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Soetikno RM, Maulahela H, Nguyen-Vu T, Kaltenbach T. Simulation-Based Learning as a Strategy to Optimizing Efficiency of Upper Endoscopy and Colonoscopy. Gastroenterol Clin North Am 2024; 53:531-538. [PMID: 39489573 DOI: 10.1016/j.gtc.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2024]
Abstract
Gastrointestinal diseases impose a significant morbidity, mortality, and health care cost burden, affecting millions annually in the United States alone. Endoscopy plays a crucial role in managing these conditions. Despite technological advancements in endoscopy, ensuring efficient, high-quality care remains challenging. A critical need to standardize high-quality endoscopy is for education reform in the training of endoscopists. Traditional apprenticeship-based training methods are dependent on the trainer as well as the patient case mix. Simulation-based mastery learning (SBML) emerges as a promising strategy to improve endoscopy training. This review discusses the current state of SBML for optimizing upper endoscopy and colonoscopy efficiency.
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Affiliation(s)
- Roy M Soetikno
- Department of Gastroenterology and Hepatology, San Francisco Veteran Affairs Medical Center, San Francisco, CA, USA; Academy of Endoscopy, Woodside, CA, USA; Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Hasan Maulahela
- Academy of Endoscopy, Woodside, CA, USA; Division of Gastroenterology, Department of Internal Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Jakarta Pusat, Indonesia
| | - Tiffany Nguyen-Vu
- Department of Gastroenterology and Hepatology, San Francisco Veteran Affairs Medical Center, San Francisco, CA, USA; Academy of Endoscopy, Woodside, CA, USA; Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Tonya Kaltenbach
- Department of Gastroenterology and Hepatology, San Francisco Veteran Affairs Medical Center, San Francisco, CA, USA; Academy of Endoscopy, Woodside, CA, USA; Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Zhang YK, Shi R, Meng RY, Lin SL, Zheng M. Erythropoietin-induced hepatocyte receptor A2 regulates effect of pyroptosis on gastrointestinal colorectal cancer occurrence and metastasis resistance. World J Gastrointest Oncol 2024; 16:3781-3797. [PMID: 39350985 PMCID: PMC11438782 DOI: 10.4251/wjgo.v16.i9.3781] [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: 04/24/2024] [Revised: 06/30/2024] [Accepted: 07/24/2024] [Indexed: 09/09/2024] Open
Abstract
Erythropoietin-induced hepatocyte receptor A2 (EphA2) is a receptor tyrosine kinase that plays a key role in the development and progression of a variety of tumors. This article reviews the expression of EphA2 in gastrointestinal (GI) colorectal cancer (CRC) and its regulation of pyroptosis. Pyroptosis is a form of programmed cell death that plays an important role in tumor suppression. Studies have shown that EphA2 regulates pyrodeath through various signaling pathways, affecting the occurrence, development and metastasis of GI CRC. The overexpression of EphA2 is closely related to the aggressiveness and metastasis of GI CRC, and the inhibition of EphA2 can induce pyrodeath and improve the sensitivity of cancer cells to treatment. In addition, EphA2 regulates intercellular communication and the microenvironment through interactions with other cytokines and receptors, further influencing cancer progression. The role of EphA2 in GI CRC and its underlying mechanisms provide us with new perspectives and potential therapeutic targets, which have important implications for future cancer treatment.
