Halvorsen Natalie, Hassan Cesare, Correale Loredana, Pilonis Nastazja, Helsingen Lise M, Spadaccini Marco, Repici Alessandro, Foroutan Farid, Olav Vandvik Per, Sultan Shanaz, Løberg Magnus, Kalager Mette, Mori Yuichi, Bretthauer Michael
Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway.
Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.
BMJ Med. 2025 Mar 27;4(1):e001446. doi: 10.1136/bmjmed-2025-001446. eCollection 2025 Jan.
To estimate the benefits, burden, and harms of implementing computer aided detection (CADe) of polyps in colonoscopy of population based screening programmes for colorectal cancer.
Microsimulation modelling study.
Cost effectiveness working package in the OperA (optimising colorectal cancer prevention through personalised treatment with artificial intelligence) project. A parallel guideline committee panel (BMJ Rapid recommendation) was consulted in defining the screening interventions and selection of outcome measures.
Four cohorts of 100 000 European individuals aged 60-69 years.
The intervention was one screening of colonoscopy and a screening of colonoscopy after faecal immunochemical test every other year with CADe. The comparison group had the same screening every other year without CADe.
Benefits (colorectal cancer incidence and death), burden (surveillance colonoscopies), and harms (colonoscopy related adverse events) over 10 years were measured. The certainty in each outcome was assessed by use of the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.
For 100 000 individuals participating in colonoscopy screening, 824 (0.82%) were diagnosed with colorectal cancer within 10 years without CADe versus 713 (0.71%) with CADe (risk difference -0.11% (95% CI -0.43% to 0.21%)). For faecal immunochemical test screening colonoscopy, the risk was 5.82% (n=5820) without CADe versus 5.77% (n=5770) with CADe (difference -0.05% (-0.33% to 0.15%)). The risk of surveillance colonoscopy increased from 26.45% (n=26 453) to 32.82% (n=32 819) (difference 6.37% (5.8% to 6.9%)) for colonoscopy screening and from 52.26% (n=52 263) to 53.08% (n=53 082) (difference 0.82% (0.38% to 1.26%)) for faecal immunochemical test screening colonoscopy. No significant differences were noted in adverse events related to the colonoscopy between CADe and no CADe. The model estimates were sensitive to the assumed effects of screening on colorectal cancer risk and of CADe on adenoma detection rates. All outcomes were graded as low certainty.
With low certainty of evidence, adoption of CADe in population based screening provides small and uncertain clinical meaningful benefit, no incremental harms, and increased surveillance burden after screening.
评估在基于人群的结直肠癌筛查计划的结肠镜检查中实施息肉计算机辅助检测（CADe）的益处、负担和危害。
微观模拟建模研究。
OperA（通过人工智能个性化治疗优化结直肠癌预防）项目中的成本效益工作包。在定义筛查干预措施和选择结局指标时咨询了一个平行的指南委员会小组（BMJ快速推荐）。
四组各100000名年龄在60 - 69岁的欧洲个体。
干预措施为每隔一年进行一次结肠镜检查筛查以及在粪便免疫化学检测后进行一次结肠镜检查并使用CADe。对照组每隔一年进行相同的筛查但不使用CADe。
测量10年内的益处（结直肠癌发病率和死亡率）、负担（监测性结肠镜检查）和危害（结肠镜检查相关不良事件）。采用GRADE（推荐评估、制定和评价分级）方法评估每个结局的确定性。
对于100000名参与结肠镜检查筛查的个体，在10年内，未使用CADe时824人（0.82%）被诊断为结直肠癌，使用CADe时为713人（0.71%）（风险差异 -0.11%（95%CI -0.43%至0.21%））。对于粪便免疫化学检测筛查结肠镜检查，未使用CADe时风险为5.82%（n = 5820），使用CADe时为5.77%（n = 5770）（差异 -0.05%（-0.33%至0.15%））。结肠镜检查筛查中，监测性结肠镜检查的风险从26.45%（n = 26453）增加到32.82%（n = 32819）（差异6.37%（5.8%至6.9%）），粪便免疫化学检测筛查结肠镜检查中，风险从52.26%（n = 52263）增加到53.08%（n = 53082）（差异0.82%（0.38%至1.26%））。在CADe组和非CADe组之间，与结肠镜检查相关的不良事件未发现显著差异。模型估计对筛查对结直肠癌风险的假定影响以及CADe对腺瘤检出率的假定影响敏感。所有结局的确定性等级均为低。
基于低确定性的证据，在基于人群的筛查中采用CADe带来的临床意义上的益处小且不确定，无额外危害，但筛查后监测负担增加。
