 30% of adenomas might be missed during screening colonoscopy-these could be polyps that appear on-screen but are not recognized by endoscopists or polyps that are in locations that do not appear on the screen at all. Computer-aided detection (CADe) systems, based on deep learning, might reduce rates of missed adenomas by displaying visual alerts that identify precancerous polyps on the endoscopy monitor in real time. We compared adenoma miss rates of CADe colonoscopy vs routine white-light colonoscopy. METHODS: We performed a prospective study of patients, 18-75 years old, referred for diagnostic, screening, or surveillance colonoscopies at a single endoscopy center of Sichuan Provincial People's Hospital from June 3, 2019 through September 24, 2019. Same day, tandem colonoscopies were performed for each participant by the same endoscopist. Patients were randomly assigned to groups that received either CADe colonoscopy (n=184) or routine colonoscopy (n=185) first, followed immediately by the other procedure. Endoscopists were blinded to the group each patient was assigned to until immediately before the start of each colonoscopy. Polyps that were missed by the CADe system but detected by endoscopists were classified as missed polyps. False polyps were those continuously traced by the CADe system but then determined not to be polyps by the endoscopists. The primary endpoint was adenoma miss rate, which was defined as the number of adenomas detected in the second-pass colonoscopy divided by the total number of adenomas detected in both passes. RESULTS: The adenoma miss rate was significantly lower with CADe colonoscopy (13.89%; 95% CI, 8.24%-19.54%) than with routine colonoscopy (40.00%; 95% CI, 31.23%-48.77%, P<.0001). The polyp miss rate was significantly lower with CADe colonoscopy (12.98%; 95% CI, 9.08%-16.88%) than with routine colonoscopy (45.90%; 95% CI, 39.65%-52.15%) (P<.0001). Adenoma miss rates in ascending, transverse, and descending colon were significantly lower with CADe colonoscopy than with routine colonoscopy (ascending colon 6.67% vs 39.13%; P=.0095; transverse colon 16.33% vs 45.16%; P=.0065; and descending colon 12.50% vs 40.91%, P=.0364). CONCLUSIONS: CADe colonoscopy reduced the overall miss rate of adenomas by endoscopists using white-light endoscopy. Routine use of CADe might reduce the incidence of interval colon cancers. chictr.org.cn study no: ChiCTR1900023086.
背景与目的：在筛查性结肠镜检查中，多达 30%的腺瘤可能会被遗漏——这些腺瘤可能是在屏幕上出现但内镜医生没有识别出的息肉，也可能是完全不在屏幕显示范围内的位置的息肉。基于深度学习的计算机辅助检测 (CADe) 系统可以通过实时在内窥镜监视器上显示识别癌前息肉的视觉警报来降低腺瘤的漏诊率。我们比较了 CADe 结肠镜检查与常规白光结肠镜检查的腺瘤漏诊率。
方法：我们对 2019 年 6 月 3 日至 2019 年 9 月 24 日在四川省人民医院单内镜中心接受诊断性、筛查性或监测性结肠镜检查的 18-75 岁患者进行了前瞻性研究。同一天，同一名内镜医生对每位患者进行了串联结肠镜检查。患者被随机分配到接受 CADe 结肠镜检查（n=184）或常规结肠镜检查（n=185）的组中，然后立即进行另一项检查。内镜医生直到开始每项结肠镜检查前才知道患者被分配到哪个组。CADe 系统遗漏但内镜医生检测到的息肉被归类为遗漏息肉。假息肉是指 CADe 系统连续追踪但随后被内镜医生确定不是息肉的息肉。主要终点是腺瘤漏诊率，定义为第二道结肠镜检查中检出的腺瘤数除以两道检查中检出的腺瘤总数。
结果：CADe 结肠镜检查的腺瘤漏诊率（13.89%；95%CI，8.24%-19.54%）显著低于常规结肠镜检查（40.00%；95%CI，31.23%-48.77%，P<.0001）。CADe 结肠镜检查的息肉漏诊率（12.98%；95%CI，9.08%-16.88%）也显著低于常规结肠镜检查（45.90%；95%CI，39.65%-52.15%）（P<.0001）。CADe 结肠镜检查的升结肠、横结肠和降结肠腺瘤漏诊率均显著低于常规结肠镜检查（升结肠 6.67%比 39.13%；P=.0095；横结肠 16.33%比 45.16%；P=.0065；降结肠 12.50%比 40.91%；P=.0364）。
结论：CADe 结肠镜检查降低了内镜医生使用白光内镜的腺瘤总体漏诊率。常规使用 CADe 可能会降低间隔期结肠癌的发生率。chictr.org.cn 注册号：ChiCTR1900023086。
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