人工智能在结肠镜检查中检测高级肿瘤中的作用：一项随机试验。
Role of Artificial Intelligence in Colonoscopy Detection of Advanced Neoplasias : A Randomized Trial.
机构信息
Department of Gastroenterology, Hospital General Universitario Dr. Balmis, Servicio de Medicina Digestiva, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Spain (C.M., N.S.).
Department of Gastroenterology, Hospital Álvaro Cunqueiro, Digestive Pathology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain (L. de-C., N.F.).
出版信息
Ann Intern Med. 2023 Sep;176(9):1145-1152. doi: 10.7326/M22-2619. Epub 2023 Aug 29.
BACKGROUND
The role of computer-aided detection in identifying advanced colorectal neoplasia is unknown.
OBJECTIVE
To evaluate the contribution of computer-aided detection to colonoscopic detection of advanced colorectal neoplasias as well as adenomas, serrated polyps, and nonpolypoid and right-sided lesions.
DESIGN
Multicenter, parallel, randomized controlled trial. (ClinicalTrials.gov: NCT04673136).
SETTING
Spanish colorectal cancer screening program.
PARTICIPANTS
3213 persons with a positive fecal immunochemical test.
INTERVENTION
Enrollees were randomly assigned to colonoscopy with or without computer-aided detection.
MEASUREMENTS
Advanced colorectal neoplasia was defined as advanced adenoma and/or advanced serrated polyp.
RESULTS
The 2 comparison groups showed no significant difference in advanced colorectal neoplasia detection rate (34.8% with intervention vs. 34.6% for controls; adjusted risk ratio [aRR], 1.01 [95% CI, 0.92 to 1.10]) or the mean number of advanced colorectal neoplasias detected per colonoscopy (0.54 [SD, 0.95] with intervention vs. 0.52 [SD, 0.95] for controls; adjusted rate ratio, 1.04 [99.9% CI, 0.88 to 1.22]). Adenoma detection rate also did not differ (64.2% with intervention vs. 62.0% for controls; aRR, 1.06 [99.9% CI, 0.91 to 1.23]). Computer-aided detection increased the mean number of nonpolypoid lesions (0.56 [SD, 1.25] vs. 0.47 [SD, 1.18] for controls; adjusted rate ratio, 1.19 [99.9% CI, 1.01 to 1.41]), proximal adenomas (0.94 [SD, 1.62] vs. 0.81 [SD, 1.52] for controls; adjusted rate ratio, 1.17 [99.9% CI, 1.03 to 1.33]), and lesions of 5 mm or smaller (polyps in general and adenomas and serrated lesions in particular) detected per colonoscopy.
LIMITATIONS
The high adenoma detection rate in the control group may limit the generalizability of the findings to endoscopists with low detection rates.
CONCLUSION
Computer-aided detection did not improve colonoscopic identification of advanced colorectal neoplasias.
PRIMARY FUNDING SOURCE
Medtronic.
背景
计算机辅助检测在识别高级结直肠肿瘤中的作用尚不清楚。
目的
评估计算机辅助检测对结肠镜检查发现高级结直肠肿瘤以及腺瘤、锯齿状息肉、非息肉样和右侧病变的作用。
设计
多中心、平行、随机对照试验。（ClinicalTrials.gov：NCT04673136）。
地点
西班牙结直肠癌筛查计划。
参与者
3213 名粪便免疫化学检测阳性者。
干预措施
入组者被随机分配至接受或不接受计算机辅助检测的结肠镜检查。
测量指标
高级结直肠肿瘤定义为高级腺瘤和/或高级锯齿状息肉。
结果
两组比较，高级结直肠肿瘤检出率无显著差异（干预组为 34.8%，对照组为 34.6%；校正风险比[aRR]，1.01[95%CI，0.92 至 1.10]）或每例结肠镜检查检出的高级结直肠肿瘤数量无显著差异（干预组为 0.54[SD，0.95]，对照组为 0.52[SD，0.95]；校正率比，1.04[99.9%CI，0.88 至 1.22]）。腺瘤检出率也无差异（干预组为 64.2%，对照组为 62.0%；aRR，1.06[99.9%CI，0.91 至 1.23]）。计算机辅助检测增加了非息肉样病变（0.56[SD，1.25]与对照组 0.47[SD，1.18]；校正率比，1.19[99.9%CI，1.01 至 1.41]）、近端腺瘤（0.94[SD，1.62]与对照组 0.81[SD，1.52]；校正率比，1.17[99.9%CI，1.03 至 1.33]）和直径 5mm 或以下病变（包括息肉和腺瘤、锯齿状病变）的检出数量。
局限性
对照组高腺瘤检出率可能限制了研究结果在检出率较低的内镜医师中的推广。
结论
计算机辅助检测并未提高结肠镜检查对高级结直肠肿瘤的识别能力。
主要资金来源
美敦力。
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