4.6 Review

The Role of Artificial Intelligence in Colorectal Cancer Screening: Lesion Detection and Lesion Characterization

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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

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Summary: The present study demonstrates that real-time artificial intelligence (AI)-assisted optical diagnosis is accurate and useful for the diagnosis of diminutive rectosigmoid polyps (DRSPs), especially for nonexperts.

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Summary: This study aimed to develop a computer-aided diagnosis (CADx) system using nonmagnified endoscopic white-light images to diagnose early-stage colorectal cancers (CRCs). The CADx system showed high specificity and accuracy for diagnosing T1b lesions, surpassing trainees and comparable to experts. The CADx system has promising potential for clinical application.

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Artificial intelligence empowers the second-observer strategy for colonoscopy: a randomized clinical trial

Pu Wang et al.

Summary: In colonoscopy screening for colorectal cancer, human vision limitations may lead to higher miss rate of lesions. Artificial intelligence (AI) assistance has been demonstrated to improve polyp detection. This study aimed to compare the effectiveness of AI and human observer during colonoscopy.

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Assessment of the Role of Artificial Intelligence in the Association Between Time of Day and Colonoscopy Quality

Zihua Lu et al.

Summary: This study aimed to validate whether the assistance of an AI system could overcome the time-related decline in adenoma detection during colonoscopy. Through comparative analysis, the study found that AI systems had higher assistance ability in the late sessions of colonoscopy, suggesting the potential to maintain high quality and homogeneity of colonoscopies and improve endoscopist performance in large screening programs and centers with high workloads.

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Real-World Validation of a Computer-Aided Diagnosis System for Prediction of Polyp Histology in Colonoscopy: A Prospective Multicenter Study

James Weiquan Li et al.

Summary: Computer-aided diagnosis (CADx) has the potential to support endoscopists in clinical decision making, but its performance in a real-world setting has not been validated. In this prospective, multicenter study, CADx predictions were compared with endoscopist predictions of polyp histology during colonoscopy. The results showed that endoscopists had higher accuracy and sensitivity compared to CADx, with moderate agreement between the two. Concordance between CADx and endoscopist predictions improved diagnostic accuracy. Further research is needed to improve the performance of CADx in clinical practice.

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Impact of Artificial Intelligence on Colonoscopy Surveillance After Polyp Removal: A Pooled Analysis of Randomized Trials

Yuichi Mori et al.

Summary: The use of AI during colonoscopy increases the proportion of patients needing intensive surveillance by approximately 35% in the United States and 20% in Europe. This contributes to improved cancer prevention but adds significant patient burden and healthcare costs.

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Benefits and challenges in implementation of artificial intelligence in colonoscopy: World Endoscopy Organization position statement

Yuichi Mori et al.

Summary: The number of AI tools for colonoscopy is increasing, but their implementation is facing challenges due to lack of clinical evidence and cost-effectiveness, lack of guidelines, uncertain indications, and implementation costs. The World Endoscopy Organization (WEO) has provided its position statement to address these issues and guide practitioners. The statement includes recommendations for the use of computer-aided detection (CADe) and computer-aided diagnosis (CADx), and emphasizes the need for cost-effectiveness research to understand the benefits of AI implementation.

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Clinical Evaluation of Computer-Aided Colorectal Neoplasia Detection Using a Novel Endoscopic Artificial Intelligence: A Single-Center Randomized Controlled Trial

Hirotaka Nakashima et al.

Summary: This study evaluated the clinical performance of a new endoscopic artificial intelligence system for computer-aided detection (CADe) of colonic adenomas. The CADe group showed a 11.8% higher adenoma detection rate (ADR) compared to the control group. Additionally, there was no need to extend the examination time or request the assistance of additional medical staff to achieve this improved effectiveness.

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Influence of artificial intelligence on the adenoma detection rate throughout the day

Rino Richter et al.

Summary: The use of artificial intelligence systems can help overcome the decline in adenoma detection rate during the daytime, potentially due to the constant awareness provided by the AI system.

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Development and validation of an artificial intelligence-based system for predicting colorectal cancer invasion depth using multi-modal data

Liwen Yao et al.

Summary: A clinically applicable artificial intelligence system was constructed to accurately predict the depth of cancer invasion in large sessile colorectal polyps, providing important guidance for treatment strategies.

