Lee Antonio, Tutticci Nicholas
Endoscopy Unit, Queen Elizabeth II Jubilee Hospital, Brisbane, Australia.
Transl Gastroenterol Hepatol. 2021 Oct 25;6:61. doi: 10.21037/tgh.2020.02.05. eCollection 2021.
The detection and removal of polyps at colonoscopy is core to the current colorectal cancer (CRC) prevention strategy. However, colonoscopy is flawed with a well described miss rate and variability in detection rates associated with incomplete protection from CRC. Consequently, there is significant interest in techniques and technologies which increase polyp detection with the aim to remedy colonoscopy's ills. Technologic advances in colonoscope imaging are numerous and include; increased definition of imaging, widening field of view, virtual technologies to supplant conventional chromocolonoscopy (CC) and now computer assisted detection. However, despite nearly two decades of technologic advances, data on gains in detection from individual technologies have been modest at best and heterogenous and conflicted as a rule. This state of detection technology science is exacerbated by use of relatively blunt metrics of improvement without consensus, the myopic search for gains over single generations of technology improvement and an unhealthy focus on adenomatous lesions. Yet there remains cause for optimism as detection gains from new technology, while small, may still improve CRC prevention. The technologies are also readily available in current generation colonoscopes and have roles beyond simply detection such as lesion characterization, further improving their worth. Coupled with the imminent expansion of computer assisted detection the detection future from colonoscope imaging advances looks bright. This review aims to cover the major imaging advances and evidence for improvement in polyp detection.
在结肠镜检查时检测并切除息肉是当前结直肠癌（CRC）预防策略的核心。然而，结肠镜检查存在缺陷，其漏诊率已得到充分描述，且与无法完全预防CRC相关的检测率存在差异。因此，人们对能够提高息肉检测率以弥补结肠镜检查不足的技术和工艺有着浓厚兴趣。结肠镜成像技术取得了诸多进展，包括成像清晰度提高、视野拓宽、取代传统染色结肠镜检查（CC）的虚拟技术以及如今的计算机辅助检测。然而，尽管技术进步已近二十年，但关于各项技术在检测方面取得的进展的数据充其量也只是微不足道，而且通常是异质且相互矛盾的。检测技术科学的这种状况因使用相对粗略且缺乏共识的改进指标、对单代技术改进中收益的短视追求以及对腺瘤性病变的过度关注而加剧。不过，仍有理由保持乐观，因为新技术带来的检测收益虽小，但仍可能改善CRC的预防。这些技术在当代结肠镜中也很容易获得，并且除了单纯的检测之外还有其他作用，比如病变特征描述，这进一步提升了它们的价值。再加上计算机辅助检测即将得到扩展，结肠镜成像技术进步所带来的检测前景看起来一片光明。本综述旨在涵盖主要的成像进展以及息肉检测改善的证据。