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Affiliation(s)
- Yu-Kun Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Ran Shi
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Ruo-Yu Meng
- Department of Minimally Invasive Comprehensive Treatment of Cancer, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Shui-Li Lin
- Department of Ana and Intestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Mei Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
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Sano Y, Hotta K, Matsuda T, Murakami Y, Fujii T, Kudo SE, Oda Y, Ishikawa H, Saito Y, Kobayashi N, Sekiguchi M, Ikematsu H, Katagiri A, Konishi K, Takeuchi Y, Iishi H, Igarashi M, Kobayashi K, Sada M, Osera S, Shinohara T, Yamaguchi Y, Hasuda K, Morishima T, Miyashiro I, Shimoda T, Taniguchi H, Fujimori T, Ajioka Y, Yoshida S. Endoscopic Removal of Premalignant Lesions Reduces Long-Term Colorectal Cancer Risk: Results From the Japan Polyp Study. Clin Gastroenterol Hepatol 2024; 22:542-551.e3. [PMID: 37544420 DOI: 10.1016/j.cgh.2023.07.021] [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: 12/01/2022] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND & AIMS To date, no regional evidence of long-term colorectal cancer (CRC) risk reduction after endoscopic premalignant lesion removal has been established. We aimed to analyze this over a long-term follow-up evaluation. METHODS This was a prospective cohort study of participants from the Japan Polyp Study conducted at 11 Japanese institutions. Participants underwent scheduled follow-up colonoscopies after a 2-round baseline colonoscopy process. The primary outcome was CRC incidence after randomization. The observed/expected ratio of CRC was calculated using data from the population-based Osaka Cancer Registry. Secondary outcomes were the incidence and characteristics of advanced neoplasia (AN). RESULTS A total of 1895 participants were analyzed. The mean number of follow-up colonoscopies and the median follow-up period were 2.8 years (range, 1-15 y) and 6.1 years (range, 0.8-11.9 y; 11,559.5 person-years), respectively. Overall, 4 patients (all males) developed CRCs during the study period. The observed/expected ratios for CRC in all participants, males, and females, were as follows: 0.14 (86% reduction), 0.18, and 0, respectively, and 77 ANs were detected in 71 patients (6.1 per 1000 person-years). Of the 77 ANs detected, 31 lesions (40.3%) were laterally spreading tumors, nongranular type. Nonpolypoid colorectal neoplasms (NP-CRNs), including flat (<10 mm), depressed, and laterally spreading, accounted for 59.7% of all detected ANs. Furthermore, 2 of the 4 CRCs corresponded to T1 NP-CRNs. CONCLUSIONS Endoscopic removal of premalignant lesions, including NP-CRNs, effectively reduced CRC risk. More than half of metachronous ANs removed by surveillance colonoscopy were NP-CRNs. The Japan Polyp Study: University Hospital Medical Information Network Clinical Trial Registry: University Hospital Medical Information Network Clinical Trial Registry, C000000058; cohort study: UMIN000040731.
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Affiliation(s)
- Yasushi Sano
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care, Sano Hospital, Kobe, Japan.
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Sunto, Japan.
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan; Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.
| | | | | | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yasushi Oda
- Oda Gastrointestinal Endoscopy and Gastroenterology Clinic, Kumamoto, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Nozomu Kobayashi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan; Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Japan
| | - Masau Sekiguchi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Atsushi Katagiri
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kazuo Konishi
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyasu Iishi
- Department of Gastroenterology, Itami City Hospital, Itami, Japan
| | - Masahiro Igarashi
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kiyonori Kobayashi
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Miwa Sada
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shozo Osera
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Saku, Japan
| | - Tomoaki Shinohara
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Saku, Japan
| | | | - Kiwamu Hasuda
- Hattori Gastrointestinal Endoscopy and Gastroenterology Clinic, Kumamoto, Japan
| | | | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | - Hirokazu Taniguchi
- Pathology and Clinical Laboratory Division, JR Tokyo General Hospital, Tokyo, Japan
| | | | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Kaltenbach T, Krop L, Nguyen-Vu T, Soetikno R. Improving Adenoma Detection and Resection: The Role of Tools, Techniques and Simulation-Based Mastery Learning. TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY 2024; 26:167-176. [DOI: 10.1016/j.tige.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Ahmad OF, Mazomenos E, Chadebecq F, Kader R, Hussein M, Haidry RJ, Puyal JG, Brandao P, Toth D, Mountney P, Seward E, Vega R, Stoyanov D, Lovat LB. Identifying key mechanisms leading to visual recognition errors for missed colorectal polyps using eye-tracking technology. J Gastroenterol Hepatol 2023; 38:768-774. [PMID: 36652526 PMCID: PMC10601973 DOI: 10.1111/jgh.16127] [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: 10/22/2022] [Revised: 01/04/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIM Lack of visual recognition of colorectal polyps may lead to interval cancers. The mechanisms contributing to perceptual variation, particularly for subtle and advanced colorectal neoplasia, have scarcely been investigated. We aimed to evaluate visual recognition errors and provide novel mechanistic insights. METHODS Eleven participants (seven trainees and four medical students) evaluated images from the UCL polyp perception dataset, containing 25 polyps, using eye-tracking equipment. Gaze errors were defined as those where the lesion was not observed according to eye-tracking technology. Cognitive errors occurred when lesions were observed but not recognized as polyps by participants. A video study was also performed including 39 subtle polyps, where polyp recognition performance was compared with a convolutional neural network. RESULTS Cognitive errors occurred more frequently than gaze errors overall (65.6%), with a significantly higher proportion in trainees (P = 0.0264). In the video validation, the convolutional neural network detected significantly more polyps than trainees and medical students, with per-polyp sensitivities of 79.5%, 30.0%, and 15.4%, respectively. CONCLUSIONS Cognitive errors were the most common reason for visual recognition errors. The impact of interventions such as artificial intelligence, particularly on different types of perceptual errors, needs further investigation including potential effects on learning curves. To facilitate future research, a publicly accessible visual perception colonoscopy polyp database was created.
