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Jahn B, Bundo M, Arvandi M, Schaffner M, Todorovic J, Sroczynski G, Knudsen A, Fischer T, Schiller-Fruehwirth I, Öfner D, Renner F, Jonas M, Kuchin I, Kruse J, Santamaria J, Ferlitsch M, Siebert U. One in three adenomas could be missed by white-light colonoscopy - findings from a systematic review and meta-analysis. BMC Gastroenterol 2025; 25:170. [PMID: 40082770 PMCID: PMC11908064 DOI: 10.1186/s12876-025-03679-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Accepted: 02/11/2025] [Indexed: 03/16/2025] Open
Abstract
BACKGROUND White light (conventional) colonoscopy (WLC) is widely used for colorectal cancer screening, diagnosis and surveillance but endoscopists may fail to detect adenomas. Our goal was to assess and synthesize overall and subgroup-specific adenoma miss rates (AMR) of WLC in daily practice. METHODS We conducted a systematic review in MEDLINE, EMBASE, Cochrane Library, and grey literature on studies evaluating diagnostic WLC accuracy in tandem studies with novel-colonoscopic technologies (NCT) in subjects undergoing screening, diagnostic or surveillance colonoscopy. Information on study design, AMR overall and specific for adenoma size, histology, location, morphology and further outcomes were extracted and reported in standardized evidence tables. Study quality was assessed using the QUADAS-2 tool. Random-effects meta-analyses and meta-regression were performed to estimate pooled estimates for AMR with 95% confidence intervals (95% CI) and to explain heterogeneity. RESULTS Out of 5,963 identified studies, we included sixteen studies with 4,101 individuals in our meta-analysis. One in three adenomas (34%; 95% CI: 30-38%) was missed by WLC in daily practice individuals. Subgroup analyses showed significant AMR differences by size (36%, adenomas 1-5 mm; 27%, adenomas 6-9 mm; 12%, adenomas ≥ 10 mm), histology (non-advanced: 42%, advanced: 21%), morphology (flat: 50%, polypoid: 27%), but not by location (distal: 36%, proximal: 36%). CONCLUSIONS Based on our meta-analysis, one in three adenomas could be missed by WLC. This may significantly contribute to interval cancers. Our results should be considered in health technology assessment when interpreting sensitivity of fecal occult blood or other screening tests derived from studies using WLC as "gold standard".
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Affiliation(s)
- Beate Jahn
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Marvin Bundo
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Marjan Arvandi
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Monika Schaffner
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Jovan Todorovic
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Gaby Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Amy Knudsen
- Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Timo Fischer
- Main Association of Austrian Social Security Institutions, Vienna, Austria
| | | | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Michael Jonas
- Medical Association of Vorarlberg, Dornbirn, Austria
| | - Igor Kuchin
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Julia Kruse
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Júlia Santamaria
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Monika Ferlitsch
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria.
- Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria.
- Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, Harvard T. H. Chan School of Public Health, Boston, USA.
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Hassan C, Bisschops R, Sharma P, Mori Y. Colon Cancer Screening, Surveillance, and Treatment: Novel Artificial Intelligence Driving Strategies in the Management of Colon Lesions. Gastroenterology 2025:S0016-5085(25)00478-0. [PMID: 40054749 DOI: 10.1053/j.gastro.2025.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Revised: 02/09/2025] [Accepted: 02/15/2025] [Indexed: 03/25/2025]
Abstract
Colonoscopy, a crucial procedure for detecting and removing colorectal polyps, has seen transformative advancements through the integration of artificial intelligence, specifically in computer-aided detection (CADe) and diagnosis (CADx). These tools enhance real-time detection and characterization of lesions, potentially reducing human error, and standardizing the quality of colonoscopy across endoscopists. CADe has proven effective in increasing adenoma detection rate, potentially reducing long-term colorectal cancer incidence. However, CADe's benefits are accompanied by challenges, such as potentially longer procedure times, increased non-neoplastic polyp resections, and a higher surveillance burden. CADx, although promising in differentiating neoplastic and non-neoplastic diminutive polyps, encounters limitations in accuracy, particularly in the proximal colon. Real-world data also revealed gaps between trial efficacy and practical outcomes, emphasizing the need for further research in uncontrolled settings. Moreover, CADx limited specificity and binary output underscore the necessity for explainable artificial intelligence to gain endoscopists' trust. This review aimed to explore the benefits, harms, and limitations of artificial intelligence for colon cancer screening, surveillance, and treatment focusing on CADe and CADx systems for lesion detection and characterization, respectively, while addressing challenges in integrating these technologies into clinical practice.
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Affiliation(s)
- Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Gastroenterology, Istituto di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Rozzano, Italy.
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium; Translational Research Center in Gastrointestinal Disorders, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan; Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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3
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Wong NACS, Jones HE, Halloran KM. How many polyps need to be histologically assessed when multiple polyps are submitted for the Bowel Cancer Screening Program? Histopathology 2025; 86:302-305. [PMID: 39375324 DOI: 10.1111/his.15337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/11/2024] [Accepted: 09/21/2024] [Indexed: 10/09/2024]
Abstract
AIMS Since 2020 there has been an increase in the number of polyps removed from patients scoped for the Bowel Cancer Screening Programme (BCSP) of England. General cellular pathology workload also continues to increase disproportionately ahead of consultant pathologist numbers in the United Kingdom. The Optical Diagnosis initiative for BCSP patients has not yet, and may not be, implemented at every hospital in England. The following study therefore aimed to determine whether only a certain number of removed polyps need to be histologically assessed to consistently guide a BCSP patient's post-polypectomy management, and whether all remaining smaller polyps beyond that number could then be discarded. METHODS This retrospective study considered all BCSP specimens/cases submitted to the Cellular Pathology department of a large English teaching hospital from 2016 to 2024. Only cases with six or more resected polyps, for which the endoscopic report stated individual sizes, were included in the final study cohort. RESULTS Of the 8066 BCSP cases submitted to the aforementioned department, there were six or more polyps for 345 cases. Analysis of the final study cohort of 135 cases showed that assessment of the seven largest polyps measured endoscopically was sufficient to correctly guide follow-up management of the BCSP patient as per the 2020 British Society of Gastroenterology post-polypectomy guidelines. CONCLUSIONS When colonoscopy of a BCSP patient leads to removal of multiple polyps, only the seven largest polyps need to be assessed histologically and the remaining smaller polyps could be discarded with no impact to the patient's BCSP-related management.
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Affiliation(s)
| | - Hannah E Jones
- Department of Cellular Pathology, Southmead Hospital, Bristol, UK
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Misawa M, Kudo SE. Current Status of Artificial Intelligence Use in Colonoscopy. Digestion 2024; 106:138-145. [PMID: 39724867 DOI: 10.1159/000543345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 12/24/2024] [Indexed: 12/28/2024]
Abstract
BACKGROUND Artificial intelligence (AI) has significantly impacted medical imaging, particularly in gastrointestinal endoscopy. Computer-aided detection and diagnosis systems (CADe and CADx) are thought to enhance the quality of colonoscopy procedures. SUMMARY Colonoscopy is essential for colorectal cancer screening but often misses a significant percentage of adenomas. AI-assisted systems employing deep learning offer improved detection and differentiation of colorectal polyps, potentially increasing adenoma detection rates by 8%-10%. The main benefit of CADe is in detecting small adenomas, whereas it has a limited impact on advanced neoplasm detection. Recent advancements include real-time CADe systems and CADx for histopathological predictions, aiding in the differentiation of neoplastic and nonneoplastic lesions. Biases such as the Hawthorne effect and potential overdiagnosis necessitate large-scale clinical trials to validate the long-term benefits of AI. Additionally, novel concepts such as computer-aided quality improvement systems are emerging to address limitations facing current CADe systems. KEY MESSAGES Despite the potential of AI for enhancing colonoscopy outcomes, its effectiveness in reducing colorectal cancer incidence and mortality remains unproven. Further prospective studies are essential to establish the overall utility and clinical benefits of AI in colonoscopy.
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Affiliation(s)
- Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
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Hassan C, Rizkala T, Mori Y, Spadaccini M, Misawa M, Antonelli G, Rondonotti E, Dekker E, Houwen BBSL, Pech O, Baumer S, Li JW, von Renteln D, Haumesser C, Maselli R, Facciorusso A, Correale L, Menini M, Schilirò A, Khalaf K, Patel H, Radadiya DK, Bhandari P, Kudo SE, Sultan S, Vandvik PO, Sharma P, Rex DK, Foroutan F, Repici A. Computer-aided diagnosis for the resect-and-discard strategy for colorectal polyps: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2024; 9:1010-1019. [PMID: 39303733 DOI: 10.1016/s2468-1253(24)00222-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/21/2024] [Accepted: 07/02/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND The resect-and-discard strategy allows endoscopists to replace post-polypectomy pathology with real-time prediction of polyp histology during colonoscopy (optical diagnosis). We aimed to investigate the benefits and harms of implementing computer-aided diagnosis (CADx) for polyp pathology into the resect-and-discard strategy. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, and Scopus from database inception to June 5, 2024, without language restrictions, for diagnostic accuracy studies that assessed the performance of real-time CADx systems, compared with histology, for the optical diagnosis of diminutive polyps (≤5 mm) in the entire colon. We synthesised data for three strategies: CADx-alone, CADx-unassisted, and CADx-assisted; when the endoscopist was involved in the optical diagnosis, we synthesised data exclusively from diagnoses for which confidence in the prediction was reported as high. The primary outcomes were the proportion of polyps that would have avoided pathological assessment (ie, the proportion optically diagnosed with high confidence; main benefit) and the proportion of polyps incorrectly predicted due to false positives and false negatives (main harm), directly compared between CADx-assisted and CADx-unassisted strategies. We used DerSimonian and Laird's random-effects model to calculate all outcomes. We used Higgins I2 to assess heterogeneity, the Grading of Recommendations, Assessment, Development, and Evaluation approach to rate certainty, and funnel plots and Egger's test to examine publication bias. This study is registered with PROSPERO, CRD42024508440. FINDINGS We found 1019 studies, of which 11 (7400 diminutive polyps, 3769 patients, and 185 endoscopists) were included in the final meta-analysis. Three studies (1817 patients and 4086 polyps [2148 neoplastic and 1938 non-neoplastic]) provided data to directly compare the primary outcome measures between the CADx-unassisted and CADx-assisted strategies. We found no significant difference between the CADx-assisted and CADx-unassisted strategies for the proportion of polyps that would have avoided pathological assessment (90% [88-93], 3653 [89·4%] of 4086 polyps diagnosed with high confidence vs 90% [95% CI 85-94], 3588 [87·8%] of 4086 polyps diagnosed with high confidence; risk ratio 1·01 [95% CI 0·99-1·04; I2=53·49%; low-certainty evidence; Egger's test p=0·18). The proportion of incorrectly predicted polyps was lower with the CADx-assisted strategy than with the CADx-unassisted strategy (12% [95% CI 7-17], 523 [14·3%] of 3653 polyps incorrectly predicted with a CADx-assisted strategy vs 13% [6-20], 582 [16·2%] of 3588 polyps incorrectly diagnosed with a CADx-unassisted strategy; risk ratio 0·88 [95% CI 0·79-0·98]; I2=0·00%; low-certainty evidence; Egger's test p=0·18). INTERPRETATION CADx did not produce benefit nor harm for the resect-and-discard strategy, questioning its value in clinical practice. Improving the accuracy and explainability of CADx is desired. FUNDING European Commission (Horizon Europe), the Japan Society of Promotion of Science, and Associazione Italiana per la Ricerca sul Cancro.
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Affiliation(s)
- Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Tommy Rizkala
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan; Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
| | - Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Giulio Antonelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Rome, Italy; Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, Netherlands; Bergman Clinics Maag and Darm Amsterdam, Amsterdam, Netherlands
| | - Britt B S L Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Sebastian Baumer
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - James Weiquan Li
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore
| | - Daniel von Renteln
- Montreal University Hospital Research Center, Montreal, QC, Canada; Division of Gastroenterology, Montreal University Hospital Center, Montreal, QC, Canada
| | - Claire Haumesser
- Montreal University Hospital Research Center, Montreal, QC, Canada
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Antonio Facciorusso
- Department of Medical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy
| | - Loredana Correale
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Maddalena Menini
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Alessandro Schilirò
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Kareem Khalaf
- Division of Gastroenterology St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Harsh Patel
- Kansas City VA Medical Center, Gastroenterology and Hepatology, Kansas City, MO, USA
| | - Dhruvil K Radadiya
- Kansas City VA Medical Center, Gastroenterology and Hepatology, Kansas City, MO, USA
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA; Veterans Affairs Healthcare System, Minneapolis, MN, USA
| | - Per Olav Vandvik
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Prateek Sharma
- Kansas City VA Medical Center, Gastroenterology and Hepatology, Kansas City, MO, USA
| | - Douglas K Rex
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Farid Foroutan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
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Wang YP, Karmakar R, Mukundan A, Tsao YM, Sung TC, Lu CL, Wang HC. Spectrum aided vision enhancer enhances mucosal visualization by hyperspectral imaging in capsule endoscopy. Sci Rep 2024; 14:22243. [PMID: 39333620 PMCID: PMC11436966 DOI: 10.1038/s41598-024-73387-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 09/17/2024] [Indexed: 09/29/2024] Open
Abstract
Narrow-band imaging (NBI) is more efficient in detecting early gastrointestinal cancer than white light imaging (WLI). NBI technology is available only in conventional endoscopy, but unavailable in magnetic-assisted capsule endoscopy (MACE) systems due to MACE's small size and obstacles in image processing issues. MACE is an easy, safe, and convenient tool for both patients and physicians to avoid the disadvantages of conventional endoscopy. Enabling NBI technology in MACE is mandatory. We developed a novel method to improve mucosal visualization using hyperspectral imaging (HSI) known as Spectrum Aided Visual Enhancer (SAVE, Transfer N, Hitspectra Intelligent Technology Co., Kaohsiung, Taiwan). The technique was developed by converting the WLI image captured by MACE to enhance SAVE images. The structural similarity index metric (SSIM) between the WLI MACE images and the enhanced SAVE images was 91%, while the entropy difference between the WLI MACE images and the enhanced SAVE images was only 0.47%. SAVE algorithm can identify the mucosal break on the esophagogastric junction in patients with gastroesophageal reflux disorder. We successfully developed a novel image-enhancing technique, SAVE, in the MACE system, showing close similarity to the NBI from the conventional endoscopy system. The future application of this novel technology in the MACE system can be promising.
