Sivananthan Arun, Nazarian Scarlet, Ayaru Lakshmana, Patel Kinesh, Ashrafian Hutan, Darzi Ara, Patel Nisha
Institute of Global Health Innovation, Imperial College, London, UK.
Department of Surgery and Cancer, Imperial College NHS Healthcare Trust, London, UK.
Clin Endosc. 2022 May;55(3):355-364. doi: 10.5946/ce.2021.228. Epub 2022 May 12.
BACKGROUND/AIMS: Colonoscopy is the gold standard diagnostic method for colorectal neoplasia, allowing detection and resection of adenomatous polyps; however, significant proportions of adenomas are missed. Computer-aided detection (CADe) systems in endoscopy are currently available to help identify lesions. Diminutive (≤5 mm) and nonpedunculated polyps are most commonly missed. This meta-analysis aimed to assess whether CADe systems can improve the real-time detection of these commonly missed lesions.
A comprehensive literature search was performed. Randomized controlled trials evaluating CADe systems categorized by morphology and lesion size were included. The mean number of polyps and adenomas per patient was derived. Independent proportions and their differences were calculated using DerSimonian and Laird random-effects modeling.
Seven studies, including 2,595 CADe-assisted colonoscopies and 2,622 conventional colonoscopies, were analyzed. CADe-assisted colonoscopy demonstrated an 80% increase in the mean number of diminutive adenomas detected per patient compared with conventional colonoscopy (0.31 vs. 0.17; effect size, 0.13; 95% confidence interval [CI], 0.09-0.18); it also demonstrated a 91.7% increase in the mean number of nonpedunculated adenomas detected per patient (0.32 vs. 0.19; effect size, 0.05; 95% CI, 0.02-0.07).
CADe-assisted endoscopy significantly improved the detection of most commonly missed adenomas. Although this method is a potentially exciting technology, limitations still apply to current data, prompting the need for further real-time studies.
背景/目的：结肠镜检查是结直肠肿瘤的金标准诊断方法，可用于检测和切除腺瘤性息肉；然而，仍有相当比例的腺瘤被漏诊。目前内镜检查中的计算机辅助检测（CADe）系统可帮助识别病变。微小（≤5mm）和无蒂息肉最常被漏诊。本荟萃分析旨在评估CADe系统能否改善这些常见漏诊病变的实时检测。
进行了全面的文献检索。纳入按形态和病变大小分类评估CADe系统的随机对照试验。得出每位患者息肉和腺瘤的平均数量。使用DerSimonian和Laird随机效应模型计算独立比例及其差异。
分析了7项研究，包括2595例CADe辅助结肠镜检查和2622例传统结肠镜检查。与传统结肠镜检查相比，CADe辅助结肠镜检查显示每位患者检测到的微小腺瘤平均数量增加了80%（0.31对0.17；效应大小，0.13；95%置信区间[CI]，0.09 - 0.18）；每位患者检测到的无蒂腺瘤平均数量也增加了91.7%（0.32对0.19；效应大小，0.05；95%CI，0.02 - 0.07）。
CADe辅助内镜检查显著改善了最常被漏诊腺瘤的检测。尽管该方法是一项潜在的令人兴奋的技术，但目前的数据仍存在局限性，这促使需要进一步进行实时研究。