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Affiliation(s)
- Omer F Ahmad
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
| | - Evangelos Mazomenos
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
| | - Francois Chadebecq
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
| | - Rawen Kader
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
| | - Mohamed Hussein
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
| | - Rehan J Haidry
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
| | - Juana González‐Bueno Puyal
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Odin Vision LtdLondonUK
| | - Patrick Brandao
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Odin Vision LtdLondonUK
| | | | | | - Ed Seward
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
| | - Roser Vega
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
| | - Laurence B Lovat
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
- Gastrointestinal ServicesUniversity College London HospitalLondonUK
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Iwatate M, Hirata D, Francisco CPD, Co JT, Byeon J, Joshi N, Banerjee R, Quach DT, Aye TT, Chiu H, Lau LHS, Ng SC, Ang TL, Khomvilai S, Li X, Ho S, Sano W, Hattori S, Fujita M, Murakami Y, Shimatani M, Kodama Y, Sano Y, The CATCH project team. Efficacy of international web-based educational intervention in the detection of high-risk flat and depressed colorectal lesions higher (CATCH project) with a video: Randomized trial. Dig Endosc 2022; 34:1166-1175. [PMID: 35122323 PMCID: PMC9540870 DOI: 10.1111/den.14244] [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: 09/29/2021] [Revised: 01/14/2022] [Accepted: 01/23/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Three subcategories of high-risk flat and depressed lesions (FDLs), laterally spreading tumors non-granular type (LST-NG), depressed lesions, and large sessile serrated lesions (SSLs), are highly attributable to post-colonoscopy colorectal cancer (CRC). Efficient and organized educational programs on detecting high-risk FDLs are lacking. We aimed to explore whether a web-based educational intervention with training on FIND clues (fold deformation, intensive stool/mucus attachment, no vessel visibility, and demarcated reddish area) may improve the ability to detect high-risk FDLs. METHODS This was an international web-based randomized control trial that enrolled non-expert endoscopists in 13 Asian countries. The participants were randomized into either education or non-education group. All participants took the pre-test and post-test to read 60 endoscopic images (40 high-risk FDLs, five polypoid, 15 no lesions) and answered whether there was a lesion. Only the education group received a self-education program (video and training questions and answers) between the tests. The primary outcome was a detection rate of high-risk FDLs. RESULTS In total, 284 participants were randomized. After excluding non-responders, the final data analyses were based on 139 participants in the education group and 130 in the non-education group. The detection rate of high-risk FDLs in the education group significantly improved by 14.7% (66.6-81.3%) compared with -0.8% (70.8-70.0%) in the non-education group. Similarly, the detection rate of LST-NG, depressed lesions, and large SSLs significantly increased only in the education group by 12.7%, 12.0%, and 21.6%, respectively. CONCLUSION Short self-education focusing on detecting high-risk FDLs was effective for Asian non-expert endoscopists. (UMIN000042348).
