Performance of computer-aided diagnosis for colorectal sessile serrated lesions: A systematic review and meta-analysis

doi:10.3748/wjg.118009

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Jul 21, 2026; 32(27): 118009
Published online Jul 21, 2026. doi: 10.3748/wjg.118009

Performance of computer-aided diagnosis for colorectal sessile serrated lesions: A systematic review and meta-analysis

Song Zhang, Shi-Hang Wang, You-Dong Zhao, Jia-Hui Wei, Xiang-Yu Sui, Xin Li, Huan-Wei Zhang, Zhi-Yao Huang, Cheng-Long Wang, Hao Hu, Jing Zhang, Zhao-Shen Li, Sheng-Bing Zhao, Yu Bai

Song Zhang, Shi-Hang Wang, You-Dong Zhao, Jia-Hui Wei, Xiang-Yu Sui, Xin Li, Huan-Wei Zhang, Zhi-Yao Huang, Cheng-Long Wang, Hao Hu, Zhao-Shen Li, Sheng-Bing Zhao, Yu Bai, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China

Jing Zhang, Department of Pathology, Changzheng Hospital, Naval Medical University, Shanghai 200433, China

Co-first authors: Song Zhang and Shi-Hang Wang.

Co-corresponding authors: Sheng-Bing Zhao and Yu Bai.

Author contributions: Zhang S and Wang SH contributed equally, as they are co-first authors; Zhao SB and Bai Y contributed equally, as they are co-corresponding authors; Zhang S contributed to formal analysis, writing-original draft, writing-review and editing, investigation, software; Wang SH contributed to visualization, data curation, writing-review and editing, software, investigation; Zhao YD contributed to writing-original draft, data curation, software, investigation; Wei JH, Sui XY, Li X, Zhang HW, Huang ZY, Wang CL and Hu H contributed to data curation, investigation, visualization; Zhang J, Li ZS contributed to supervision; Zhao SB, Bai Y contributed to conception, conceptualization, methodology, project administration, resources, supervision, writing-review and editing.

Supported by The China National Postdoctoral Program for Innovative Talents, No. BX20230482; Shanghai Sailing Program, No. 23YF1458600; Noncommunicable Chronic Diseases-National Science and Technology Major Project, No. 2023ZD0501601; Shanghai Oriental Talents Program Top-Notch Project, No. BJKJ2025002; Chenguang Program of Shanghai Education Development Foundation and Shanghai Municipal Education Commission, No. 22CGA42; Special Clinical Research on Health Industry of Shanghai Municipal Health Commission, No. 20244Y0231; Natural Science Foundation of Shanghai, No. 23ZR1478700; Shanghai Eastern Talent Youth Program, No. QNWS2024100 and No. QNWS2024108; Shanghai Public Health Key Discipline Project, No. GWVI-11.1-21; Shanghai Medical Innovation Research Project, No. 23Y11902500; Shanghai Hospital Development Center Foundation, No. SHDC22025222; Changhai Hospital Special Foundation for Clinical Research Program, No. 2024 LYB05; and Changfeng Guhai Project of Changhai Hospital (Changying Youth Seedling Plan).

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Yu Bai, MD, Doctor, Department of Gastroenterology, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai 200433, China. changhaibaiyu@smmu.edu.cn

Received: December 22, 2025
Revised: January 26, 2026
Accepted: March 24, 2026
Published online: July 21, 2026
Processing time: 196 Days and 21.1 Hours

Abstract

BACKGROUND

The efficacy of computer-aided diagnosis (CADx) systems in identifying sessile serrated lesions (SSLs), which are critical precancerous lesions in colorectal cancer, remains unclear.

AIM

To comprehensively evaluate the diagnostic performance of CADx systems in differentiating between SSLs and non-SSLs and hyperplastic polyps (HPs).

METHODS

MEDLINE, EMBASE, and the Cochrane Library were searched up to 11 June 2025 for studies evaluating the performance of CADx systems in differentiating SSLs. The primary outcomes were the pooled diagnostic accuracy, sensitivity, and specificity of the CADx systems in distinguishing SSLs from non-SSLs or HPs.

RESULTS

Nine studies encompassing 2915 images and 746 videos on SSL differentiation were included. For SSLs vs non-SSLs, the CADx system demonstrated an overall area under the curve (AUC) of 0.93, 66% sensitivity, 95% specificity, a positive predictive value (PPV) of 0.56, a negative predictive value (NPV) of 0.96, a positive likelihood ratio (LR+) of 12.3, and a negative likelihood ratio (LR-) of 0.36. For SSLs vs HPs, the overall AUC was 0.64, with 55% sensitivity, 64% specificity, a PPV of 0.40, an NPV of 0.80, an LR+ of 1.5, and an LR- of 0.70. The sensitivity analysis indicated stable findings, whereas the latest World Health Organization pathological standards, image classification algorithms (ICAs), real-time scenarios, multicenter settings and narrow band imaging (NBI) significantly affected CADx system sensitivity. ICA served as an independent factor influencing the sensitivity of differentiating between SSLs and non-SSLs [odds ratio (OR) = 14.13], whereas NBI was an independent factor influencing the sensitivity of differentiating between SSLs and HPs (OR = 7.27) according to multivariate meta-regression.

CONCLUSION

Current CADx systems cannot adequately differentiate SSLs from non-SSLs or HPs. Future development should focus on improving the differentiation capability and sensitivity of SSLs.

Keywords: Computer-aided diagnosis; Sessile serrated lesions; Colonoscopy; Diagnostic accuracy; Sensitivity; Specificity

Core Tip: This is the first meta-analysis to comprehensively evaluate the efficacy of computer aided diagnosis (CADx) systems in identifying sessile serrated lesions (SSLs). The meta-analysis demonstrated the limited differentiation performance of CADx systems for SSLs, which is also significantly inferior to the distinguishing ability of colonoscopists. Although CADx systems perform well in differentiating SSLs from non-SSLs with relatively high specificity, their sensitivity is far lower than that of the optical biopsy criteria, particularly for differentiating between SSL and hyperplastic polyp.