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Affiliation(s)
- Yen-Po Wang
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan
- Institute of Brain Sciences, National Yang Ming Chiao Tung University, 155, Li-Nong St., Sec.2, Peitou, Taipei City, 11217, Taiwan
| | - Riya Karmakar
- Department of Mechanical Engineering, National Chung Cheng University, 168, University Rd., Min Hsiung, Chia Yi, 62102, Taiwan
| | - Arvind Mukundan
- Department of Mechanical Engineering, National Chung Cheng University, 168, University Rd., Min Hsiung, Chia Yi, 62102, Taiwan
| | - Yu-Ming Tsao
- Department of Mechanical Engineering, National Chung Cheng University, 168, University Rd., Min Hsiung, Chia Yi, 62102, Taiwan
| | - Te-Chin Sung
- Insight Medical Solutions Inc., No. 1, Lixing 6th Rd., East Dist., Hsinchu City, 300096, Taiwan
| | - Ching-Liang Lu
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan.
- Institute of Brain Sciences, National Yang Ming Chiao Tung University, 155, Li-Nong St., Sec.2, Peitou, Taipei City, 11217, Taiwan.
| | - Hsiang-Chen Wang
- Department of Mechanical Engineering, National Chung Cheng University, 168, University Rd., Min Hsiung, Chia Yi, 62102, Taiwan.
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Road, Dalin, Chiayi, 62247, Taiwan.
- Hitspectra Intelligent Technology Co., Ltd., 8F.11-1, No. 25, Chenggong 2nd Rd., Kaohsiung, 80661, Taiwan.
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Peng C, Tian CX, Mu Y, Ma M, Zhang Z, Wan M, Liu J, Li Z, Zuo X, Li W, Li Y. Hyperspectral imaging facilitating resect-and-discard strategy through artificial intelligence-assisted diagnosis of colorectal polyps: A pilot study. Cancer Med 2024; 13:e70195. [PMID: 39320133 PMCID: PMC11423483 DOI: 10.1002/cam4.70195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 08/15/2024] [Accepted: 08/25/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND AND AIMS The resect-and-discard strategy for colorectal polyps based on accurate optical diagnosis remains challenges. Our aim was to investigate the feasibility of hyperspectral imaging (HSI) for identifying colorectal polyp properties and diagnosis of colorectal cancer in fresh tissues during colonoscopy. METHODS 144,900 two dimensional images generated from 161 hyperspectral images of colorectal polyp tissues were prospectively obtained from patients undergoing colonoscopy. A residual neural network model was trained with transfer learning to automatically differentiate colorectal polyps, validated by histopathologic diagnosis. The diagnostic performances of the HSI-AI model and endoscopists were calculated respectively, and the auxiliary efficiency of the model was evaluated after a 2-week interval. RESULTS Quantitative HSI revealed histological differences in colorectal polyps. The HSI-AI model showed considerable efficacy in differentiating nonneoplastic polyps, non-advanced adenomas, and advanced neoplasia in vitro, with sensitivities of 96.0%, 94.0%, and 99.0% and specificities of 99.0%, 99.0%, and 96.5%, respectively. With the assistance of the model, the median negative predictive value of neoplastic polyps increased from 50.0% to 88.2% (p = 0.013) in novices. CONCLUSION This study demonstrated the feasibility of using HSI as a diagnostic tool to differentiate neoplastic colorectal polyps in vitro and the potential of AI-assisted diagnosis synchronized with colonoscopy. The tool may improve the diagnostic performance of novices and facilitate the application of resect-and-discard strategy to decrease the cost.
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Affiliation(s)
- Cheng Peng
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Chong Xuan Tian
- Department of Biomedical Engineering Institute, School of Control Science and EngineeringShandong UniversityJinanChina
| | - Yijun Mu
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Mingjun Ma
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Zhenlei Zhang
- Department of Biomedical Engineering Institute, School of Control Science and EngineeringShandong UniversityJinanChina
| | - Meng Wan
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Jing Liu
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Zhen Li
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Xiuli Zuo
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
- Shandong Provincial Clinical Research Center for Digestive DiseaseJinanChina
| | - Wei Li
- Department of Biomedical Engineering Institute, School of Control Science and EngineeringShandong UniversityJinanChina
| | - Yanqing Li
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
- Shandong Provincial Clinical Research Center for Digestive DiseaseJinanChina
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Pettis J, Paruch J. Endoscopic Assessment of Colorectal Polyps. Clin Colon Rectal Surg 2024; 37:271-276. [PMID: 39132200 PMCID: PMC11309797 DOI: 10.1055/s-0043-1770940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Colorectal cancer is the third most common cancer among men and the second among women. In the United States alone, there are 150,000 cases diagnosed each year. Colonoscopy remains the best method for identifying, evaluating, and intervening on patients with precancerous lesions. Multiple guidelines and techniques are available to assist the endoscopist with accurate diagnosis of these lesions. These include the Paris, Narrow-Band Imaging (NBI) International Colorectal Endoscopic (NICE), Japan NBI Expert Team (JNET), Kudo, Hiroshima, and Shudo classifications which utilize techniques such as chromoendoscopy, narrow-band imaging, and endocytoscopy to evaluate pit pattern and surface morphology. Utilization of these tools can help the endoscopist predict the cytology of a colonic lesion and select the most appropriate method for resection while maximizing organ preservation.
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Affiliation(s)
- Jaron Pettis
- Ochsner Clinic Foundation, Department of Colon and Rectal Surgery, New Orleans, Louisiana
| | - Jennifer Paruch
- Ochsner Clinic Foundation, Department of Colon and Rectal Surgery, New Orleans, Louisiana
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Lu SC, Mukundan A, Karmakar R, Tsao YM, Nguyen HT, Wang HC. Research progress in narrow-band imaging of capsule endoscopes based on hyperspectral image conversion technology. 2024 CONFERENCE ON LASERS AND ELECTRO-OPTICS PACIFIC RIM (CLEO-PR) 2024:1-2. [DOI: https:/doi.org/10.1109/cleo-pr60912.2024.10676538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Affiliation(s)
- Song-Cun Lu
- National Chung Cheng University,Department of Mechanical Engineering,Chia Yi,Taiwan,62102
| | - Arvind Mukundan
- National Chung Cheng University,Department of Mechanical Engineering,Chia Yi,Taiwan,62102
| | - Riya Karmakar
- National Chung Cheng University,Department of Mechanical Engineering,Chia Yi,Taiwan,62102
| | - Yu-Ming Tsao
- National Chung Cheng University,Department of Mechanical Engineering,Chia Yi,Taiwan,62102
| | - Hong-Thai Nguyen
- National Chung Cheng University,Department of Mechanical Engineering,Chia Yi,Taiwan,62102
| | - Hsiang-Cheng Wang
- National Chung Cheng University,Department of Mechanical Engineering,Chia Yi,Taiwan,62102
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10
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Rex DK, Bhavsar-Burke I, Buckles D, Burton J, Cartee A, Comar K, Edwards A, Fennimore B, Fischer M, Gerich M, Gilmore A, Hamdeh S, Hoffman J, Ibach M, Jackson M, James-Stevenson T, Kaltenbach T, Kaplan J, Kapur S, Kohm D, Kriss M, Kundumadam S, Kyanam Kabir Baig KR, Menard-Katcher P, Kraft C, Langworthy J, Misra B, Molloy E, Munoz JC, Norvell J, Nowak T, Obaitan I, Patel S, Patel M, Peter S, Reid BM, Rogers N, Ross J, Ryan J, Sagi S, Saito A, Samo S, Sarkis F, Scott FI, Siwiec R, Sullivan S, Wieland A, Zhang J, Repici A, Hassan C, Byrne MF, Rastogi A. Artificial Intelligence for Real-Time Prediction of the Histology of Colorectal Polyps by General Endoscopists. Ann Intern Med 2024; 177:911-918. [PMID: 38768450 DOI: 10.7326/m24-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Real-time prediction of histologic features of small colorectal polyps may prevent resection and/or pathologic evaluation and therefore decrease colonoscopy costs. Previous studies showed that computer-aided diagnosis (CADx) was highly accurate, though it did not outperform expert endoscopists. OBJECTIVE To assess the diagnostic performance of histologic predictions by general endoscopists before and after assistance from CADx in a real-life setting. DESIGN Prospective, multicenter, single-group study. (ClinicalTrials.gov: NCT04437615). SETTING 6 centers across the United States. PARTICIPANTS 1252 consecutive patients undergoing colonoscopy and 49 general endoscopists with variable experience in real-time prediction of polyp histologic features. INTERVENTION Real-time use of CADx during routine colonoscopy. MEASUREMENTS The primary end points were the sensitivity and specificity of CADx-unassisted and CADx-assisted histologic predictions for adenomas measuring 5 mm or less. For clinical purposes, additional estimates according to location and confidence level were provided. RESULTS The CADx device made a diagnosis for 2695 polyps measuring 5 mm or less (96%) in 1252 patients. There was no difference in sensitivity between the unassisted and assisted groups (90.7% vs. 90.8%; P = 0.52). Specificity was higher in the CADx-assisted group (59.5% vs. 64.7%; P < 0.001). Among all 2695 polyps measuring 5 mm or less, 88.2% and 86.1% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be resected and discarded without pathologic evaluation. Among 743 rectosigmoid polyps measuring 5 mm or less, 49.5% and 47.9% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be left in situ without resection. LIMITATION Decision making based on CADx might differ outside a clinical trial. CONCLUSION CADx assistance did not result in increased sensitivity of optical diagnosis. Despite a slight increase, the specificity of CADx-assisted diagnosis remained suboptimal. PRIMARY FUNDING SOURCE Olympus America Corporation served as the clinical study sponsor.
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Affiliation(s)
- Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Indira Bhavsar-Burke
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Daniel Buckles
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - James Burton
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Amanda Cartee
- University of Alabama at Birmingham, Birmingham, Alabama (A.C., A.E., K.R.K.K.B., S.P., F.S.)
| | - Kevin Comar
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - Adam Edwards
- University of Alabama at Birmingham, Birmingham, Alabama (A.C., A.E., K.R.K.K.B., S.P., F.S.)
| | - Blair Fennimore
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Monika Fischer
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Mark Gerich
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Ashley Gilmore
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Shadi Hamdeh
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - Jeffrey Hoffman
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - Michael Ibach
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - Mollie Jackson
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - Toyia James-Stevenson
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Tonya Kaltenbach
- San Francisco VA Medical Center, San Francisco, California (T.K., C.K., J.R.)
| | - Jeffrey Kaplan
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Saurabh Kapur
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - Daniel Kohm
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - Michael Kriss
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Shanker Kundumadam
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | | | - Paul Menard-Katcher
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Cary Kraft
- San Francisco VA Medical Center, San Francisco, California (T.K., C.K., J.R.)
| | - James Langworthy
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - Bharat Misra
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - Eric Molloy
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - Juan Carlos Munoz
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - John Norvell
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Thomas Nowak
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Itegbemie Obaitan
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Swati Patel
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Mitesh Patel
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - Shajan Peter
- University of Alabama at Birmingham, Birmingham, Alabama (A.C., A.E., K.R.K.K.B., S.P., F.S.)
| | - B Marie Reid
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - Nicholas Rogers
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Jason Ross
- Borland Groover, Jacksonville, Florida (K.C., J.H., M.I., D.K., B.M., J.C.M., B.M.R., J.R.)
| | - James Ryan
- San Francisco VA Medical Center, San Francisco, California (T.K., C.K., J.R.)
| | - Sashidhar Sagi
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Akira Saito
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Salih Samo
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
| | - Fayez Sarkis
- University of Alabama at Birmingham, Birmingham, Alabama (A.C., A.E., K.R.K.K.B., S.P., F.S.)
| | - Frank I Scott
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Robert Siwiec
- Indiana University School of Medicine, Indianapolis, Indiana (D.K.R., I.B., M.F., A.G., T.J., S.K., T.N., I.O., N.R., S.S., A.S., R.S.)
| | - Shelby Sullivan
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Amanda Wieland
- University of Colorado Boulder, Boulder, Colorado (J.B., B.F., M.G., J.K., M.K., P.M., J.N., S.P., F.S., S.S., A.W.)
| | - Jianying Zhang
- Department of Statistics, Olympus America Corporation, Center Valley, Pennsylvania (J.Z.)
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy, and Endoscopy Unit and Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Italy (A.R., C.H.)
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy, and Endoscopy Unit and Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Italy (A.R., C.H.)
| | - Michael F Byrne
- Division of Gastroenterology, Vancouver General Hospital; University of British Columbia; and Satisfai Health, Vancouver, British Columbia, Canada (M.F.B.)
| | - Amit Rastogi
- University of Kansas Medical Center, Kansas City, Kansas (D.B., S.H., M.J., S.K., J.L., E.M., M.P., S.S., A.R.)
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Spadaccini M, Troya J, Khalaf K, Facciorusso A, Maselli R, Hann A, Repici A. Artificial Intelligence-assisted colonoscopy and colorectal cancer screening: Where are we going? Dig Liver Dis 2024; 56:1148-1155. [PMID: 38458884 DOI: 10.1016/j.dld.2024.01.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 03/10/2024]
Abstract
Colorectal cancer is a significant global health concern, necessitating effective screening strategies to reduce its incidence and mortality rates. Colonoscopy plays a crucial role in the detection and removal of colorectal neoplastic precursors. However, there are limitations and variations in the performance of endoscopists, leading to missed lesions and suboptimal outcomes. The emergence of artificial intelligence (AI) in endoscopy offers promising opportunities to improve the quality and efficacy of screening colonoscopies. In particular, AI applications, including computer-aided detection (CADe) and computer-aided characterization (CADx), have demonstrated the potential to enhance adenoma detection and optical diagnosis accuracy. Additionally, AI-assisted quality control systems aim to standardize the endoscopic examination process. This narrative review provides an overview of AI principles and discusses the current knowledge on AI-assisted endoscopy in the context of screening colonoscopies. It highlights the significant role of AI in improving lesion detection, characterization, and quality assurance during colonoscopy. However, further well-designed studies are needed to validate the clinical impact and cost-effectiveness of AI-assisted colonoscopy before its widespread implementation.