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Affiliation(s)
- Mineo Iwatate
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
| | - Daizen Hirata
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
- Department of Gastroenterology and HepatologyKindai UniversityOsakaJapan
| | | | - Jonard Tan Co
- Institute of Digestive and Liver DiseasesSt. Luke’s Medical CenterTaguig CityPhilippines
| | - Jeong‐Sik Byeon
- Department of GastroenterologyAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Neeraj Joshi
- Gastro Enterology UnitNepal Cancer Hospital and Research CentreLalitpurNepal
| | - Rupa Banerjee
- Medical GastroenterologyAsian Institute of GastroenterologyNew DelhiIndia
| | - Duc Trong Quach
- University of Medicine and Pharmacy at Ho Chi Minh CityHo Chi MinhVietnam
| | | | - Han‐Mo Chiu
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Louis H. S. Lau
- Department of Medicine and TherapeuticsFaculty of MedicineInstitute of Digestive DiseaseThe Chinese University of Hong KongHong KongChina
| | - Siew C. Ng
- Department of Medicine and TherapeuticsFaculty of MedicineInstitute of Digestive DiseaseThe Chinese University of Hong KongHong KongChina
| | - Tiing Leong Ang
- Department of Gastroenterology and HepatologyChangi General HospitalSingHealthSingapore
| | - Supakij Khomvilai
- Surgical EndoscopyColorectal DivisionDepartment of SurgeryFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Xiao‐Bo Li
- Division of Gastroenterology and HepatologyKey Laboratory of Gastroenterology and HepatologyMinistry of Health, Renji HospitalSchool of MedicineShanghai Institute of Digestive DiseaseShanghai Jiao Tong UniversityShanghaiChina
| | - Shiaw‐Hooi Ho
- Department of MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Wataru Sano
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
| | - Santa Hattori
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
| | - Mikio Fujita
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
| | | | - Masaaki Shimatani
- The Third Department of Internal MedicineDivision of Gastroenterology and HepatologyKansai Medical University Medical CenterOsakaJapan
| | - Yuzo Kodama
- Division of GastroenterologyDepartment of Internal MedicineKobe University Graduate School of MedicineHyogoJapan
| | - Yasushi Sano
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
- Kansai Medical UniversityOsakaJapan
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Deliwala SS, Hamid K, Barbarawi M, Lakshman H, Zayed Y, Kandel P, Malladi S, Singh A, Bachuwa G, Gurvits GE, Chawla S. Artificial intelligence (AI) real-time detection vs. routine colonoscopy for colorectal neoplasia: a meta-analysis and trial sequential analysis. Int J Colorectal Dis 2021; 36:2291-2303. [PMID: 33934173 DOI: 10.1007/s00384-021-03929-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 02/04/2023]
Abstract
GOALS AND BACKGROUND Studies analyzing artificial intelligence (AI) in colonoscopies have reported improvements in detecting colorectal cancer (CRC) lesions, however its utility in the realworld remains limited. In this systematic review and meta-analysis, we evaluate the efficacy of AI-assisted colonoscopies against routine colonoscopy (RC). STUDY We performed an extensive search of major databases (through January 2021) for randomized controlled trials (RCTs) reporting adenoma and polyp detection rates. Odds ratio (OR) and standardized mean differences (SMD) with 95% confidence intervals (CIs) were reported. Additionally, trial sequential analysis (TSA) was performed to guard against errors. RESULTS Six RCTs were included (4996 participants). The mean age (SD) was 51.99 (4.43) years, and 49% were females. Detection rates favored AI over RC for adenomas (OR 1.77; 95% CI: 1.570-2.08) and polyps (OR 1.91; 95% CI: 1.68-2.16). Secondary outcomes including mean number of adenomas (SMD 0.23; 95% CI: 0.18-0.29) and polyps (SMD 0.23; 95% CI: 0.17-0.29) detected per procedure favored AI. However, RC outperformed AI in detecting pedunculated polyps. Withdrawal times (WTs) favored AI when biopsies were included, while WTs without biopsies, cecal intubation times, and bowel preparation adequacy were similar. CONCLUSIONS Colonoscopies equipped with AI detection algorithms could significantly detect previously missed adenomas and polyps while retaining the ability to self-assess and improve periodically. More effective clearance of diminutive adenomas may allow lengthening in surveillance intervals, reducing the burden of surveillance colonoscopies, and increasing its accessibility to those at higher risk. TSA ruled out the risk for false-positive results and confirmed a sufficient sample size to detect the observed effect. Currently, these findings suggest that AI-assisted colonoscopy can serve as a useful proxy to address critical gaps in CRC identification.