DIGESTIVE ENDOSCOPY (2023)

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Performance and attitudes toward real-time computer-aided polyp detection during colonoscopy in a large tertiary referral center in the United States

Fredy Nehme et al.

Summary: This study evaluated the effectiveness of the first FDA-approved CADe device for polyp detection in colonoscopy and investigated the attitudes toward its implementation. The results showed that CADe did not improve adenoma detection in clinical practice, and there were concerns raised by healthcare professionals regarding AI-assisted colonoscopy.

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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

Ejaz Hossain et al.

Summary: This study validates a novel AI algorithm developed by NEC Corporation for the characterization of colorectal polyps. The algorithm demonstrates higher sensitivity, accuracy, and consistency compared to endoscopists in diagnosing diminutive polyps and predicting post-polypectomy surveillance intervals. AI-based optical diagnosis shows promise in improving the performance of general endoscopists.

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A computer-aided diagnosis system using white-light endoscopy for the prediction of conventional adenoma with high grade dysplasia

Sijun Meng et al.

Summary: ECRC-CAD is a computer-aided diagnosis system developed using standard white-light endoscopy for predicting conventional adenomas with high-grade dysplasia. It achieved good diagnostic capability for HGD and outperformed expert endoscopists in diagnosing HGD.

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Polyp detection and false-positive rates by computer-aided analysis of withdrawal-phase videos of colonoscopy of the right-sided colon segment in a randomized controlled trial comparing water exchange and air insufflation

Chia-Pei Tang et al.

Summary: Water exchange improves polyp detection rate and reduces false positive numbers. Computer-aided detection complements water exchange, optimizing polyp detection.

GASTROINTESTINAL ENDOSCOPY (2022)

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Effect of artificial intelligence-aided colonoscopy for adenoma and polyp detection: a meta-analysis of randomized clinical trials

Ding Huang et al.

Summary: This meta-analysis included 10 randomized controlled trials with 6629 individuals in AI-aided and routine groups, showing that AI-aided endoscopy significantly improved ADR and PDR compared to routine colonoscopy. Lesion detection rates such as APC, PPC, and SSLPC were significantly higher in the AI-aided group, while withdrawal time was longer in the AI-aided group when biopsies were included.

INTERNATIONAL JOURNAL OF COLORECTAL DISEASE (2022)

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Pranav Rajpurkar et al.

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Deep Learning Computer-aided Polyp Detection Reduces Adenoma Miss Rate: A United States Multi-center Randomized Tandem Colonoscopy Study (CADeT-CS Trial)

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Misaki Ishiyama et al.

Summary: This study found that using CADe system for colonoscopy significantly increased the adenoma detection rate in a large-scale prospective evaluation, while there was no significant increase in the detection rate of advanced neoplasia.

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Artificial intelligence and colonoscopy experience: lessons from two randomised trials

Alessandro Repici et al.

Summary: Artificial intelligence assistance during colonoscopy can increase adenoma detection rate (ADR) and related polyp parameters in less experienced examiners compared to the control group. The level of examiner experience does not play a significant role in determining ADR, as shown in this study.
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Efficacy of a computer-aided detection system in a fecal immunochemical test-based organized colorectal cancer screening program: a randomized controlled trial (AIFIT study)

Emanuele Rondonotti et al.

Summary: The use of CADe in a FIT-based CRC screening program significantly increases the adenoma detection rate and the number of adenomas per colonoscopy. The impact of CADe appears to be consistent regardless of the endoscopist's baseline ADR.

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Computer-Aided Detection Improves Adenomas per Colonoscopy for Screening and Surveillance Colonoscopy: A Randomized Trial

Aasma Shaukat et al.

Summary: This study evaluated the clinical benefit and safety of using a computer-aided detection (CADe) device in colonoscopy procedures. The results showed that the use of CADe device significantly increased adenoma detection rate without increasing the resection of non-neoplastic lesions.

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Impact of Artificial Intelligence on Miss Rate of Colorectal Neoplasia

Michael B. Wallace et al.

Summary: This study demonstrates that the use of artificial intelligence can significantly reduce the miss rate of colorectal neoplasia, especially for small and subtle lesions. This is of great importance in improving the prevention of colorectal cancer.

