Comparative Optical Diagnosis Performance of Autonomous Computer-Aided Diagnosis (CADx) Versus Human-Assisted by CADx: A Systematic Review and Meta-Analysis

Aims Computer-aided diagnosis (CADx) allows the real-time prediction of polyp histology during colonoscopy based on their appearance. This systematic review aims to compare the diagnostic performance of two future CADx utilization: the autonomous CADx strategy (CADx-alone) and the endoscopist with CADx assistance strategy (CADx-assisted).

Methods We searched MEDLINE, EMBASE, and Scopus databases published before 20 March 2024. We screened for histologically-verified accuracy diagnostic studies that compared the real-time optical diagnosis performance of CADx-alone strategy versus CADx-assisted strategy for polyps≤5mm. Only high confidence optical diagnosis were condsidered for the CADx-assisted optical diagnosis. A random effect model was used to calculated the pooled sensitivity, specificity, negative predictive value, positive predictive value and accuracy. Two separate analyses were performed: one on polyps in the whole colon and another restricted to rectosigmoid polyps.

Results The analysis was based on seven studies. The entire colon included 5,765 polyps for CADx-alone and 5,009 polyps for CADx-assisted; CADx-alone showed a significant reduction in sensitivity (88% vs. 93%; RR: 0.95; 95% CI: 0.92, 0.99; I²: 79.46%), negative predictive value (NPV) (85% vs. 90%; RR: 0.94; 95% CI: 0.91, 0.98; I²: 74.96%), PPV (81% vs. 83%; RR: 0.98; 95% CI: 0.96, 1.00; I²: 0%) and overall accuracy (84% vs. 86%; RR: 0.96; 95% CI: 0.95, 0.98; I²: 0%). However, there was no significant difference in specificity (74% vs. 75%; RR: 0.98; 95% CI: 0.94, 1.02; I²: 55.78%). When the analysis was restricted to rectosigmoid polyps, which included 2,515 polyps evaluated by CADx-alone and 2,153 by CADx-assisted, CADx-alone showed significantly lower specificity (83% vs. 85%; RR: 0.97; 95% CI: 0.95, 1.00; I²: 26.36%), PPV (73% vs. 79%; RR: 0.94; 95% CI: 0.89, 1.00; I²: 15.50%). No significant difference was observed in sensitivity (87% vs. 92%; RR: 0.96; 95% CI: 0.92, 1.01; I²: 33.60%) and NPV (94% vs. 95%; RR: 0.99; 95% CI: 0.97, 1.00; I²: 0%).

Conclusions Our findings show that autonomous CADx failed to reach the CADx-assisted sensitivity, NPV, PPV and accuracy in the whole colon. When restricted to rectosigmoid polyps, autonomous CADx failed to reach specificity, PPV and accuracy. These findings underscore the necessity for further enhancements in the autonomous CADx diagnostic performance and the need for further studies that investigate the human-machine interaction.

Publication History

Article published online:
27 March 2025