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Affiliation(s)
- Smit S Deliwala
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Two Hurley Plaza, Ste 212, Flint, MI, 48503, USA.
| | - Kewan Hamid
- Department of Internal Medicine/Pediatrics, Michigan State University at Hurley Medical Center, Flint, MI, USA
| | - Mahmoud Barbarawi
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Two Hurley Plaza, Ste 212, Flint, MI, 48503, USA
| | - Harini Lakshman
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Two Hurley Plaza, Ste 212, Flint, MI, 48503, USA
| | - Yazan Zayed
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Two Hurley Plaza, Ste 212, Flint, MI, 48503, USA
| | - Pujan Kandel
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Two Hurley Plaza, Ste 212, Flint, MI, 48503, USA
| | - Srikanth Malladi
- Department of Internal Medicine/Pediatrics, Michigan State University at Hurley Medical Center, Flint, MI, USA
| | - Adiraj Singh
- Department of Internal Medicine/Pediatrics, Michigan State University at Hurley Medical Center, Flint, MI, USA
| | - Ghassan Bachuwa
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Two Hurley Plaza, Ste 212, Flint, MI, 48503, USA
| | - Grigoriy E Gurvits
- Department of Internal Medicine - Division of Gastroenterology, New York University/Langone Medical Center, New York, NY, USA
| | - Saurabh Chawla
- Department of Internal Medicine - Division of Gastroenterology, Emory University, Atlanta, GA, USA
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Sinagra E, Badalamenti M, Maida M, Spadaccini M, Maselli R, Rossi F, Conoscenti G, Raimondo D, Pallio S, Repici A, Anderloni A. Use of artificial intelligence in improving adenoma detection rate during colonoscopy: Might both endoscopists and pathologists be further helped. World J Gastroenterol 2020; 26:5911-5918. [PMID: 33132644 PMCID: PMC7584058 DOI: 10.3748/wjg.v26.i39.5911] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/18/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023] Open
Abstract
Colonoscopy remains the standard strategy for screening for colorectal cancer around the world due to its efficacy in both detecting adenomatous or pre-cancerous lesions and the capacity to remove them intra-procedurally. Computer-aided detection and diagnosis (CAD), thanks to the brand new developed innovations of artificial intelligence, and especially deep-learning techniques, leads to a promising solution to human biases in performance by guarantying decision support during colonoscopy. The application of CAD on real-time colonoscopy helps increasing the adenoma detection rate, and therefore contributes to reduce the incidence of interval cancers improving the effectiveness of colonoscopy screening on critical outcome such as colorectal cancer related mortality. Furthermore, a significant reduction in costs is also expected. In addition, the assistance of the machine will lead to a reduction of the examination time and therefore an optimization of the endoscopic schedule. The aim of this opinion review is to analyze the clinical applications of CAD and artificial intelligence in colonoscopy, as it is reported in literature, addressing evidence, limitations, and future prospects.
