Endoscopy 2021; 53(12): 1219-1226
DOI: 10.1055/a-1343-1597
Original article

Optical diagnosis of colorectal polyp images using a newly developed computer-aided diagnosis system (CADx) compared with intuitive optical diagnosis

 1  Division of Gastroenterology and Hepatology, Maastricht University Medical Center + Maastricht, the Netherlands
 2  GROW, School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
,
Ramon M. Schreuder*
 3  Division of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
,
Roger Fonollà
 4  Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
,
 4  Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
,
Fons van der Sommen
 4  Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
,
Bjorn Winkens
 5  Department of Methodology and Statistics, CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
,
Patrick Aepli
 6  Division of Gastroenterology and Hepatology, Luzerner Kantonsspital, Lucerne, Switzerland
,
 7  Division of Gastroenterology and Hepatology, King’s College Hospital, London, United Kingdom
,
Andreas B. Pischel
 8  Division of Gastroenterology and Hepatology, University Hospital Gothenburg, Gothenburg, Sweden
,
Milan Stefanovic
 9  Division of Gastroenterology and Hepatology, Diagnostični Center Bled, Ljubljana, Slovenia
,
10  Division of Gastroenterology and Hepatology, Queen Alexandra Hospital, Portsmouth, United Kingdom
,
Pradeep Bhandari
10  Division of Gastroenterology and Hepatology, Queen Alexandra Hospital, Portsmouth, United Kingdom
,
Peter H. N. de With
 4  Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
,
Ad A. M. Masclee
 1  Division of Gastroenterology and Hepatology, Maastricht University Medical Center + Maastricht, the Netherlands
,
Erik J. Schoon
 2  GROW, School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
 3  Division of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
› Author Affiliations
Trial Registration: ClinicalTrials.gov (http://www.clinicaltrials.gov/)Registration number (trial ID): NCT04349787 Type of study: Prospective, non-interventional study

Abstract

Background Optical diagnosis of colorectal polyps remains challenging. Image-enhancement techniques such as narrow-band imaging and blue-light imaging (BLI) can improve optical diagnosis. We developed and prospectively validated a computer-aided diagnosis system (CADx) using high-definition white-light (HDWL) and BLI images, and compared the system with the optical diagnosis of expert and novice endoscopists.

Methods CADx characterized colorectal polyps by exploiting artificial neural networks. Six experts and 13 novices optically diagnosed 60 colorectal polyps based on intuition. After 4 weeks, the same set of images was permuted and optically diagnosed using the BLI Adenoma Serrated International Classification (BASIC).

Results CADx had a diagnostic accuracy of 88.3 % using HDWL images and 86.7 % using BLI images. The overall diagnostic accuracy combining HDWL and BLI (multimodal imaging) was 95.0 %, which was significantly higher than that of experts (81.7 %, P = 0.03) and novices (66.7 %, P < 0.001). Sensitivity was also higher for CADx (95.6 % vs. 61.1 % and 55.4 %), whereas specificity was higher for experts compared with CADx and novices (95.6 % vs. 93.3 % and 93.2 %). For endoscopists, diagnostic accuracy did not increase when using BASIC, either for experts (intuition 79.5 % vs. BASIC 81.7 %, P = 0.14) or for novices (intuition 66.7 % vs. BASIC 66.5 %, P = 0.95).

Conclusion CADx had a significantly higher diagnostic accuracy than experts and novices for the optical diagnosis of colorectal polyps. Multimodal imaging, incorporating both HDWL and BLI, improved the diagnostic accuracy of CADx. BASIC did not increase the diagnostic accuracy of endoscopists compared with intuitive optical diagnosis.

* These authors contributed equally to this manuscript.


Fig. 1s, Tables 1s, 2s



Publication History

Received: 10 June 2020

Accepted after revision: 23 December 2020

Publication Date:
23 December 2020 (online)

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