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Affiliation(s)
- Marco Spadaccini
- Department of Endoscopy, Humanitas Research Hospital, IRCCS, 20089 Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy.
| | - Joel Troya
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Kareem Khalaf
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Roberta Maselli
- Department of Endoscopy, Humanitas Research Hospital, IRCCS, 20089 Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
| | - Alexander Hann
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Alessandro Repici
- Department of Endoscopy, Humanitas Research Hospital, IRCCS, 20089 Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
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12
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Hassan C, Misawa M, Rizkala T, Mori Y, Sultan S, Facciorusso A, Antonelli G, Spadaccini M, Houwen BBSL, Rondonotti E, Patel H, Khalaf K, Li JW, Fernandez GM, Bhandari P, Dekker E, Gross S, Berzin T, Vandvik PO, Correale L, Kudo SE, Sharma P, Rex DK, Repici A, Foroutan F. Computer-Aided Diagnosis for Leaving Colorectal Polyps In Situ : A Systematic Review and Meta-analysis. Ann Intern Med 2024; 177:919-928. [PMID: 38768453 DOI: 10.7326/m23-2865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Computer-aided diagnosis (CADx) allows prediction of polyp histology during colonoscopy, which may reduce unnecessary removal of nonneoplastic polyps. However, the potential benefits and harms of CADx are still unclear. PURPOSE To quantify the benefit and harm of using CADx in colonoscopy for the optical diagnosis of small (≤5-mm) rectosigmoid polyps. DATA SOURCES Medline, Embase, and Scopus were searched for articles published before 22 December 2023. STUDY SELECTION Histologically verified diagnostic accuracy studies that evaluated the real-time performance of physicians in predicting neoplastic change of small rectosigmoid polyps without or with CADx assistance during colonoscopy. DATA EXTRACTION The clinical benefit and harm were estimated on the basis of accuracy values of the endoscopist before and after CADx assistance. The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. The outcome measure for benefit was the proportion of polyps predicted to be nonneoplastic that would avoid removal with the use of CADx. The outcome measure for harm was the proportion of neoplastic polyps that would be not resected and left in situ due to an incorrect diagnosis with the use of CADx. Histology served as the reference standard for both outcomes. DATA SYNTHESIS Ten studies, including 3620 patients with 4103 small rectosigmoid polyps, were analyzed. The studies that assessed the performance of CADx alone (9 studies; 3237 polyps) showed a sensitivity of 87.3% (95% CI, 79.2% to 92.5%) and specificity of 88.9% (CI, 81.7% to 93.5%) in predicting neoplastic change. In the studies that compared histology prediction performance before versus after CADx assistance (4 studies; 2503 polyps), there was no difference in the proportion of polyps predicted to be nonneoplastic that would avoid removal (55.4% vs. 58.4%; risk ratio [RR], 1.06 [CI, 0.96 to 1.17]; moderate-certainty evidence) or in the proportion of neoplastic polyps that would be erroneously left in situ (8.2% vs. 7.5%; RR, 0.95 [CI, 0.69 to 1.33]; moderate-certainty evidence). LIMITATION The application of optical diagnosis was only simulated, potentially altering the decision-making process of the operator. CONCLUSION Computer-aided diagnosis provided no incremental benefit or harm in the management of small rectosigmoid polyps during colonoscopy. PRIMARY FUNDING SOURCE European Commission. (PROSPERO: CRD42023402197).
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Affiliation(s)
- Cesare Hassan
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, and Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Rozzano, Italy (C.H., M.S., A.R.)
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan (M.M., S.K.)
| | - Tommy Rizkala
- Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Rozzano, Italy (T.R., L.C.)
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan; University of Oslo, Clinical Effectiveness Research Group, and Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway (Y.M.)
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, and VA Health Care System, Minneapolis, Minnesota (S.S.)
| | - Antonio Facciorusso
- University of Foggia, Department of Medical Sciences, Section of Gastroenterology, Foggia, Italy (A.F.)
| | - Giulio Antonelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Ariccia, and Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy (G.A.)
| | - Marco Spadaccini
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, and Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Rozzano, Italy (C.H., M.S., A.R.)
| | - Britt B S L Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands (B.B.S.L.H.)
| | | | - Harsh Patel
- Kansas City VA Medical Center, Gastroenterology and Hepatology, Kansas City, Missouri (H.P., P.S.)
| | - Kareem Khalaf
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (K.K.)
| | - James Weiquan Li
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, and Duke-NUS Academic Medicine Centre, Singapore Health Services, Singapore (J.W.L.)
| | - Gloria M Fernandez
- Endoscopy Unit, Gastroenterology Department, Clinical Institute of Digestive and Metabolic Disease, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain (G.M.F.)
| | - Pradeep Bhandari
- Queen Alexandra Hospital, Department of Gastroenterology, Portsmouth, United Kingdom (P.B.)
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, and Bergman Clinics Maag and Darm Amsterdam, Amsterdam, the Netherlands (E.D.)
| | - Seth Gross
- Department of Gastroenterology, Tisch Hospital, New York University Langone Medical Center, New York, New York (S.G.)
| | - Tyler Berzin
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (T.B.)
| | - Per Olav Vandvik
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway (P.O.V.)
| | - Loredana Correale
- Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Rozzano, Italy (T.R., L.C.)
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan (M.M., S.K.)
| | - Prateek Sharma
- Kansas City VA Medical Center, Gastroenterology and Hepatology, Kansas City, Missouri (H.P., P.S.)
| | - Douglas K Rex
- Indiana University School of Medicine, Division of Gastroenterology, Indianapolis, Indiana (D.K.R.)
| | - Alessandro Repici
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, and Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Rozzano, Italy (C.H., M.S., A.R.)
| | - Farid Foroutan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada (F.F.)
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Rondonotti E, Bergna IMB, Paggi S, Amato A, Andrealli A, Scardino G, Tamanini G, Lenoci N, Mandelli G, Terreni N, Rocchetto SI, Piagnani A, Di Paolo D, Bina N, Filippi E, Ambrosiani L, Hassan C, Correale L, Radaelli F. White light computer-aided optical diagnosis of diminutive colorectal polyps in routine clinical practice. Endosc Int Open 2024; 12:E676-E683. [PMID: 38774861 PMCID: PMC11108657 DOI: 10.1055/a-2303-0922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 04/04/2024] [Indexed: 05/24/2024] Open
Abstract
Background and study aims Artificial Intelligence (AI) systems could make the optical diagnosis (OD) of diminutive colorectal polyps (DCPs) more reliable and objective. This study was aimed at prospectively evaluating feasibility and diagnostic performance of AI-standalone and AI-assisted OD of DCPs in a real-life setting by using a white light-based system (GI Genius, Medtronic Co, Minneapolis, Minnesota, United States). Patients and methods Consecutive colonoscopy outpatients with at least one DCP were evaluated by 11 endoscopists (5 experts and 6 non-experts in OD). DCPs were classified in real time by AI (AI-standalone OD) and by the endoscopist with the assistance of AI (AI-assisted OD), with histopathology as the reference standard. Results Of the 480 DCPs, AI provided the outcome "adenoma" or "non-adenoma" in 81.4% (95% confidence interval [CI]: 77.5-84.6). Sensitivity, specificity, positive and negative predictive value, and accuracy of AI-standalone OD were 97.0% (95% CI 94.0-98.6), 38.1% (95% CI 28.9-48.1), 80.1% (95% CI 75.2-84.2), 83.3% (95% CI 69.2-92.0), and 80.5% (95% CI 68.7-82.8%), respectively. Compared with AI-standalone, the specificity of AI-assisted OD was significantly higher (58.9%, 95% CI 49.7-67.5) and a trend toward an increase was observed for other diagnostic performance measures. Overall accuracy and negative predictive value of AI-assisted OD for experts and non-experts were 85.8% (95% CI 80.0-90.4) vs. 80.1% (95% CI 73.6-85.6) and 89.1% (95% CI 75.6-95.9) vs. 80.0% (95% CI 63.9-90.4), respectively. Conclusions Standalone AI is able to provide an OD of adenoma/non-adenoma in more than 80% of DCPs, with a high sensitivity but low specificity. The human-machine interaction improved diagnostic performance, especially when experts were involved.
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Affiliation(s)
| | - Irene Maria Bambina Bergna
- Gastroenterology Unit, Valduce Hospital, Como, Italy
- University of Milan, Milano, Italy
- Gastroenterology and Digestive Endoscopy Unit, Alessandro Manzoni Hospital, Lecco, Italy
| | - Silvia Paggi
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | - Arnaldo Amato
- Gastroenterology Unit, Valduce Hospital, Como, Italy
- Gastroenterology and Digestive Endoscopy Unit, Alessandro Manzoni Hospital, Lecco, Italy
| | | | | | | | | | | | | | - SImone Rocchetto
- Gastroenterology Unit, Valduce Hospital, Como, Italy
- University of Milan, Milano, Italy
| | - Alessandra Piagnani
- Gastroenterology Unit, Valduce Hospital, Como, Italy
- University of Milan, Milano, Italy
| | | | - Niccolò Bina
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | | | | | - Cesare Hassan
- Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Loredana Correale
- Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
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Groza AL, Miutescu B, Tefas C, Popa A, Ratiu I, Sirli R, Popescu A, Motofelea AC, Tantau M. Evaluating the Efficacy of Resect-and-Discard and Resect-and-Retrieve Strategies for Diminutive Colonic Polyps. Life (Basel) 2024; 14:532. [PMID: 38672802 PMCID: PMC11051488 DOI: 10.3390/life14040532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/11/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Diminutive polyps present a unique challenge in colorectal cancer (CRC) prevention strategies. This study aims to assess the characteristics and variables of diminutive polyps in a Romanian cohort, intending to develop a combined resect-and-retrieve or resect-and-discard strategy that reduces the need for an optical diagnosis. MATERIALS AND METHODS A prospective cohort study was conducted at two endoscopy centers in Romania from July to December 2021. Adult patients undergoing colonoscopies where polyps were identified and resected were included. Endoscopic procedures employed advanced diagnostic features, including blue-light imaging (BLI) and narrow-band imaging (NBI). Logistic regression analysis was utilized to determine factors impacting the probability of adenomatous polyps with high-grade dysplasia (HGD). RESULTS A total of 427 patients were included, with a mean age of 59.42 years (±11.19), predominantly male (60.2%). The most common indication for a colonoscopy was lower gastrointestinal symptoms (42.6%), followed by screening (28.8%). Adequate bowel preparation was achieved in 87.8% of cases. The logistic regression analysis revealed significant predictors of HGD in adenomatous polyps: age (OR = 1.05, 95% CI: 1.01-1.08, p = 0.01) and polyp size (>5 mm vs. ≤5 mm, OR = 4.4, 95% CI: 1.94-10.06, p < 0.001). Polyps classified as Paris IIa, Ip, and Isp were significantly more likely to harbor HGD compared to the reference group (Is), with odds ratios of 6.05, 3.68, and 2.7, respectively. CONCLUSIONS The study elucidates significant associations between the presence of HGD in adenomatous polyps and factors such as age, polyp size, and Paris classification. These findings support the feasibility of a tailored approach in the resect-and-discard and resect-and-retrieve strategies for diminutive polyps, potentially optimizing CRC prevention and intervention practices. Further research is warranted to validate these strategies in broader clinical settings.
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Affiliation(s)
- Andrei Lucian Groza
- 3rd Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.L.G.); (C.T.); (M.T.)
| | - Bogdan Miutescu
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.P.); (I.R.); (R.S.); (A.P.)
| | - Cristian Tefas
- 3rd Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.L.G.); (C.T.); (M.T.)
- Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, 400162 Cluj-Napoca, Romania
| | - Alexandru Popa
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.P.); (I.R.); (R.S.); (A.P.)
| | - Iulia Ratiu
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.P.); (I.R.); (R.S.); (A.P.)
| | - Roxana Sirli
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.P.); (I.R.); (R.S.); (A.P.)
| | - Alina Popescu
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.P.); (I.R.); (R.S.); (A.P.)
| | - Alexandru Catalin Motofelea
- Department of Internal Medicine, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Marcel Tantau
- 3rd Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.L.G.); (C.T.); (M.T.)
- Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, 400162 Cluj-Napoca, Romania
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15
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van der Zander QEW, Schreuder RM, Thijssen A, Kusters CHJ, Dehghani N, Scheeve T, Winkens B, van der Ende - van Loon MCM, de With PHN, van der Sommen F, Masclee AAM, Schoon EJ. Artificial intelligence for characterization of diminutive colorectal polyps: A feasibility study comparing two computer-aided diagnosis systems. Artif Intell Gastrointest Endosc 2024; 5:90574. [DOI: 10.37126/aige.v5.i1.90574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/11/2024] [Accepted: 02/02/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI) has potential in the optical diagnosis of colorectal polyps.
AIM To evaluate the feasibility of the real-time use of the computer-aided diagnosis system (CADx) AI for ColoRectal Polyps (AI4CRP) for the optical diagnosis of diminutive colorectal polyps and to compare the performance with CAD EYETM (Fujifilm, Tokyo, Japan). CADx influence on the optical diagnosis of an expert endoscopist was also investigated.
METHODS AI4CRP was developed in-house and CAD EYE was proprietary software provided by Fujifilm. Both CADx-systems exploit convolutional neural networks. Colorectal polyps were characterized as benign or premalignant and histopathology was used as gold standard. AI4CRP provided an objective assessment of its characterization by presenting a calibrated confidence characterization value (range 0.0-1.0). A predefined cut-off value of 0.6 was set with values < 0.6 indicating benign and values ≥ 0.6 indicating premalignant colorectal polyps. Low confidence characterizations were defined as values 40% around the cut-off value of 0.6 (< 0.36 and > 0.76). Self-critical AI4CRP’s diagnostic performances excluded low confidence characterizations.
RESULTS AI4CRP use was feasible and performed on 30 patients with 51 colorectal polyps. Self-critical AI4CRP, excluding 14 low confidence characterizations [27.5% (14/51)], had a diagnostic accuracy of 89.2%, sensitivity of 89.7%, and specificity of 87.5%, which was higher compared to AI4CRP. CAD EYE had a 83.7% diagnostic accuracy, 74.2% sensitivity, and 100.0% specificity. Diagnostic performances of the endoscopist alone (before AI) increased non-significantly after reviewing the CADx characterizations of both AI4CRP and CAD EYE (AI-assisted endoscopist). Diagnostic performances of the AI-assisted endoscopist were higher compared to both CADx-systems, except for specificity for which CAD EYE performed best.
CONCLUSION Real-time use of AI4CRP was feasible. Objective confidence values provided by a CADx is novel and self-critical AI4CRP showed higher diagnostic performances compared to AI4CRP.