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Affiliation(s)
- Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, Cefalù 90015, Italy
| | - Matteo Badalamenti
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano 20089, Italy
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta 93100, Italy
| | - Marco Spadaccini
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano 20089, Italy
| | - Roberta Maselli
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano 20089, Italy
| | - Francesca Rossi
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, Cefalù 90015, Italy
| | - Giuseppe Conoscenti
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, Cefalù 90015, Italy
| | - Dario Raimondo
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, Cefalù 90015, Italy
| | - Socrate Pallio
- Endoscopy Unit, AOUP Policlinico G. Martino, Messina 98125, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano 20089, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano 20089, Italy
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Takeuchi Y, Sawaya M, Oka S, Tamai N, Kawamura T, Uraoka T, Ikematsu H, Moriyama T, Arao M, Ishikawa H, Ito Y, Matsuda T. Efficacy of autofluorescence imaging for flat neoplasm detection: a multicenter randomized controlled trial (A-FLAT trial). Gastrointest Endosc 2019; 89:460-469. [PMID: 30452914 DOI: 10.1016/j.gie.2018.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Colorectal flat (nonpolypoid) lesions can be overlooked during colonoscopy. This study evaluated the efficacy of updated autofluorescence imaging (AFI) for detecting colorectal flat neoplasms. METHODS This was a prospective, multicenter, randomized controlled trial in 9 Japanese tertiary institutions. Patients undergoing colonoscopy because of positive fecal immunochemical tests, surveillance after polypectomy, or investigation of minor symptoms were enrolled and randomly assigned to either the white-light imaging (WLI) or the AFI group. Primary outcome measurement was number of flat neoplasms per patient. RESULTS From November 2015 to June 2017, 817 patients were enrolled. After excluding 15 patients, 802 were finally analyzed (404, WLI; 398, AFI). Patients' backgrounds (sex, age, indication of colonoscopy, experience of endoscopists) and quality of colonoscopy (bowel preparation, sedative use, cecal insertion rate, insertion and withdrawal time) were not different between groups. Number of flat neoplasms in each patient was significantly higher in the AFI than in the WLI group (.87 [95% confidence interval [CI], .78-.97] vs .53 [95% CI, .46-.61]), whereas overall and polypoid neoplasm detection was not significantly different between the groups (1.33 [95% CI, 1.22-1.45] vs 1.14 [95% CI, 1.03-1.24], .46 [95% CI, .40-.53] vs .60 [95% CI, .53-.68]). Flat neoplasms were more frequently detected in the right-sided colon with AFI (.61 [95% CI, .54-.70] vs .30 [95% CI, .25-.36]) but not in the left-sided colon and rectum (.26 [95% CI, .21-.32] vs .23 [95% CI, .19-.28]). CONCLUSIONS Updated AFI improves the detection of flat colorectal neoplasms in the right-sided colon compared with WLI. (Clinical trial registration number: UMIN000019355.).
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Affiliation(s)
- Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Manabu Sawaya
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Japan
| | - Naoto Tamai
- Department of Endoscopy, The Jikei University School of Medicine, Japan
| | - Takuji Kawamura
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Japan
| | - Toshio Uraoka
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Japan
| | | | - Tomohiko Moriyama
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Masamichi Arao
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuri Ito
- Department of Cancer Epidemiology and Prevention, Center for Cancer Control and Statistics, Osaka International Cancer Institute, Osaka, Japan
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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10
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Ahmad OF, Soares AS, Mazomenos E, Brandao P, Vega R, Seward E, Stoyanov D, Chand M, Lovat LB. Artificial intelligence and computer-aided diagnosis in colonoscopy: current evidence and future directions. Lancet Gastroenterol Hepatol 2018; 4:71-80. [PMID: 30527583 DOI: 10.1016/s2468-1253(18)30282-6] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/10/2018] [Accepted: 08/20/2018] [Indexed: 12/15/2022]
Abstract
Computer-aided diagnosis offers a promising solution to reduce variation in colonoscopy performance. Pooled miss rates for polyps are as high as 22%, and associated interval colorectal cancers after colonoscopy are of concern. Optical biopsy, whereby in-vivo classification of polyps based on enhanced imaging replaces histopathology, has not been incorporated into routine practice because it is limited by interobserver variability and generally only meets accepted standards in expert settings. Real-time decision-support software has been developed to detect and characterise polyps, and also to offer feedback on the technical quality of inspection. Some of the current algorithms, particularly with recent advances in artificial intelligence techniques, match human expert performance for optical biopsy. In this Review, we summarise the evidence for clinical applications of computer-aided diagnosis and artificial intelligence in colonoscopy.
