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World J Gastroenterol. Sep 7, 2026; 32(33): 119646
Published online Sep 7, 2026. doi: 10.3748/wjg.119646
Published online Sep 7, 2026. doi: 10.3748/wjg.119646
Development and validation of a tongue image-clinical nomogram for detection of advanced colorectal adenoma
Jing Zhang, Mei-Li Zhu, Yu-Xuan Xie, Ya-Qin Fan, Wei Zhang, Shi-Shi Liu, Wei Wang, Xiao-Yan Fu, Department of Gastroenterology and Hepatology, The Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350003, Fujian Province, China
Xiang-Mei Yu, Department of Public Health Fundamentals, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, Fujian Province, China
Co-corresponding authors: Wei Wang and Xiao-Yan Fu.
Author contributions: Zhang J designed the research study and wrote the first draft of the manuscript; Zhu ML, Xie YX, Fan YQ, Zhang W, Liu SS contributed data collection; Yu XM contributed to the analysis; Wang W and Fu XY conceived and supervised the manuscript, and shared responsibility for correspondence as co-corresponding authors; all authors have read and approved the final manuscript.
Supported by Fujian Provincial Financial Subsidy Special Program, No. X2023010; and Natural Science Foundation of Fujian Province, No. 2024Y0020.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine (No. SPHFJP-Y2025106-01).
Informed consent statement: Written informed consent was obtained from all participants.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at fxy001@sohu.com. Participants gave informed consent for data sharing.
Corresponding author: Xiao-Yan Fu, MD, Chief Physician, Department of Gastroenterology and Hepatology, The Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, No. 282 Wusi Road, Fuzhou 350003, Fujian Province, China.
Received: February 3, 2026
Revised: April 9, 2026
Accepted: April 28, 2026
Published online: September 7, 2026
Processing time: 188 Days and 5.9 Hours
Revised: April 9, 2026
Accepted: April 28, 2026
Published online: September 7, 2026
Processing time: 188 Days and 5.9 Hours
Core Tip
Core Tip: This study developed and internally validated a noninvasive nomogram integrating quantitative tongue phenotypes with clinical factors for advanced adenoma detection. In the validation cohort, the nomogram showed higher discrimination than the Asia-Pacific colorectal screening (APCS) and modified APCS scores. In the high-risk subgroup (APCS ≥ 4), where conventional scores had limited discriminative value, the nomogram maintained moderate performance and detected 2-3 times as many advanced adenomas as the conventional scores did at approximately 80% specificity, suggesting potential as a noninvasive risk-refinement tool for opportunistic screening.