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Affiliation(s)
- Quirine Eunice Wennie van der Zander
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
- GROW, School for Oncology and Reproduction, Maastricht University, Maastricht 6200 MD, Netherlands
| | - Ramon M Schreuder
- Division of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Eindhoven 5602 ZA, Netherlands
| | - Ayla Thijssen
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
- GROW, School for Oncology and Reproduction, Maastricht University, Maastricht 6200 MD, Netherlands
| | - Carolus H J Kusters
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven 5600 MB, Netherlands
| | - Nikoo Dehghani
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven 5600 MB, Netherlands
| | - Thom Scheeve
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven 5600 MB, Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University, Postbus 616, 6200 MD Maastricht, Netherlands
- School for Public Health and Primary Care, Maastricht University, Maastricht 6200 MD, Netherlands
| | | | - Peter H N de With
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven 5600 MB, Netherlands
| | - Fons van der Sommen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven 5600 MB, Netherlands
| | - Ad A M Masclee
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Erik J Schoon
- GROW, School for Oncology and Reproduction, Maastricht University, Maastricht 6200 MD, Netherlands
- Division of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Eindhoven 5602 ZA, Netherlands
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16
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Kato S, Kudo SE, Minegishi Y, Miyata Y, Maeda Y, Kuroki T, Takashina Y, Mochizuki K, Tamura E, Abe M, Sato Y, Sakurai T, Kouyama Y, Tanaka K, Ogawa Y, Nakamura H, Ichimasa K, Ogata N, Hisayuki T, Hayashi T, Wakamura K, Miyachi H, Baba T, Ishida F, Nemoto T, Misawa M. Impact of computer-aided characterization for diagnosis of colorectal lesions, including sessile serrated lesions: Multireader, multicase study. Dig Endosc 2024; 36:341-350. [PMID: 37937532 DOI: 10.1111/den.14612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/06/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Computer-aided characterization (CADx) may be used to implement optical biopsy strategies into colonoscopy practice; however, its impact on endoscopic diagnosis remains unknown. We aimed to evaluate the additional diagnostic value of CADx when used by endoscopists for assessing colorectal polyps. METHODS This was a single-center, multicase, multireader, image-reading study using randomly extracted images of pathologically confirmed polyps resected between July 2021 and January 2022. Approved CADx that could predict two-tier classification (neoplastic or nonneoplastic) by analyzing narrow-band images of the polyps was used to obtain a CADx diagnosis. Participating endoscopists determined if the polyps were neoplastic or not and noted their confidence level using a computer-based, image-reading test. The test was conducted twice with a 4-week interval: the first test was conducted without CADx prediction and the second test with CADx prediction. Diagnostic performances for neoplasms were calculated using the pathological diagnosis as reference and performances with and without CADx prediction were compared. RESULTS Five hundred polyps were randomly extracted from 385 patients and diagnosed by 14 endoscopists (including seven experts). The sensitivity for neoplasia was significantly improved by referring to CADx (89.4% vs. 95.6%). CADx also had incremental effects on the negative predictive value (69.3% vs. 84.3%), overall accuracy (87.2% vs. 91.8%), and high-confidence diagnosis rate (77.4% vs. 85.8%). However, there was no significant difference in specificity (80.1% vs. 78.9%). CONCLUSIONS Computer-aided characterization has added diagnostic value for differentiating colorectal neoplasms and may improve the high-confidence diagnosis rate.
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Affiliation(s)
- Shun Kato
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yosuke Minegishi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yuki Miyata
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yasuharu Maeda
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Takanori Kuroki
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yuki Takashina
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Kenichi Mochizuki
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Eri Tamura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Masahiro Abe
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yuta Sato
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Tatsuya Sakurai
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yuta Kouyama
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Kenta Tanaka
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yushi Ogawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Hiroki Nakamura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore City, Singapore
| | - Noriyuki Ogata
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Tomokazu Hisayuki
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Takemasa Hayashi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Kunihiko Wakamura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Toshiyuki Baba
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Tetsuo Nemoto
- Department of Diagnostic Pathology and Laboratory Medicine, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
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Elshaarawy O, Alboraie M, El-Kassas M. Artificial Intelligence in endoscopy: A future poll. Arab J Gastroenterol 2024; 25:13-17. [PMID: 38220477 DOI: 10.1016/j.ajg.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 09/18/2022] [Accepted: 11/28/2023] [Indexed: 01/16/2024]
Abstract
Artificial Intelligence [AI] has been a trendy topic in recent years, with many developed medical applications. In gastrointestinal endoscopy, AI systems include computer-assisted detection [CADe] for lesion detection as bleedings and polyps and computer-assisted diagnosis [CADx] for optical biopsy and lesion characterization. The technology behind these systems is based on a computer algorithm that is trained for a specific function. This function could be to recognize or characterize target lesions such as colonic polyps. Moreover, AI systems can offer technical assistance to improve endoscopic performance as scope insertion guidance. Currently, we believe that such technologies still lack legal and regulatory validations as a large sector of doctors and patients have concerns. However, there is no doubt that these technologies will bring significant improvement in the endoscopic management of patients as well as save money and time.
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Affiliation(s)
- Omar Elshaarawy
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt; Gastroenterology Department, Royal Liverpool University Hospital, NHS, UK
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
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Halvorsen N, Mori Y. Computer-aided polyp characterization in colonoscopy: sufficient performance or not? Clin Endosc 2024; 57:18-23. [PMID: 38178329 PMCID: PMC10834281 DOI: 10.5946/ce.2023.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/03/2023] [Accepted: 05/24/2023] [Indexed: 01/06/2024] Open
Abstract
Computer-assisted polyp characterization (computer-aided diagnosis, CADx) facilitates optical diagnosis during colonoscopy. Several studies have demonstrated high sensitivity and specificity of CADx tools in identifying neoplastic changes in colorectal polyps. To implement CADx tools in colonoscopy, there is a need to confirm whether these tools satisfy the threshold levels that are required to introduce optical diagnosis strategies such as "diagnose-and-leave," "resect-and-discard" or "DISCARD-lite." In this article, we review the available data from prospective trials regarding the effect of multiple CADx tools and discuss whether they meet these thresholds.
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Affiliation(s)
- Natalie Halvorsen
- Clinical Effectiveness Research Group, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Yuichi Mori
- Clinical Effectiveness Research Group, Oslo University Hospital and University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
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19
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Ueda T, Li JW, Ho SH, Singh R, Uedo N. Precision endoscopy in the era of climate change and sustainability. J Gastroenterol Hepatol 2024; 39:18-27. [PMID: 37881033 DOI: 10.1111/jgh.16383] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/27/2023]
Abstract
Global warming caused by increased greenhouse gas (GHG) emissions has a direct impact on human health. Gastrointestinal (GI) endoscopy contributes significantly to GHG emissions due to energy consumption, reprocessing of endoscopes and accessories, production of equipment, safe disposal of biohazardous waste, and travel by patients. Moreover, GHGs are also generated in histopathology through tissue processing and the production of biopsy specimen bottles. The reduction in unnecessary surveillance endoscopies and biopsies is a practical approach to decrease GHG emissions without affecting disease outcomes. This narrative review explores the role of precision medicine in GI endoscopy, such as image-enhanced endoscopy and artificial intelligence, with a focus on decreasing unnecessary endoscopic procedures and biopsies in the surveillance and diagnosis of premalignant lesions in the esophagus, stomach, and colon. This review offers strategies to minimize unnecessary endoscopic procedures and biopsies, decrease GHG emissions, and maintain high-quality patient care, thereby contributing to sustainable healthcare practices.
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Affiliation(s)
- Tomoya Ueda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - James Weiquan Li
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore, Singapore
| | - Shiaw-Hooi Ho
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin and Modbury Hospitals, University of Adelaide, Adelaide, Australia
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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Lv YC, Yao YH, Lei JJ, Tang T. Cold snare polypectomy compared to cold forceps polypectomy for endoscopic resection of guideline defined diminutive polyps: A systematic review and meta-analysis of randomized trials. Indian J Gastroenterol 2023; 42:757-765. [PMID: 37776439 DOI: 10.1007/s12664-023-01441-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/28/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND International guidelines recommend cold snare polypectomy (CSP) for polyps < 10 mm in size. However, recent randomized clinical trials (RCTs) showed conflicting results for the use of cold forceps polypectomy (CFP) vs. CSP for the resection of diminutive colorectal polyps (DCPs) (≤ 5 mm), especially for polyps ≤ 3 mm. Herein we compared CFP with CSP for patients with DCPs in this meta-analysis of RCTs. METHODS We systematically searched the Cochrane Library, PubMed and EMBASE databases from inception to November 24, 2022, (Registration number INPLASY2022110135). The primary endpoint was DCP complete resection rate. The secondary endpoints were mean polypectomy time, polyp retrieval rate and complications. RESULTS Seven RCTs involving 1023 DCPs were included. The complete resection rate (91.6% vs. 94.7%) for CFP was not significantly lower for polyps ≤ 5 mm (relative risk [RR] = 1.03; 95% confidence interval [CI]: 0.98-1.07). Sub-group analysis showed that the complete resection rate (88.7% vs. 92.4%) for CFP was not significantly lower for DCPs > 3 mm (RR = 1.04; 95% CI: 0.97-1.12). Another sub-group analysis showed that the complete resection rate (97.0% vs. 96.3%) was similar for polyps ≤ 3 mm for CFP vs. CSP (RR = 1.00; 95% CI: 0.98-1.03). The mean polypectomy time was not different between CFP and CSP (95% CI: -11.86-10.18). The polyp retrieval rate (100% vs. 96.9%) was not significantly higher for CFP (RR = 1.02; 95% CI: 0.98-1.07). There were no reported complications in the included studies. The overall study quality was moderate except for the removal of polyps ≤ 5 mm (low-quality evidence). CONCLUSION CFP was comparable to CSP for the resection of polyps ≤ 3 mm; however, caution should be taken for DCPs > 3 mm because of the low complete resection rate (< 90%).
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Affiliation(s)
- Yong-Cai Lv
- Department of Gastroenterology, Zhenning Buyi and Miao Autonomous County People's Hospital, Zhenning, 561200, Guizhou Province, China
| | - Yan-Hua Yao
- Department of Gastroenterology, Zhenning Buyi and Miao Autonomous County People's Hospital, Zhenning, 561200, Guizhou Province, China
| | - Jing-Jing Lei
- Department of Geriatric Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, Guizhou Province, China
| | - Tao Tang
- Department of Gastroenterology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, No. 1558 Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China.
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Tsao Y, Mukundan A, Lu S, Wang HC, Wang YP, Lu CL. Development of narrow-band image imaging based on hyperspectral image conversion technology for capsule endoscopy. OPTICS IN HEALTH CARE AND BIOMEDICAL OPTICS XIII 2023:8. [DOI: 10.1117/12.2688844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
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Tsao Y, Mukundan A, Lu S, Wang HC, Wang YP, Lu CL. Development of narrow-band image imaging based on hyperspectral image conversion technology for capsule endoscopy. OPTICS IN HEALTH CARE AND BIOMEDICAL OPTICS XIII 2023:8. [DOI: https:/doi.org/10.1117/12.2688844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
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23
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Kim J, Lim SH, Kang HY, Song JH, Yang SY, Chung GE, Jin EH, Choi JM, Bae JH. Impact of 3-second rule for high confidence assignment on the performance of endoscopists for the real-time optical diagnosis of colorectal polyps. Endoscopy 2023; 55:945-951. [PMID: 37172938 DOI: 10.1055/a-2073-3411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Confusion between high and low confidence decisions in optical diagnosis hinders the implementation of real-time optical diagnosis in clinical practice. We evaluated the effect of a 3-second rule (decision time limited to 3 seconds for a high confidence assignment) in expert and nonexpert endoscopists. METHODS This single-center prospective study included eight board-certified gastroenterologists. A 2-month baseline phase used standard real-time optical diagnosis for colorectal polyps < 10 mm and was followed by a 6-month intervention phase using optical diagnosis with the 3-second rule. Performance, including high confidence accuracy, and Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) and Simple Optical Diagnosis Accuracy (SODA) thresholds, was measured. RESULTS Real-time optical diagnosis was performed on 1793 patients with 3694 polyps. There was significant improvement in high confidence accuracy between baseline and intervention phases in the nonexpert group (79.2 % vs. 86.3 %; P = 0.01) but not in the expert group (85.3 % vs. 87.5 %; P = 0.53). Using the 3-second rule improved the overall performance of PIVI and SODA in both groups. CONCLUSIONS The 3-second rule was effective in improving real-time optical diagnosis performance, especially in nonexperts.
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Affiliation(s)
- Jung Kim
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Seon Hee Lim
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Hae Yeon Kang
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Ji Hyun Song
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Sun Young Yang
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Goh Eun Chung
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Eun Hyo Jin
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Ji Min Choi
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Jung Ho Bae
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
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Baumer S, Streicher K, Alqahtani SA, Brookman-Amissah D, Brunner M, Federle C, Muehlenberg K, Pfeifer L, Salzberger A, Schorr W, Zustin J, Pech O. Accuracy of polyp characterization by artificial intelligence and endoscopists: a prospective, non-randomized study in a tertiary endoscopy center. Endosc Int Open 2023; 11:E818-E828. [PMID: 37727511 PMCID: PMC10506867 DOI: 10.1055/a-2096-2960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/08/2023] [Indexed: 09/21/2023] Open
Abstract
Background and study aims Artificial intelligence (AI) in gastrointestinal endoscopy is developing very fast. Computer-aided detection of polyps and computer-aided diagnosis (CADx) for polyp characterization are available now. This study was performed to evaluate the diagnostic performance of a new commercially available CADx system in clinical practice. Patients and methods This prospective, non-randomized study was performed at a tertiary academic endoscopy center from March to August 2022. We included patients receiving a colonoscopy. Polypectomy had to be performed in all polyps. Every patient was examined concurrently by an endoscopist and AI using two opposing screens. The AI system, overseen by a second observer, was not visible to the endoscopist. The primary outcome was accuracy of the AI classifying the polyps into "neoplastic" and "non-neoplastic." The secondary outcome was accuracy of the classification by the endoscopists. Sessile serrated lesions were classified as neoplastic. Results We included 156 patients (mean age 65; 57 women) with 262 polyps ≤10 mm. Eighty-four were hyperplastic polyps (32.1%), 158 adenomas (60.3%), seven sessile serrated lesions (2.7%) and 13 other entities (normal/inflammatory colonmucosa, lymphoidic polyp) (4.9%) on histological diagnosis. Sensitivity, specificity and accuracy of AI were 89.70% (95% confidence interval [CI]: 84.02%-93.88%), 75.26% (95% CI: 65.46%-83.46%) and 84.35% (95% CI:79.38%-88.53%), respectively. Sensitivity, specificity and accuracy for less experienced endoscopists (2-5 years of endoscopy) were 95.56% (95% CI: 84.85%-99.46%), 61.54% (95% CI: 40.57%-79.77%) and 83.10% (95% CI: 72.34%-90.95%) and for experienced endoscopists 90.83% (95% CI: 84.19%-95.33%), 71.83% (95% CI: 59.90%-81.87%) and 83.77% (95% CI: 77.76%-88.70%), respectively. Conclusion Accuracy for polyp characterization by a new commercially available AI system is high, but does not fulfill the criteria for a "resect-and-discard" strategy.