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Affiliation(s)
- Omer F Ahmad
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK; Gastrointestinal Services, University College London Hospital, London, UK.
| | - Antonio S Soares
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Evangelos Mazomenos
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK
| | - Patrick Brandao
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK
| | - Roser Vega
- Gastrointestinal Services, University College London Hospital, London, UK
| | - Edward Seward
- Gastrointestinal Services, University College London Hospital, London, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK
| | - Manish Chand
- Division of Surgery & Interventional Science, University College London, London, UK; Gastrointestinal Services, University College London Hospital, London, UK
| | - Laurence B Lovat
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK; Division of Surgery & Interventional Science, University College London, London, UK; Gastrointestinal Services, University College London Hospital, London, UK
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11
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Impact of endoscopist training on postcolonoscopy colorectal cancer rate. Gastrointest Endosc 2017; 85:1113-1114. [PMID: 28411757 DOI: 10.1016/j.gie.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 01/07/2017] [Indexed: 02/08/2023]
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12
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McGill SK, Soetikno R, Rouse RV, Lai H, Kaltenbach T. Patients With Nonpolypoid (Flat and Depressed) Colorectal Neoplasms at Increased Risk for Advanced Neoplasias, Compared With Patients With Polypoid Neoplasms. Clin Gastroenterol Hepatol 2017; 15:249-256.e1. [PMID: 27639328 DOI: 10.1016/j.cgh.2016.08.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/21/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Nonpolypoid colorectal neoplasms (NP-CRNs) are more likely to contain high-grade dysplasia or early-stage cancer than polypoid neoplasms. We aimed to determine the long-term outcomes of patients with at least 1 NP-CRN. METHODS We performed a longitudinal cohort study of 4454 patients at a Veterans' Affairs hospital who underwent colonoscopy from 2000 through 2005; 341 were found to have 1 or more NP-CRNs and were matched (3:1) with patients found to have 1 or more polypoid neoplasms (controls, n = 1025). We collected and analyzed data on baseline colonoscopy findings and first follow-up colonoscopy results through August 2014. We calculated the incidence of advanced neoplasia at first follow-up colonoscopy, as defined by the presence of ≥1 tubular or sessile serrated adenomas ≥10 mm in diameter, tubulovillous adenoma, high-grade dysplasia, or invasive cancer. RESULTS A significantly higher proportion of patients with 1 or more NP-CRNs (16.0%) were found to have advanced neoplasia at their first follow-up colonoscopy than controls (8.6%); the adjusted risk ratio was 1.6 (95% confidence interval, 1.05-2.6; P = .03). A significantly higher proportion of patients with 1 or more NP-CRNs were found to have additional NP-CRNs at the follow-up colonoscopy (17%) than controls (7%; relative risk, 2.3; 95% confidence interval, 1.5-3.5; P < .001). Similar proportions of patients in each group developed cancers after colonoscopy. CONCLUSIONS In a longitudinal cohort study, we found that patients with NP-CRN were more likely to develop additional NP-CRNs and to have advanced neoplasms at their first follow-up colonoscopy than patients with only polypoid neoplasms. However, patients with NP-CRN were not more likely to develop cancers after colonoscopy when surveillance guidelines were followed. Larger studies are needed to determine risk of colorectal cancer in patients with NP-CRN.
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Affiliation(s)
- Sarah K McGill
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Stanford University School of Medicine, Stanford, California; University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Roy Soetikno
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Stanford University School of Medicine, Stanford, California
| | - Robert V Rouse
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Stanford University School of Medicine, Stanford, California
| | - Hobart Lai
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Tonya Kaltenbach
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Stanford University School of Medicine, Stanford, California.
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13
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Sakata S, Grove PM, Stevenson ARL, Hewett DG. The impact of three-dimensional imaging on polyp detection during colonoscopy: a proof of concept study. Gut 2016; 65:730-1. [PMID: 26896460 DOI: 10.1136/gutjnl-2016-311507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 02/05/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Shinichiro Sakata
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Philip M Grove
- School of Psychology, The University of Queensland, Brisbane, Australia
| | | | - David G Hewett
- School of Medicine, The University of Queensland, Brisbane, Australia
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14
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Sakata S, Kheir AO, Hewett DG. Optical diagnosis of colorectal neoplasia: A Western perspective. Dig Endosc 2016; 28:281-8. [PMID: 26841371 DOI: 10.1111/den.12625] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/25/2016] [Accepted: 02/01/2016] [Indexed: 02/08/2023]
Abstract
Optical diagnosis is an emerging paradigm in Western endoscopic practice for the colonoscopic management of diminutive polyps, and includes two complementary clinical strategies: 'resect and discard', in which diminutive high-confidence adenomas are identified, and then removed and discarded without pathological assessment; and 'diagnose and leave', where diminutive high-confidence hyperplastic polyps are identified in the rectosigmoid and then left without resection or biopsy. Like other aspects of colonoscopy performance, adoption of optical diagnosis in Western practice is limited by operator dependency and variation in clinical effectiveness. There is substantial potential for optical diagnosis of colorectal neoplasia during colonoscopy to alleviate the rising costs of health care in the West. However, operator dependence in diagnostic performance together with critical system factors such as informed consent, credentialing, medical legal support and reimbursement incentives must be overcome before optical diagnosis of diminutive lesions is considered for widespread adoption in Western clinical practice.
