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Endoscopy 2022; 54(02): 180-184
DOI: 10.1055/a-1372-0419
Innovations and brief communications

Performance of a new integrated computer-assisted system (CADe/CADx) for detection and characterization of colorectal neoplasia

Jochen Weigt
1   Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-v. Guericke University, Magdeburg, Germany
,
Alessandro Repici
2   Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS, Milan, Italy
3   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
,
Giulio Antonelli
4   Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
,
Ahmed Afifi
1   Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-v. Guericke University, Magdeburg, Germany
,
Leon Kliegis
1   Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-v. Guericke University, Magdeburg, Germany
,
Loredana Correale
2   Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS, Milan, Italy
,
Cesare Hassan
4   Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
,
Helmut Neumann 
5   Department of Interdisciplinary Endoscopy, University Hospital Mainz, Mainz, Germany
6   GastroZentrum Lippe, Interventional Endoscopy, Bad Salzuflen, Germany
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Abstract

Background Use of artificial intelligence may increase detection of colorectal neoplasia at colonoscopy by improving lesion recognition (CADe) and reduce pathology costs by improving optical diagnosis (CADx).

Methods A multicenter library of ≥ 200 000 images from 1572 polyps was used to train a combined CADe/CADx system. System testing was performed on two independent image sets (CADe: 446 with polyps, 234 without; CADx: 267) from 234 polyps, which were also evaluated by six endoscopists (three experts, three non-experts).

Results CADe showed sensitivity, specificity, and accuracy of 92.9 %, 90.6 %, and 91.7 %, respectively. Experts showed significantly higher accuracy and specificity, and similar sensitivity, while non-experts + CADe showed comparable sensitivity but lower specificity and accuracy than CADe and experts. CADx showed sensitivity, specificity, and accuracy of 85.0 %, 79.4 %, and 83.6 %, respectively. Experts showed comparable performance, whereas non-experts + CADx showed comparable accuracy but lower specificity than CADx and experts.

Conclusions The high accuracy shown by CADe and CADx was similar to that of experts, supporting further evaluation in a clinical setting. When using CAD, non-experts achieved a similar performance to experts, with suboptimal specificity.

Appendix 1s, Tables 1s, 2s, Fig. 1s



Publication History

Received: 16 July 2020

Accepted: 25 January 2021

Accepted Manuscript online:
25 January 2021

Article published online:
20 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Pilonis ND, Bugajski M, Wieszczy P. et al. Long-term colorectal cancer incidence and mortality after a single negative screening colonoscopy. Ann Intern Med 2020; 173: 81-91
    CrossrefPubMedGoogle Scholar
  • 2 Wieszczy P, Kaminski MF, Franczyk R. et al. Colorectal cancer incidence and mortality after removal of adenomas during screening colonoscopies. Gastroenterology 2020; 158: 875-883
    CrossrefPubMedGoogle Scholar
  • 3 Anderson R, Burr NE, Valori R. Causes of post-colonoscopy colorectal cancers based on World Endoscopy Organization system of analysis. Gastroenterology 2020; 158: 1287-1299
    CrossrefPubMedGoogle Scholar
  • 4 Fuccio L, Rex D, Ponchon T. et al. New and recurrent colorectal cancers after resection: a systematic review and meta-analysis of endoscopic surveillance studies. Gastroenterology 2019; 156: 1309-1323
    CrossrefPubMedGoogle Scholar
  • 5 Zhao S, Wang S, Pan P. et al. Magnitude, risk factors, and factors associated with adenoma miss rate of tandem colonoscopy: a systematic review and meta-analysis. Gastroenterology 2019; 156: 1661-1674
    CrossrefPubMedGoogle Scholar
  • 6 Greuter MJE, de Klerk CM, Meijer GA. et al. Screening for colorectal cancer with fecal immunochemical testing with and without postpolypectomy surveillance colonoscopy: a cost-effectiveness analysis. Ann Intern Med 2017; 167: 544-554
    CrossrefPubMedGoogle Scholar
  • 7 Gupta N, Bansal A, Rao D. et al. Prevalence of advanced histological features in diminutive and small colon polyps. Gastrointest Endosc 2012; 75: 1022-1030
    CrossrefPubMedGoogle Scholar
  • 8 Hassan C, Pickhardt PJ, Rex DK. A resect and discard strategy would improve cost-effectiveness of colorectal cancer screening. Clin Gastroenterol Hepatol 2010; 8: 865-869
    CrossrefPubMedGoogle Scholar
  • 9 Rex DK, Kahi C, O’Brien M. et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2011; 73: 419-422
    CrossrefPubMedGoogle Scholar
  • 10 Bisschops R, East JE, Hassan C. et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: 1155-1179
    Article in Thieme ConnectPubMedGoogle Scholar