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Affiliation(s)
- Sebastian Baumer
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Kilian Streicher
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Saleh A. Alqahtani
- Department of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, United States
- Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Dominic Brookman-Amissah
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Monika Brunner
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Christoph Federle
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Klaus Muehlenberg
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Lukas Pfeifer
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Andrea Salzberger
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Wolfgang Schorr
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Jozef Zustin
- Private Practice, Histopathology Service Private Practice, Regensburg, Germany
- Gerhard-Domagk-Institute of Pathology, Universitätsklinikum Münster, Munster, Germany
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
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Mena-Ramírez R, Macari-Jorge A, Juárez-Hernández E, Uribe M, López-Méndez I. Accuracy of Narrow-Band Imaging International Colorectal Endoscopic Classification for Predicting the Histology of Colon Polyps by Experienced Endoscopists and Trainees. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2023; 34:866-872. [PMID: 37533278 PMCID: PMC10544491 DOI: 10.5152/tjg.2023.22854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/02/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND/AIMS Digital chromoendoscopy has proven to be useful in the histological prediction of premalignant lesions in the colon. The aim of the study was to describe the diagnostic performance of Narrow-Band Imaging International Colorectal Endoscopic Classification in the histological differentiation of colonic lesions, applied by expert endoscopists and trainees. MATERIALS AND METHODS Cross-sectional study that includes high-definition endoscopic images and histopathological reports of 94 patients over 50 years. Images were evaluated and classified as Narrow-Band Imaging International Colorectal Endoscopic 1, 2, or 3 by 2 experts and 2 trainee endoscopists, all of them blinded to histological results. Diagnostic accuracy for each Narrow-Band Imaging International Colorectal Endoscopic category was calculated for trainees and expert endoscopists. Intra-observer agreement was evaluated by means of Cohen's kappa coefficient; meanwhile, inter-observer agreement was calculated by means of Fleiss' kappa. RESULTS Evaluations performed by expert and trainee endoscopists showed a performance for Narrow-Band Imaging International Colorectal Endoscopic category 1: sensitivity 62%, specificity 85%, area under receiver operator characteristic 0.73; Narrow-Band Imaging International Colorectal Endoscopic category 2: sensitivity 61%, specificity 73%, area under receiver operator characteristic 0.66; and Narrow-Band Imaging International Colorectal Endoscopic category 3: sensitivity 88%, specificity 91%, area under receiver operator characteristic 0.86. The total agreement of the evaluations was 72.5%, with an inter-observer variability of K 0.60 (95% CI 0.52-0.74). When the diagnostic performance for non-dysplastic lesions and dysplastic lesions (Narrow-Band Imaging International Colorectal Endoscopic 1 vs 2 and 3) was compared, we observed an increase in sensitivity for differentiated adenomas (Narrow-Band Imaging International Colorectal Endoscopic 2). CONCLUSION Narrow-Band Imaging International Colorectal Endoscopic Classification applied in the histological prediction of static images of colonic lesions has a good diagnostic performance for Narrow-Band Imaging International Colorectal Endoscopic category 3, as well as an acceptable performance for Narrow-Band Imaging International Colorectal Endoscopic category 1, with a moderate agreement among observers.
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Affiliation(s)
- Ramón Mena-Ramírez
- Department of Gastroenterology and Obesity, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Andres Macari-Jorge
- Department of Pathological Anatomy, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Eva Juárez-Hernández
- Department of Translational Research, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Misael Uribe
- Department of Pathological Anatomy, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Iván López-Méndez
- Department of Endoscopy, Medica Sur Clinic & Foundation, Mexico City, Mexico
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Houwen BBSL, Hazewinkel Y, Giotis I, Vleugels JLA, Mostafavi NS, van Putten P, Fockens P, Dekker E. Computer-aided diagnosis for optical diagnosis of diminutive colorectal polyps including sessile serrated lesions: a real-time comparison with screening endoscopists. Endoscopy 2023; 55:756-765. [PMID: 36623839 PMCID: PMC10374350 DOI: 10.1055/a-2009-3990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/09/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND : We aimed to compare the accuracy of the optical diagnosis of diminutive colorectal polyps, including sessile serrated lesions (SSLs), between a computer-aided diagnosis (CADx) system and endoscopists during real-time colonoscopy. METHODS : We developed the POLyp Artificial Recognition (POLAR) system, which was capable of performing real-time characterization of diminutive colorectal polyps. For pretraining, the Microsoft-COCO dataset with over 300 000 nonpolyp object images was used. For training, eight hospitals prospectively collected 2637 annotated images from 1339 polyps (i. e. publicly available online POLAR database). For clinical validation, POLAR was tested during colonoscopy in patients with a positive fecal immunochemical test (FIT), and compared with the performance of 20 endoscopists from eight hospitals. Endoscopists were blinded to the POLAR output. Primary outcome was the comparison of accuracy of the optical diagnosis of diminutive colorectal polyps between POLAR and endoscopists (neoplastic [adenomas and SSLs] versus non-neoplastic [hyperplastic polyps]). Histopathology served as the reference standard. RESULTS : During clinical validation, 423 diminutive polyps detected in 194 FIT-positive individuals were included for analysis (300 adenomas, 41 SSLs, 82 hyperplastic polyps). POLAR distinguished neoplastic from non-neoplastic lesions with 79 % accuracy, 89 % sensitivity, and 38 % specificity. The endoscopists achieved 83 % accuracy, 92 % sensitivity, and 44 % specificity. The optical diagnosis accuracy between POLAR and endoscopists was not significantly different (P = 0.10). The proportion of polyps in which POLAR was able to provide an optical diagnosis was 98 % (i. e. success rate). CONCLUSIONS : We developed a CADx system that differentiated neoplastic from non-neoplastic diminutive polyps during endoscopy, with an accuracy comparable to that of screening endoscopists and near-perfect success rate.
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Affiliation(s)
- Britt B. S. L. Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Radboud University of Nijmegen, Nijmegen, The Netherlands
| | | | - Jasper L. A. Vleugels
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Nahid S. Mostafavi
- Department of Gastroenterology and Hepatology, Subdivision Statistics, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul van Putten
- Department of Gastroenterology and Hepatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Bergman Clinics Maag and Darm Amsterdam, Amsterdam, The Netherlands
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27
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João M, Areia M, Pinto-Pais T, Gomes LC, Saraiva S, Alves S, Elvas L, Brito D, Saraiva S, Teixeira-Pinto A, Claro I, Dinis-Ribeiro M, Cadime AT. Can white-light endoscopy or narrow-band imaging avoid biopsy of colorectal endoscopic mucosal resection scars? A multicenter randomized single-blind crossover trial. Endoscopy 2023; 55:601-607. [PMID: 36690030 DOI: 10.1055/a-2018-1612] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND : Current guidelines suggest that routine biopsy of post-endoscopic mucosal resection (EMR) scars can be abandoned, provided that a standardized imaging protocol with virtual chromoendoscopy is used. However, few studies have examined the accuracy of advanced endoscopic imaging, such as narrow-band imaging (NBI) vs. white-light endoscopy (WLE) for prediction of histological recurrence. We aimed to assess whether NBI accuracy is superior to that of WLE and whether one or both techniques can replace biopsies. METHODS : The study was a multicenter, randomized, pathologist-blind, crossover trial, with consecutive patients undergoing first colonoscopy after EMR of lesions ≥ 20 mm. Computer-generated randomization and opaque envelope concealed allocation. Patients were randomly assigned to scar examination with NBI followed by WLE (NBI + WLE), or WLE followed by NBI (WLE + NBI). Histology was the reference method, with biopsies being performed for all tissues. RESULTS : The study included 203 scars (103 in the NBI + WLE group, 100 in the WLE + NBI group). Recurrence was confirmed histologically in 29.6 % of the scars. The diagnostic accuracy of NBI was not statistically different from that of WLE (95 % [95 %CI 92 %-98 %] vs. 94 % [95 %CI 90 %-97 %]; P = 0.48). The negative predictive values (NPVs) were 96 % (95 %CI 93 %-99 %) for NBI and 93 % (95 %CI 89 %-97 %) for WLE (P = 0.06). CONCLUSIONS : The accuracy of NBI for the diagnosis of recurrence was not superior to that of WLE. Endoscopic assessment of EMR scars with WLE and NBI achieved an NPV that would allow routine biopsy to be avoided in cases of negative optical diagnosis.
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Affiliation(s)
- Mafalda João
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Miguel Areia
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Teresa Pinto-Pais
- RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto / Porto Comprehensive Cancer Center, Porto, Portugal
| | - Luís Correia Gomes
- Gastroenterology Department, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Sofia Saraiva
- Gastroenterology Department, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Susana Alves
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Luís Elvas
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Daniel Brito
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Sandra Saraiva
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | | | - Isabel Claro
- Gastroenterology Department, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Mário Dinis-Ribeiro
- RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto / Porto Comprehensive Cancer Center, Porto, Portugal
- Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Teresa Cadime
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
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Orlovic M, Ahmad A, Saunders BP. Economic impact of implementing optical diagnosis with a "resect and discard" strategy within the English Bowel Cancer Screening Programme: findings from the DISCARD3 study. Gastrointest Endosc 2023; 98:73-81.e1. [PMID: 36739996 DOI: 10.1016/j.gie.2023.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Advances in endoscopic technology, such as narrow-band imaging and high-definition colonoscopes, offer the potential for optical diagnosis (OD) with a "resect and discard" (RD) strategy for diminutive (≤5 mm) and small (6-9 mm) colorectal polyps. This could help alleviate the huge cost and time burden required for histopathology. The aim of this study was to conduct an economic analysis of an RD strategy within the English Bowel Cancer Screening Programme (BCSP). METHODS A decision tree was designed to compare an RD strategy with standard histopathology for patients included in the DISCARD3 study (Detect InSpect ChAracterise Resect and Discard 3) and was extrapolated to a national BCSP patient cohort. RESULTS Of the 525 patients in the DISCARD3 study, 354 were assessed for surveillance intervals (after excluding cases with colorectal cancer and at least 1 polyp >10 mm). Of 354 patients, 269 had polyps, of which 182 had only diminutive polyps, 77 had both small and diminutive polyps, and 10 had only small polyps. Surveillance interval concordance was 97.9% in patients with at least 1 diminutive polyp and 98.7% in patients with at least 1 diminutive or small polyp. In DISCARD3, an RD approach was found to reduce overall direct healthcare costs by $44,285.63 (-72.3%) for patients with diminutive polyps or by $66,129.13 (-75.0%) for patients with diminutive or small polyps. When extrapolated to the entire English BCSP, the annual savings were almost $3 million for patients with diminutive polyps or $4.3 million for patients with diminutive or small polyps, after adjusting for the costs of an OD quality assurance process. CONCLUSIONS OD with an RD strategy for diminutive and small polyps during BCSP colonoscopy would offer substantial cost savings without adversely affecting surveillance interval concordance.
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Affiliation(s)
- Martina Orlovic
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ahmir Ahmad
- Wolfson Unit of Endoscopy, St Mark's Hospital, Harrow, London, UK
| | - Brian P Saunders
- Wolfson Unit of Endoscopy, St Mark's Hospital, Harrow, London, UK
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Sinonquel P, Vermeire S, Maes F, Bisschops R. Advanced Imaging in Gastrointestinal Endoscopy: A Literature Review of the Current State of the Art. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:175-191. [PMID: 37387720 PMCID: PMC10305270 DOI: 10.1159/000527083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/11/2022] [Indexed: 01/03/2025]
Abstract
BACKGROUND AND AIMS Gastrointestinal (GI) endoscopy has known a great evolution in the last decades. Imaging techniques evolved from imaging with only standard white light endoscopes toward high-definition resolution endoscopes and the use of multiple color enhancement techniques, over to automated endoscopic assessment systems based on artificial intelligence. This narrative literature review aimed to provide a detailed overview on the latest evolutions within the field of advanced GI endoscopy, mainly focusing on the screening, diagnosis, and surveillance of common upper and lower GI pathology. METHODS This review comprises only literature about screening, diagnosis, and surveillance strategies using advanced endoscopic imaging techniques published in (inter)national peer-reviewed journals and written in English. Studies with only adult patients included were selected. A search was performed using MESH terms: dye-based chromoendoscopy, virtual chromoendoscopy, video enhancement technique, upper GI tract, lower GI tract, Barrett's esophagus, esophageal squamous cell carcinoma, gastric cancer, colorectal polyps, inflammatory bowel disease, artificial intelligence. This review does not elaborate on the therapeutic application or impact of advanced GI endoscopy. CONCLUSIONS Focusing on current and future applications and evolutions in the field of both upper and lower GI advanced endoscopy, this overview is a practical but detailed projection of the latest developments. Within this review, an active leap toward artificial intelligence and its recent developments in GI endoscopy was made. Additionally, the literature is weighted against the current international guidelines and assessed for its potential positive future impact.