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Affiliation(s)
- Shinichiro Sakata
- School of Medicine, The University of Queensland, Brisbane, Australia.,Division of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
| | - Ammar O Kheir
- Division of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
| | - David G Hewett
- School of Medicine, The University of Queensland, Brisbane, Australia.,Division of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
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15
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Sanduleanu S, Kaltenbach T, Barkun A, McCabe RP, Velayos F, Picco MF, Laine L, Soetikno R, McQuaid KR. A roadmap to the implementation of chromoendoscopy in inflammatory bowel disease colonoscopy surveillance practice. Gastrointest Endosc 2016; 83:213-22. [PMID: 26364967 DOI: 10.1016/j.gie.2015.08.076] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/26/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Silvia Sanduleanu
- Division of Gastroenterology, Department of Medicine and GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Tonya Kaltenbach
- Stanford University and VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Alan Barkun
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | | | - Fernando Velayos
- Department of Medicine, University of California, San Francisco, California, USA
| | - Michael F Picco
- Division of Gastroenterology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Loren Laine
- Yale School of Medicine, New Haven and VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Roy Soetikno
- Stanford University and VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Kenneth R McQuaid
- University of California, San Francisco and San Francisco VA Medical Center, San Francisco, California, USA
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16
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Muscatiello N, Facciorusso A. Use of polidocanol in colon polypectomy. Gastrointest Endosc 2016; 83:271. [PMID: 26264435 DOI: 10.1016/j.gie.2015.07.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 07/27/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Nicola Muscatiello
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
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17
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Domènech X, Garcia M, Benito L, Binefa G, Vidal C, Milà N, Moreno V. [Interval cancers and episode sensitivity in population-based screening programmes for colorectal cancer: a systematic review]. GACETA SANITARIA 2015; 29:464-71. [PMID: 26341155 DOI: 10.1016/j.gaceta.2015.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 06/26/2015] [Accepted: 07/08/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To describe interval cancers (IC) and the sensitivity of colorectal cancer (CRC) screening programmes. METHODS A systematic review of the literature was conducted through a MEDLINE (PubMed) search. The search strategy combined the terms 'interval cancer', 'false negative', 'mass screening', 'screening' 'early detection of cancer', 'colorectal cancer' and 'bowel cancer'. Inclusion criteria consisted of population-based screening programmes, original articles written in English or Spanish and publication dates between 1999/01/01 and 2015/02/28. A narrative synthesis of the included articles was performed detailing the characteristics of the screening programmes, the IC rate, and the information sources used in each study. RESULTS Thirteen articles were included. The episode sensitivity of CRC screening programmes ranged from 42.2% to 65.3% in programmes using the guaiac test and between 59.1% and 87.0% with the immunochemical test. We found a higher proportion of women who were diagnosed with IC and these lesions were mainly located in the proximal colon. CONCLUSION There is wide variability in the IC rate in CRC programmes. To ensure comparability between programmes, there is a need for consensus on the working definition of IC and the methods used for their identification and quantification.
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Affiliation(s)
- Xènia Domènech
- Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Montse Garcia
- Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
| | - Llúcia Benito
- Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; Departamento de Enfermería Fundamental y Médico-Quirúrgica, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - Gemma Binefa
- Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Carmen Vidal
- Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Núria Milà
- Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Víctor Moreno
- Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Departamento de Ciencias Clínicas, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
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