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Affiliation(s)
- Pieter Sinonquel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Translational Research in Gastrointestinal Diseases (TARGID), KU Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Translational Research in Gastrointestinal Diseases (TARGID), KU Leuven, Leuven, Belgium
| | - Frederik Maes
- Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Translational Research in Gastrointestinal Diseases (TARGID), KU Leuven, Leuven, Belgium
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30
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Sharma A, Kumar R, Yadav G, Garg P. Artificial intelligence in intestinal polyp and colorectal cancer prediction. Cancer Lett 2023; 565:216238. [PMID: 37211068 DOI: 10.1016/j.canlet.2023.216238] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/23/2023]
Abstract
Artificial intelligence (AI) algorithms and their application to disease detection and decision support for healthcare professions have greatly evolved in the recent decade. AI has been widely applied and explored in gastroenterology for endoscopic analysis to diagnose intestinal cancers, premalignant polyps, gastrointestinal inflammatory lesions, and bleeding. Patients' responses to treatments and prognoses have both been predicted using AI by combining multiple algorithms. In this review, we explored the recent applications of AI algorithms in the identification and characterization of intestinal polyps and colorectal cancer predictions. AI-based prediction models have the potential to help medical practitioners diagnose, establish prognoses, and find accurate conclusions for the treatment of patients. With the understanding that rigorous validation of AI approaches using randomized controlled studies is solicited before widespread clinical use by health authorities, the article also discusses the limitations and challenges associated with deploying AI systems to diagnose intestinal malignancies and premalignant lesions.
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Affiliation(s)
- Anju Sharma
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research, S.A.S Nagar, 160062, Punjab, India
| | - Rajnish Kumar
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow Campus, Uttar Pradesh, 226010, India; Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | - Garima Yadav
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow Campus, Uttar Pradesh, 226010, India
| | - Prabha Garg
- Department of Pharmacoinformatics, National Institute of Pharmaceutical Education and Research, S.A.S Nagar, 160062, Punjab, India.
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31
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Mori Y, East JE, Hassan C, Halvorsen N, Berzin TM, Byrne M, von Renteln D, Hewett DG, Repici A, Ramchandani M, Al Khatry M, Kudo SE, Wang P, Yu H, Saito Y, Misawa M, Parasa S, Matsubayashi CO, Ogata H, Tajiri H, Pausawasdi N, Dekker E, Ahmad OF, Sharma P, Rex DK. Benefits and challenges in implementation of artificial intelligence in colonoscopy: World Endoscopy Organization position statement. Dig Endosc 2023; 35:422-429. [PMID: 36749036 DOI: 10.1111/den.14531] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/06/2023] [Indexed: 02/08/2023]
Abstract
The number of artificial intelligence (AI) tools for colonoscopy on the market is increasing with supporting clinical evidence. Nevertheless, their implementation is not going smoothly for a variety of reasons, including lack of data on clinical benefits and cost-effectiveness, lack of trustworthy guidelines, uncertain indications, and cost for implementation. To address this issue and better guide practitioners, the World Endoscopy Organization (WEO) has provided its perspective about the status of AI in colonoscopy as the position statement. WEO Position Statement: Statement 1.1: Computer-aided detection (CADe) for colorectal polyps is likely to improve colonoscopy effectiveness by reducing adenoma miss rates and thus increase adenoma detection; Statement 1.2: In the short term, use of CADe is likely to increase health-care costs by detecting more adenomas; Statement 1.3: In the long term, the increased cost by CADe could be balanced by savings in costs related to cancer treatment (surgery, chemotherapy, palliative care) due to CADe-related cancer prevention; Statement 1.4: Health-care delivery systems and authorities should evaluate the cost-effectiveness of CADe to support its use in clinical practice; Statement 2.1: Computer-aided diagnosis (CADx) for diminutive polyps (≤5 mm), when it has sufficient accuracy, is expected to reduce health-care costs by reducing polypectomies, pathological examinations, or both; Statement 2.2: Health-care delivery systems and authorities should evaluate the cost-effectiveness of CADx to support its use in clinical practice; Statement 3: We recommend that a broad range of high-quality cost-effectiveness research should be undertaken to understand whether AI implementation benefits populations and societies in different health-care systems.
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Affiliation(s)
- Yuichi Mori
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, UK
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Natalie Halvorsen
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
| | - Tyler M Berzin
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Michael Byrne
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Daniel von Renteln
- Division of Gastroenterology, University of Montreal Medical Center (CHUM) and Research Center (CRCHUM), Montreal, Canada
| | - David G Hewett
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | | | - Maryam Al Khatry
- Department of Gastroenterology, Obaidulla Hospital, Ras Al Khaimah, United Arab Emirates
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Pu Wang
- Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | | | - Carolina Ogawa Matsubayashi
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Hisao Tajiri
- Jikei University School of Medicine, Tokyo, Japan
| | - Nonthalee Pausawasdi
- Vikit Viranuvatti Siriraj GI Endoscopy Center, Mahidol University, Bangkok, Thailand
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Prateek Sharma
- Division of Gastroenterology and Hepatology, University of Kansas School of Medicine and VA Medical Center, Kansas City, USA
| | - Douglas K Rex
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, USA
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Mehta A, Kumar H, Yazji K, Wireko AA, Sivanandan Nagarajan J, Ghosh B, Nahas A, Morales Ojeda L, Anand A, Sharath M, Huang H, Garg T, Isik A. Effectiveness of artificial intelligence-assisted colonoscopy in early diagnosis of colorectal cancer: a systematic review. Int J Surg 2023; 109:946-952. [PMID: 36917126 PMCID: PMC10389330 DOI: 10.1097/js9.0000000000000285] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION As artificial intelligence (AI)-assisted diagnosis gained immense popularity, it is imperative to consider its utility and efficiency in the early diagnosis of colorectal cancer (CRC), responsible for over 1.8 million cases and 881 000 deaths globally, as reported in 2018. Improved adenoma detection rate, as well as better characterizations of polyps, are significant advantages of AI-assisted colonoscopy (AIC). This systematic review (SR) investigates the effectiveness of AIC in the early diagnosis of CRC as compared to conventional colonoscopy. MATERIALS AND METHODS Electronic databases such as PubMed/Medline, SCOPUS, and Web of Science were reviewed for original studies (randomized controlled trials, observational studies), SRs, and meta-analysis between 2017 and 2022 utilizing Medical Subject Headings terminology in a broad search strategy. All searches were performed and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology and were conducted from November 2022. A data extraction form based on the Cochrane Consumers and Communication Review group's extraction template for quality assessment and evidence synthesis was used for data extraction. All included studies considered for bias and ethical criteria and provided valuable evidence to answer the research question. RESULTS The database search identified 218 studies, including 87 from PubMed, 60 from SCOPUS, and 71 from Web of Science databases. The retrieved studies from the databases were imported to Rayyan software and a duplicate article check was performed, all duplicate articles were removed after careful evaluation of the data. The abstract and full-text screening was performed in accordance with the following eligibility criteria: Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for observational studies; Preferred Reporting Items for Systematic Reviews and Meta-Analysis for review articles, ENTREQ for narrative studies; and modified JADAD for randomized controlled trials. This yielded 15 studies that met the requirements for this SR and were finally included in the review. CONCLUSION AIC is a safe, highly effective screening tool that can increase the detection rate of adenomas, and polyps resulting in an early diagnosis of CRC in adults when compared to conventional colonoscopy. The results of this SR prompt further large-scale research to investigate the effectiveness in accordance with sex, race, and socioeconomic status, as well as its influence on prognosis and survival rate.
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Affiliation(s)
- Aashna Mehta
- Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Katia Yazji
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Bikona Ghosh
- Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Ahmad Nahas
- Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Luis Morales Ojeda
- Institute of Urology, University of Southern California, Los Angeles California, USA
| | - Ayush Anand
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Medha Sharath
- Bangalore Medical College and Research Institute, Bangalore, Karnataka
| | - Helen Huang
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Tulika Garg
- Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Arda Isik
- Department of General Surgery, Istanbul Medeniyet University, Istanbul, Turkey
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Spadaccini M, Massimi D, Mori Y, Alfarone L, Fugazza A, Maselli R, Sharma P, Facciorusso A, Hassan C, Repici A. Artificial Intelligence-Aided Endoscopy and Colorectal Cancer Screening. Diagnostics (Basel) 2023; 13:1102. [PMID: 36980409 PMCID: PMC10047293 DOI: 10.3390/diagnostics13061102] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/19/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide, with the highest incidence reported in high-income countries. However, because of the slow progression of neoplastic precursors, along with the opportunity for their endoscopic detection and resection, a well-designed endoscopic screening program is expected to strongly decrease colorectal cancer incidence and mortality. In this regard, quality of colonoscopy has been clearly related with the risk of post-colonoscopy colorectal cancer. Recently, the development of artificial intelligence (AI) applications in the medical field has been growing in interest. Through machine learning processes, and, more recently, deep learning, if a very high numbers of learning samples are available, AI systems may automatically extract specific features from endoscopic images/videos without human intervention, helping the endoscopists in different aspects of their daily practice. The aim of this review is to summarize the current knowledge on AI-aided endoscopy, and to outline its potential role in colorectal cancer prevention.
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Affiliation(s)
- Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, 20090 Rozzano, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, 20090 Rozzano, Italy
| | - Davide Massimi
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, 20090 Rozzano, Italy
| | - Yuichi Mori
- Clinical Effectiveness Research Group, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0315 Oslo, Norway
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama 224-0032, Japan
| | - Ludovico Alfarone
- Department of Biomedical Sciences, Humanitas University, 20090 Rozzano, Italy
| | - Alessandro Fugazza
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, 20090 Rozzano, Italy
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, 20090 Rozzano, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, 20090 Rozzano, Italy
| | - Prateek Sharma
- Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, MO 64128, USA
| | - Antonio Facciorusso
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, 20090 Rozzano, Italy
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, 20090 Rozzano, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, 20090 Rozzano, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, 20090 Rozzano, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, 20090 Rozzano, Italy
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Nazarian S, Koo H, Carrington E, Darzi A, Patel N. The future of endoscopy – what are the thoughts on artificial intelligence? J EXP THEOR ARTIF IN 2023. [DOI: 10.1080/0952813x.2023.2178516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- S. Nazarian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - H.F Koo
- Department of Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - E. Carrington
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - A. Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - N. Patel
- Department of Surgery and Cancer, Imperial College London, London, UK
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González-Bueno Puyal J, Brandao P, Ahmad OF, Bhatia KK, Toth D, Kader R, Lovat L, Mountney P, Stoyanov D. Spatio-temporal classification for polyp diagnosis. BIOMEDICAL OPTICS EXPRESS 2023; 14:593-607. [PMID: 36874484 PMCID: PMC9979670 DOI: 10.1364/boe.473446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/25/2022] [Accepted: 12/06/2022] [Indexed: 06/18/2023]
Abstract
Colonoscopy remains the gold standard investigation for colorectal cancer screening as it offers the opportunity to both detect and resect pre-cancerous polyps. Computer-aided polyp characterisation can determine which polyps need polypectomy and recent deep learning-based approaches have shown promising results as clinical decision support tools. Yet polyp appearance during a procedure can vary, making automatic predictions unstable. In this paper, we investigate the use of spatio-temporal information to improve the performance of lesions classification as adenoma or non-adenoma. Two methods are implemented showing an increase in performance and robustness during extensive experiments both on internal and openly available benchmark datasets.
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Affiliation(s)
- Juana González-Bueno Puyal
- Wellcome/EPSRC Centre for Interventional
and Surgical Sciences (WEISS), University College London, London
W1W 7TY, UK
- Odin Vision, London W1W 7TY, UK
| | | | - Omer F. Ahmad
- Wellcome/EPSRC Centre for Interventional
and Surgical Sciences (WEISS), University College London, London
W1W 7TY, UK
| | | | | | - Rawen Kader
- Wellcome/EPSRC Centre for Interventional
and Surgical Sciences (WEISS), University College London, London
W1W 7TY, UK
| | - Laurence Lovat
- Wellcome/EPSRC Centre for Interventional
and Surgical Sciences (WEISS), University College London, London
W1W 7TY, UK
| | | | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional
and Surgical Sciences (WEISS), University College London, London
W1W 7TY, UK
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van der Zander QEW, der Sommen FV, Schoon EJ. Assessing the Level of Expertise of Endoscopists in Optical Diagnosis of Colorectal Polyps-Not Every Expert Is an Expert. Gastroenterology 2023:S0016-5085(23)00037-9. [PMID: 36646392 DOI: 10.1053/j.gastro.2022.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/17/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Quirine E W van der Zander
- Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands; GROW, School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Fons van der Sommen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Erik J Schoon
- GROW, School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Division of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
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Artificial intelligence-assisted optical diagnosis for the resect-and-discard strategy in clinical practice: the Artificial intelligence BLI Characterization (ABC) study. Endoscopy 2023; 55:14-22. [PMID: 35562098 DOI: 10.1055/a-1852-0330] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Optical diagnosis of colonic polyps is poorly reproducible outside of high volume referral centers. The present study aimed to assess whether real-time artificial intelligence (AI)-assisted optical diagnosis is accurate enough to implement the leave-in-situ strategy for diminutive (≤ 5 mm) rectosigmoid polyps (DRSPs). METHODS Consecutive colonoscopy outpatients with ≥ 1 DRSP were included. DRSPs were categorized as adenomas or nonadenomas by the endoscopists, who had differing expertise in optical diagnosis, with the assistance of a real-time AI system (CAD-EYE). The primary end point was ≥ 90 % negative predictive value (NPV) for adenomatous histology in high confidence AI-assisted optical diagnosis of DRSPs (Preservation and Incorporation of Valuable endoscopic Innovations [PIVI-1] threshold), with histopathology as the reference standard. The agreement between optical- and histology-based post-polypectomy surveillance intervals (≥ 90 %; PIVI-2 threshold) was also calculated according to European Society of Gastrointestinal Endoscopy (ESGE) and United States Multi-Society Task Force (USMSTF) guidelines. RESULTS Overall 596 DRSPs were retrieved for histology in 389 patients; an AI-assisted high confidence optical diagnosis was made in 92.3 %. The NPV of AI-assisted optical diagnosis for DRSPs (PIVI-1) was 91.0 % (95 %CI 87.1 %-93.9 %). The PIVI-2 threshold was met with 97.4 % (95 %CI 95.7 %-98.9 %) and 92.6 % (95 %CI 90.0 %-95.2 %) of patients according to ESGE and USMSTF, respectively. AI-assisted optical diagnosis accuracy was significantly lower for nonexperts (82.3 %, 95 %CI 76.4 %-87.3 %) than for experts (91.9 %, 95 %CI 88.5 %-94.5 %); however, nonexperts quickly approached the performance levels of experts over time. CONCLUSION AI-assisted optical diagnosis matches the required PIVI thresholds. This does not however offset the need for endoscopists' high level confidence and expertise. The AI system seems to be useful, especially for nonexperts.
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NBI International Colorectal Endoscopic-derived high-confidence optical diagnosis of small polyps compared with histology: understanding errors to improve diagnostic accuracy. Gastrointest Endosc 2023; 97:78-88. [PMID: 36029884 DOI: 10.1016/j.gie.2022.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/05/2022] [Accepted: 08/19/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Developments in image-enhancing endoscopy and polyp classification systems have led to a number of gastroenterology societies endorsing an optical diagnosis (OD) approach for small polyps at colonoscopy. In this study we performed a root-cause analysis of ODs to determine the most likely causes of OD error. METHODS As part of a prospective feasibility study, DISCARD3 (Detect InSpect ChAracterise Resect and Discard 3), evaluating implementation and quality assurance of a "resect and discard" strategy for consecutive small polyps <10 mm, a root-cause analysis of 184 cases of high-confidence OD error was performed. In all cases, histopathology underwent a second blinded review and, where discrepancy persisted, further review with deeper levels. RESULTS After a root-cause analysis, 133 of 184 true OD errors were identified and classified into 4 types: A (OD, adenoma; histology, serrated), 45/133 (33.8%); B (OD, serrated; histology, adenoma), 55/133 (41.4%); C (OD, adenoma; histology, normal), 19/133 (14.3%); and D (OD, serrated; histology, normal), 14/133 (10.5%). The remaining 51 of 184 errors were because of a pathology error requiring deeper levels (43/184), pathology observer or laboratory error (7/184), or other error (1/184). CONCLUSIONS OD errors can be related to endoscopist-related factors such as poor photodocumentation, failures of current classification systems, and incomplete histology. We identified a subset of serrated polyps frequently misdiagnosed as adenomas ("pseudoadenomas") using the NBI International Colorectal Endoscopic (NICE) classification. An enhanced algorithm for OD is proposed based on the NICE classification including morphologic and adjunct polyp features.
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Teramoto A, Hamada S, Ogino B, Yasuda I, Sano Y. Updates in narrow-band imaging for colorectal polyps: Narrow-band imaging generations, detection, diagnosis, and artificial intelligence. Dig Endosc 2022; 35:453-470. [PMID: 36480465 DOI: 10.1111/den.14489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/01/2022] [Indexed: 01/20/2023]
Abstract
Narrow-band imaging (NBI) is an optical digital enhancement method that allows the observation of vascular and surface structures of colorectal lesions. Its usefulness in the detection and diagnosis of colorectal polyps has been demonstrated in several clinical trials and the diagnostic algorithms have been simplified after the establishment of endoscopic classifications such as the Japan NBI Expert Team classification. However, there were issues including lack of brightness in the earlier models, poor visibility under insufficient bowel preparation, and the incompatibility of magnifying endoscopes in certain endoscopic platforms, which had impeded NBI from becoming standardized globally. Nonetheless, NBI continued its evolution and the newest endoscopic platform launched in 2020 offers significantly brighter and detailed images. Enhanced visualization is expected to improve the detection of polyps while universal compatibility across all scopes including magnifying endoscopy will promote the global standardization of magnifying diagnosis. Therefore, knowledge related to magnifying colonoscopy will become essential as magnification becomes standardly equipped in future models, although the advent of computer-aided diagnosis and detection may greatly assist endoscopists to ensure quality of practice. Given that most endoscopic departments will be using both old and new models, it is important to understand how each generation of endoscopic platforms differ from each other. We reviewed the advances in the endoscopic platforms, artificial intelligence, and evidence related to NBI essential for the next generation of endoscopic practice.
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Affiliation(s)
- Akira Teramoto
- Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Seiji Hamada
- Gastrointestinal Center, Urasoe General Hospital, Okinawa, Japan
| | - Banri Ogino
- Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Yasushi Sano
- Gastrointestinal Center, Sano Hospital, Hyogo, Japan
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Ahmad A, Moorghen M, Wilson A, Stasinos I, Haycock A, Humphries A, Monahan K, Suzuki N, Thomas-Gibson S, Vance M, Thiruvilangam K, Dhillon A, Saunders BP. Implementation of optical diagnosis with a "resect and discard" strategy in clinical practice: DISCARD3 study. Gastrointest Endosc 2022; 96:1021-1032.e2. [PMID: 35724693 DOI: 10.1016/j.gie.2022.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Optical diagnosis (OD) of polyps can be performed with advanced endoscopic imaging. For high-confidence diagnoses, a "resect and discard" strategy could offer significant histopathology time and cost savings. The implementation threshold is a ≥90% OD-histology surveillance interval concordance. Here we assessed the OD learning curve and feasibility of a resect and discard strategy for ≤5-mm and <10-mm polyps in a bowel cancer screening setting. METHODS In this prospective feasibility study, 8 bowel cancer screening endoscopists completed a validated OD training module and performed procedures. All <10-mm consecutive polyps had white-light and narrow-band images taken and were given high- or low-confidence diagnoses until 120 high-confidence ≤5-mm polyp diagnoses had been performed. All polyps had standard histology. High-confidence OD errors underwent root-cause analysis. Histology and OD-derived surveillance intervals were calculated. RESULTS Of 565 invited patients, 525 patients were included. A total of 1560 <10-mm polyps underwent OD and were resected and retrieved (1329 ≤5 mm and 231 6-9 mm). There were no <10-mm polyp cancers. High-confidence OD was accurate in 81.5% of ≤5-mm and 92.8% of 6-9-mm polyps. Sensitivity for OD of a ≤5-mm adenoma was 93.0% with a positive predictive value of 90.8%. OD-histology surveillance interval concordance for ≤5-mm OD was 91.3% (209/229) for U.S. Multi-Society Task Force, 98.3% (225/229) for European Society of Gastrointestinal Endoscopy, and 98.7% (226/229) for British Society of Gastroenterology guidelines, respectively. CONCLUSIONS A resect and discard strategy for high-confidence ≤5-mm polyp OD in a group of bowel cancer screening colonoscopists is feasible and safe, with performance exceeding the 90% surveillance interval concordance required for implementation in clinical practice. (Clinical trial registration number: NCT04710693.).
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Affiliation(s)
- Ahmir Ahmad
- Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, London, UK
| | - Morgan Moorghen
- Pathology Department, St Mark's Hospital, Harrow, London, UK
| | - Ana Wilson
- Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, London, UK
| | | | - Adam Haycock
- Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, London, UK
| | - Adam Humphries
- Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, London, UK
| | - Kevin Monahan
- Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, London, UK
| | - Noriko Suzuki
- Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, London, UK
| | | | - Margaret Vance
- Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, London, UK
| | | | - Angad Dhillon
- Gastroenterology Department, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK
| | - Brian P Saunders
- Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, London, UK
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It's not lack of evidence holding back resect and discard. Gastrointest Endosc 2022; 96:1033-1035. [PMID: 36253191 DOI: 10.1016/j.gie.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 12/11/2022]
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Hassan C, Balsamo G, Lorenzetti R, Zullo A, Antonelli G. Artificial Intelligence Allows Leaving-In-Situ Colorectal Polyps. Clin Gastroenterol Hepatol 2022; 20:2505-2513.e4. [PMID: 35835342 DOI: 10.1016/j.cgh.2022.04.045] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Artificial Intelligence (AI) could support cost-saving strategies for colonoscopy because of its accuracy in the optical diagnosis of colorectal polyps. However, AI must meet predefined criteria to be implemented in clinical settings. METHODS An approved computer-aided diagnosis (CADx) module for differentiating between adenoma and nonadenoma in unmagnified white-light colonoscopy was used in a consecutive series of colonoscopies. For each polyp, CADx output and subsequent endoscopist diagnosis with advanced imaging were matched against the histology gold standard. The primary outcome was the negative predictive value (NPV) of CADx for adenomatous histology for ≤5-mm rectosigmoid lesions. We also calculated the NPV for AI-assisted endoscopist predictions, and agreement between CADx and histology-based postpolypectomy surveillance intervals according to European and American guidelines. RESULTS Overall, 544 polyps were removed in 162 patients, of which 295 (54.2%) were ≤5-mm rectosigmoid histologically verified lesions. CADx diagnosis was feasible in 291 of 295 (98.6%), and the NPV for ≤5-mm rectosigmoid lesions was 97.6% (95% CI, 94.1%-99.1%). There were 242 of 295 (82%) lesions that were amenable for a leave-in-situ strategy. Based on CADx output, 212 of 544 (39%) would be amenable to a resect-and-discard strategy, resulting in a 95.6% (95% CI, 90.8%-98.0%) and 95.9% (95% CI, 89.8%-98.4%) agreement between CADx- and histology-based surveillance intervals according to European and American guidelines, respectively. A similar NPV (97.6%; 95% CI, 94.8%-99.1%) for ≤5-mm rectosigmoids was achieved by AI-assisted endoscopists assessing polyps with electronic chromoendoscopy, with a CADx-concordant diagnosis in 97.2% of cases. CONCLUSIONS In this study, CADx without advanced imaging exceeded the benchmarks required for optical diagnosis of colorectal polyps. CADx could help implement cost-saving strategies in colonoscopy by reducing the burden of polypectomy and/or pathology. CLINICALTRIALS gov registration number: NCT04884581.
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Affiliation(s)
- Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy; Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy.
| | | | | | - Angelo Zullo
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Giulio Antonelli
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy; Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Rome, Italy; Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
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Hossain E, Abdelrahim M, Tanasescu A, Yamada M, Kondo H, Yamada S, Hamamoto R, Marugame A, Saito Y, Bhandari P. Performance of a novel computer-aided diagnosis system in the characterization of colorectal polyps, and its role in meeting Preservation and Incorporation of Valuable Endoscopic Innovations standards set by the American Society of Gastrointestinal Endoscopy. DEN OPEN 2022; 3:e178. [PMID: 36320934 PMCID: PMC9614381 DOI: 10.1002/deo2.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
Background and aims There has been an increasing role of artificial intelligence (AI) in the characterization of colorectal polyps. Recently, a novel AI algorithm for the characterization of polyps was developed by NEC Corporation (Japan). The aim of our study is to perform an external validation of this algorithm. Methods The study was a video-based evaluation of the computer-aided diagnosis (CADx) system. Patients undergoing colonoscopy were recruited to record videos of colonic polyps. The frozen polyp images extracted from these videos were used for real-time histological prediction by the endoscopists and by the CADx system, and the results were compared. Results A total of 115 polyp images were extracted from 66 patients. Sensitivity, negative predictive value and accuracy for diminutive polyps on white light imaging (WLI) and image-enhanced endoscopy (IEE) when assessed by CADx was 90.9% [95% confidence interval (CI) 77.3-100] and 95.8% [95% CI 87.5-100], 80% [95% CI 44.4-97.5] and 90.9% [95% CI 58.7-99.8], 84.8% [95% CI 72.7-97] and 84.6% [95%CI 71.8-94.9], respectively, compared to 48.1% [95%CI 37.7-59.1] and 72% [95% CI 62.5-81], 37.5% [95% CI 28.8-46.8] and 55% [95% CI 44.7-65.0], 53.7% [95% CI 44.2-63.2] and 66.7% [95% CI 59.7-73.3] when assessed by endoscopists. Concordance between histology and CADx-based post-polypectomy surveillance intervals was 93.02% on WLI and 96% on IEE. Conclusion AI-based optical diagnosis is promising and has the potential to be better than the performance of general endoscopists. We believe that AI can help make real-time optical diagnoses of polyps meeting the Preservation and Incorporation of Valuable endoscopic Innovations standards set by the American Society of Gastrointestinal Endoscopy.
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Affiliation(s)
| | | | | | - Masayoshi Yamada
- National Cancer Center HospitalEndoscopy DivisionTokyoJapan,National Cancer Center Research InstituteDivision of Molecular Modification and Cancer BiologyTokyoJapan
| | - Hiroko Kondo
- National Cancer Center Research InstituteDivision of Molecular Modification and Cancer BiologyTokyoJapan,RIKEN Center for Advanced Intelligence ProjectTokyoJapan
| | - Shijemi Yamada
- National Cancer Center Research InstituteDivision of Molecular Modification and Cancer BiologyTokyoJapan,RIKEN Center for Advanced Intelligence ProjectTokyoJapan
| | - Ryuji Hamamoto
- National Cancer Center Research InstituteDivision of Molecular Modification and Cancer BiologyTokyoJapan,RIKEN Center for Advanced Intelligence ProjectTokyoJapan
| | | | | | - Pradeep Bhandari
- Portsmouth Hospitals NHS TrustPortsmouthUK,University of Portsmouth, University HousePortsmouthUK
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Denis B, Gendre I, Tuzin N, Murris J, Guignard A, Perrin P, Rahmi G. Adenoma detection rate is enough to assess endoscopist performance: a population-based observational study of FIT-positive colonoscopies. Endosc Int Open 2022; 10:E1208-E1217. [PMID: 36118642 PMCID: PMC9473817 DOI: 10.1055/a-1859-8277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background and study aims Neoplasia-related indicators, such as adenoma detection rate (ADR), are a priority in the quality improvement process for colonoscopy. Our aim was to assess and compare different detection and characterization indicators in fecal immunochemical test (FIT)-positive colonoscopies, to determine associated factors, and to propose benchmarks. Patients and methods Retrospective analysis of prospectively collected data from all colonoscopies performed between 2015 and 2019 after a positive quantitative FIT in the population-based colorectal cancer screening program conducted in Alsace, part of the French national program. Detection indicators included ADR, mean number of adenomas per colonoscopy, and proximal serrated lesion (SL) detection rate. Characterization indicators included rate of non-neoplastic polyp (NNP) detection. Results Overall, 13,067 FIT-positive colonoscopies were evaluated, performed by 80 community gastroenterologists. The overall ADR was 57.6 %, and a 10 µg/g increase in fecal hemoglobin concentration was significantly associated with higher ADR (odds ratio [95 % confidence interval] = 1.02 [1.02-1.03]). Endoscopists whose ADR was ≥ 55 % were high detectors for all neoplasia, including proximal SLs and number of adenomas. The rate of detection of NNPs was 39.5 % in highest detectors (ADR > 70 %), significantly higher than in lower detectors (21.4 %) ( P < 0.001). There was a strong correlation between detection and characterization indicators, e. g. between rates of detection of proximal SLs and NNPs (Pearson = 0.73; P < 0.01). Conclusions A single indicator, ADR, is enough to assess endoscopist performance for both detection and characterization in routine practice provided the minimum target standard is raised and a maximum standard is added: 55 % and 70 % for FIT-positive colonoscopies, respectively.
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Affiliation(s)
- Bernard Denis
- Department of Gastroenterology, Pasteur Hospital, Colmar, France,ADECA Alsace, Colmar, France
| | - Isabelle Gendre
- ADECA Alsace, Colmar, France,CRCDC Grand Est, Colmar, France
| | - Nicolas Tuzin
- Department of Public Health, University Hospital of Strasbourg, Strasbourg, France
| | - Juliette Murris
- Inserm, Centre de recherche des Cordeliers, Université de Paris, Sorbonne Université, Paris, France,HeKA, Inria, Paris, France
| | - Anne Guignard
- Department of Gastroenterology, Pasteur Hospital, Colmar, France
| | - Philippe Perrin
- ADECA Alsace, Colmar, France,CRCDC Grand Est, Colmar, France
| | - Gabriel Rahmi
- Paris University, PARCC, INSERM, Paris, France,Department of Gastroenterology, Georges Pompidou European Hospital, Paris University, Paris, France
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García-Rodríguez A, Tudela Y, Córdova H, Carballal S, Ordás I, Moreira L, Vaquero E, Ortiz O, Rivero L, Sánchez FJ, Cuatrecasas M, Pellisé M, Bernal J, Fernández-Esparrach G. In vivo computer-aided diagnosis of colorectal polyps using white light endoscopy. Endosc Int Open 2022; 10:E1201-E1207. [PMID: 36118638 PMCID: PMC9473851 DOI: 10.1055/a-1881-3178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/10/2022] [Indexed: 12/24/2022] Open
Abstract
Background and study aims Artificial intelligence is currently able to accurately predict the histology of colorectal polyps. However, systems developed to date use complex optical technologies and have not been tested in vivo. The objective of this study was to evaluate the efficacy of a new deep learning-based optical diagnosis system, ATENEA, in a real clinical setting using only high-definition white light endoscopy (WLE) and to compare its performance with endoscopists. Methods ATENEA was prospectively tested in real life on consecutive polyps detected in colorectal cancer screening colonoscopies at Hospital Clínic. No images were discarded, and only WLE was used. The in vivo ATENEA's prediction (adenoma vs non-adenoma) was compared with the prediction of four staff endoscopists without specific training in optical diagnosis for the study purposes. Endoscopists were blind to the ATENEA output. Histology was the gold standard. Results Ninety polyps (median size: 5 mm, range: 2-25) from 31 patients were included of which 69 (76.7 %) were adenomas. ATENEA correctly predicted the histology in 63 of 69 (91.3 %, 95 % CI: 82 %-97 %) adenomas and 12 of 21 (57.1 %, 95 % CI: 34 %-78 %) non-adenomas while endoscopists made correct predictions in 52 of 69 (75.4 %, 95 % CI: 60 %-85 %) and 20 of 21 (95.2 %, 95 % CI: 76 %-100 %), respectively. The global accuracy was 83.3 % (95 % CI: 74%-90 %) and 80 % (95 % CI: 70 %-88 %) for ATENEA and endoscopists, respectively. Conclusion ATENEA can accurately be used for in vivo characterization of colorectal polyps, enabling the endoscopist to make direct decisions. ATENEA showed a global accuracy similar to that of endoscopists despite an unsatisfactory performance for non-adenomatous lesions.
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Affiliation(s)
- Ana García-Rodríguez
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain
| | - Yael Tudela
- Computer Science Department. Autonomous University of Barcelona and Computer Vision Center, Barcelona, Catalonia, Spain
| | - Henry Córdova
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
| | - Sabela Carballal
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
| | - Ingrid Ordás
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
| | - Leticia Moreira
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
| | - Eva Vaquero
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
| | - Oswaldo Ortiz
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain
| | - Liseth Rivero
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
| | - F. Javier Sánchez
- Computer Science Department. Autonomous University of Barcelona and Computer Vision Center, Barcelona, Catalonia, Spain
| | - Miriam Cuatrecasas
- IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain,Pathology Department. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain
| | - Maria Pellisé
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
| | - Jorge Bernal
- Computer Science Department. Autonomous University of Barcelona and Computer Vision Center, Barcelona, Catalonia, Spain
| | - Glòria Fernández-Esparrach
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
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Netinatsunton N, Cheewasereechon N, Pattarapuntakul T, Sottisuporn J, Kanjanapradit K, Ovartlarnporn B. Optical diagnosis by near-focus versus normal-focus narrow band imaging colonoscopy in colorectal polyps based on combined NICE and WASP classification: a randomized controlled trial. Clin Endosc 2022; 55:645-654. [PMID: 36071005 PMCID: PMC9539289 DOI: 10.5946/ce.2022.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background/Aims Narrow Band Imaging (NBI) International Colorectal Endoscopic (NICE) and Workgroup Serrated Polyps and Polyposis (WASP) classifications were developed for optical diagnosis of neoplastic and sessile serrated polyps, respectively. Near-focus NBI with NICE combined with WASP criteria for optical diagnosis of colonic polyps has not yet been evaluated. We aimed to compare the accuracy of near-focus NBI (group A) with normal-focus NBI (group B) in real-time optical diagnosis of colorectal polyps using combined NICE and WASP criteria.
Methods Among 362 patients, 118 with 227 polyps were recruited. Groups A and B included 62 patients with 130 polyps (three lost polyps) and 56 patients with 106 polyps (six lost polyps), respectively. Optical diagnoses were compared with pathological reports.
Results The accuracy of optical diagnosis of neoplastic polyps in groups A and B was not significantly different (76% vs. 71%, p=0.52). WASP criteria provided all false positive diagnoses of sessile polyps as serrated polyps in 31 (16.2%) patients.
Conclusions Near-focus NBI was not superior to normal-focus NBI in optical diagnostics of neoplastic polyps using NICE criteria. In our study, WASP classification yielded all false positives in the diagnosis of sessile serrated adenomas/polyps. Routine real-life optical diagnosis of polyps is still unadvisable.
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Affiliation(s)
- Nisa Netinatsunton
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Natcha Cheewasereechon
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Tanawat Pattarapuntakul
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jaksin Sottisuporn
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kanet Kanjanapradit
- Division of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Bancha Ovartlarnporn
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Chang A, Munjit P, Sriprayoon T, Pongpaibul A, Prachayakul V. Comparison of blue laser imaging and narrow band imaging for the differentiation of diminutive colorectal polyps: A randomized controlled trial. Surg Endosc 2022; 36:5743-5752. [PMID: 35182217 DOI: 10.1007/s00464-022-09079-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 01/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND To compare the diagnostic efficacy of blue laser imaging (BLI)- bright and narrow band imaging (NBI) modes of image enhanced endoscopy (IEE) in differentiating neoplastic and non-neoplastic lesions of diminutive colorectal polyps. METHODS We conducted a prospective randomized controlled trial from September 2015 to July 2016. The participants were randomly assigned (1:1) for colonoscopy with polyp classification under NBI or BLI-bright mode without magnification. Histopathologic diagnosis was used as the gold standard. RESULTS Three hundred and twenty-four diminutive polyps in 164 patients were included for analysis (BLI: 162 polyps in 73 patients, NBI: 162 polyps in 91 patients). These polyps were located at colon proximal to sigmoid (61.1 and 58.0%) and rectosigmoid colon (38.9 and 42.0%) in the BLI and NBI groups, respectively. Most polyps (71.9%) were adenomatous with one malignant polyp (0.3%). BLI achieved 86.4% accuracy, 98.3% sensitivity, 55.6% specificity, 85.2% positive predictive value (PPV), and 92.6% negative predictive value (NPV), similar to NBI which exhibited 90.1% accuracy, 99.1% sensitivity, 67.4% specificity, 88.5% PPV, and 96.9% NPV in the diagnosis of adenomatous polyps. Based on the location of the polyp, both modes of IEE provided ≥ 95% NPV for diagnosis of adenomatous polyps at the rectosigmoid colon. CONCLUSIONS BLI-bright and NBI modes of IEE have similar accuracy in differentiation between neoplastic and non-neoplastic lesions of diminutive polyps. Both modes provided ≥ 90% NPV which allows for the adaptation of the American Society of Gastrointestinal Endoscopy "diagnose-and-leave" recommended strategy for diminutive polyps at the rectosigmoid colon.
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Affiliation(s)
- Arunchai Chang
- Division of Gastroenterology, Department of Medicine, Hatyai Hospital, Songkhla, Thailand
| | - Parnwad Munjit
- Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Tassanee Sriprayoon
- Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Ananya Pongpaibul
- Department of Pathology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varayu Prachayakul
- Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand.
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Redondo-Cerezo E, Heredia-Carrasco C, Alegría-Motte C, Caballero-Mateos A, Vadillo-Calles F, Ortega-Suazo EJ, Martos-Ruiz V, Ariza-Fernández JL, López-González E, Martínez-Cara JG, Valverde-Lopez F, de Hierro ML, Sánchez-Capilla D, López-Hidalgo JL, Jimenez-Rosales R. Accuracy in optical diagnosis for polyps between 5 and 15 mm and its implications on surveillance. A prospective, multicenter study. (POPS study). Surg Endosc 2022; 36:5356-5365. [PMID: 34988735 DOI: 10.1007/s00464-021-08917-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Polyps histology and diameter up to 1 cm determine whether a patient needs a colonoscopy after 3 years or less, or far ahead. Endoscopists' and pathologists' size estimations can be imprecise. Our aim was to assess endoscopist ability to correctly recommend surveillance colonoscopies for patients with polyps around the 10 mm threshold, based on its endoscopic sizing and optical diagnosis by NBI. METHODS NBI-assisted diagnosis and endoscopist estimation of polyp size were compared with reference standard, considering this as the post resection polyp measurements by the nurse assistant and the pathologic results, in a prospective, multicenter, real life study, that recruited adults undergoing colonoscopy in five hospitals. By comparing the endoscopic and pathologist size estimation, with polyps' measurement after resection, and optical and histological diagnoses in patients with polyps between 5 and 15 mm, sensitivity was assessed at the patient level by means of two characteristics: the presence of adenoma, and the surveillance interval. Surveillance intervals were established by the endoscopist, based on optical diagnosis, and by another gastroenterologist, grounded on the pathologic report. Determinants of accuracy were explored at the polyp level. RESULTS 532 polyps were resected in 451 patients. Size estimation was more precise for the endoscopist. Endoscopist sensitivity for the presence of adenoma or carcinoma was 98.7%. Considering the presence of high-grade dysplasia or cancer, sensitivity was 82.6% for the endoscopic optical diagnosis. Sensitivity for a correct 3-year surveillance interval was 91.5%, specificity 82.3%, with a PPV of 93.2% and NPV of 78.5% for the endoscopist. 6.51% of patients would have had their follow-up colonoscopy delayed, whereas 22 (4.8%) would have it been performed earlier, had endoscopist recommendations been followed. CONCLUSION Our study observes that NBI optical diagnosis can be recommended in routine practice to establish surveillance intervals for polyps between 5 and 15 mm. CLINICAL TRIALS REGISTRATION NUMBER NCT04232176.
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Affiliation(s)
- Eduardo Redondo-Cerezo
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain.
| | - Clara Heredia-Carrasco
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | | | | | | | - Eva Julissa Ortega-Suazo
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | | | | | | | - Juan Gabriel Martínez-Cara
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | - Francisco Valverde-Lopez
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | - Mercedes López de Hierro
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | - Damián Sánchez-Capilla
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | | | - Rita Jimenez-Rosales
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
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Minegishi Y, Kudo SE, Miyata Y, Nemoto T, Mori K, Misawa M. Comprehensive Diagnostic Performance of Real-Time Characterization of Colorectal Lesions Using an Artificial Intelligence-Assisted System: A Prospective Study. Gastroenterology 2022; 163:323-325.e3. [PMID: 35398043 DOI: 10.1053/j.gastro.2022.03.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/24/2022] [Accepted: 03/29/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Yosuke Minegishi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yuki Miyata
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Tetsuo Nemoto
- Pathology Department, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kensaku Mori
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
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Biffi C, Salvagnini P, Dinh NN, Hassan C, Sharma P, Cherubini A. A novel AI device for real-time optical characterization of colorectal polyps. NPJ Digit Med 2022; 5:84. [PMID: 35773468 PMCID: PMC9247164 DOI: 10.1038/s41746-022-00633-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/16/2022] [Indexed: 01/03/2023] Open
Abstract
Accurate in-vivo optical characterization of colorectal polyps is key to select the optimal treatment regimen during colonoscopy. However, reported accuracies vary widely among endoscopists. We developed a novel intelligent medical device able to seamlessly operate in real-time using conventional white light (WL) endoscopy video stream without virtual chromoendoscopy (blue light, BL). In this work, we evaluated the standalone performance of this computer-aided diagnosis device (CADx) on a prospectively acquired dataset of unaltered colonoscopy videos. An international group of endoscopists performed optical characterization of each polyp acquired in a prospective study, blinded to both histology and CADx result, by means of an online platform enabling careful video assessment. Colorectal polyps were categorized by reviewers, subdivided into 10 experts and 11 non-experts endoscopists, and by the CADx as either “adenoma” or “non-adenoma”. A total of 513 polyps from 165 patients were assessed. CADx accuracy in WL was found comparable to the accuracy of expert endoscopists (CADxWL/Exp; OR 1.211 [0.766–1.915]) using histopathology as the reference standard. Moreover, CADx accuracy in WL was found superior to the accuracy of non-expert endoscopists (CADxWL/NonExp; OR 1.875 [1.191–2.953]), and CADx accuracy in BL was found comparable to it (CADxBL/CADxWL; OR 0.886 [0.612–1.282]). The proposed intelligent device shows the potential to support non-expert endoscopists in systematically reaching the performances of expert endoscopists in optical characterization.
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Affiliation(s)
- Carlo Biffi
- Artificial Intelligence Group, Cosmo AI/Linkverse, Lainate/Rome, Italy
| | - Pietro Salvagnini
- Artificial Intelligence Group, Cosmo AI/Linkverse, Lainate/Rome, Italy
| | - Nhan Ngo Dinh
- Artificial Intelligence Group, Cosmo AI/Linkverse, Lainate/Rome, Italy
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy.,Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Prateek Sharma
- VA Medical Center, Kansas City, MO, USA.,University of Kansas School of Medicine, Kansas City, MO, USA
| | | | - Andrea Cherubini
- Artificial Intelligence Group, Cosmo AI/Linkverse, Lainate/Rome, Italy. .,Milan Center for Neuroscience, University of Milano-Bicocca, 20126, Milano, Italy.
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