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Real-time, computer-aided, detection-assisted colonoscopy eliminates differences in adenoma detection rate between trainee and experienced endoscopists

Giuseppe Biscaglia et al.

Summary: This study aimed to assess whether AI might eliminate any difference in ADR or AMR between trainee endoscopists and experienced endoscopists. The results showed no significant difference in ADR or AMR between the AI-supported trainee endoscopists and experienced endoscopists.

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Does computer-aided diagnostic endoscopy improve the detection of commonly missed polyps? A meta-analysis

Arun Sivananthan et al.

Summary: This meta-analysis examines the application of computer-aided detection (CADe) systems in colonoscopy. The results demonstrate that CADe systems can significantly improve the detection rate of commonly missed lesions.

CLINICAL ENDOSCOPY (2022)

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Mucosal imaging in colon polyps: New advances and what the future may hold

Edward John Young et al.

Summary: An expanding range of advanced mucosal imaging technologies have been developed to improve the detection and characterization of gastrointestinal tract lesions, particularly colorectal neoplasia. Improved adenoma detection reduces miss rates and prevents cancer development without significantly increasing procedural time. Accurate polyp characterization guides resection techniques and the use of different strategies. This review aims to summarize the evidence regarding these technologies and guide colonoscopic practice.

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Robust automated prediction of the revised Vienna Classification in colonoscopy using deep learning: development and initial external validation

Masayoshi Yamada et al.

Summary: An AI system has been developed that can predict pathological diagnosis based on standard colonoscopy images. The system utilizes deep learning algorithms and a large dataset of pathologically proven lesions. It outperforms expert endoscopists in differential diagnosis of colorectal neoplasia during colonoscopy.

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Artificial Intelligence-Aided Colonoscopy Does Not Increase Adenoma Detection Rate in Routine Clinical Practice

Idan Levy et al.

Summary: The study compared the effectiveness of AIAC and traditional colonoscopy, and found that the introduction of artificial intelligence did not improve the detection rates, and raised important questions on AI-human interactions in medicine.

AMERICAN JOURNAL OF GASTROENTEROLOGY (2022)

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Expected value of artificial intelligence in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Helmut Messmann et al.

Summary: The ESGE defines the expected value of AI for the diagnosis and management of gastrointestinal neoplasia and sets recommendations for its acceptance in different aspects of endoscopy.

ENDOSCOPY (2022)

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Performance and comparison of artificial intelligence and human experts in the detection and classification of colonic polyps

Ming-De Li et al.

Summary: The aim of this study was to analyze the performance of different artificial intelligence models in endoscopic colonic polyp detection and classification and compare them with doctors of different experience. The results showed that the performance of AI group in detecting and classifying colonic polyps was similar to that of the expert group, with high sensitivity and moderate specificity. Different tasks may have an impact on the performance of deep learning models and human experts, especially in terms of sensitivity and specificity.

BMC GASTROENTEROLOGY (2022)

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Cost-effectiveness of artificial intelligence for screening colonoscopy: a modelling study

Miguel Areia et al.

Summary: The study investigated the impact of implementing AI detection tools in screening colonoscopy on colorectal cancer incidence, mortality, and cost-effectiveness. The results showed that using AI tools during colonoscopy can further reduce the incidence and mortality of colorectal cancer and save costs.

LANCET DIGITAL HEALTH (2022)

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Artificial intelligence for polyp detection during colonoscopy: a systematic review and meta-analysis

Ishita Barua et al.

Summary: Through analysis of five randomized trials, it was found that the introduction of AI systems in colonoscopy can increase the detection rates of polyps and adenomas, but has no significant effect on the detection rate of advanced adenomas.

ENDOSCOPY (2021)

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Performance of artificial intelligence in colonoscopy for adenoma and polyp detection: a systematic review and meta-analysis

Cesare Hassan et al.

Summary: The meta-analysis found that incorporating artificial intelligence as an aid for detecting colorectal neoplasia significantly increases the detection rate of colorectal neoplasia, independently of the main adenoma characteristics.

GASTROINTESTINAL ENDOSCOPY (2021)

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Factors Associated with Fibrosis during Colorectal Endoscopic Submucosal Dissection: Does Pretreatment Biopsy Potentially Elicit Submucosal Fibrosis and Affect Endoscopic Submucosal Dissection Outcomes?

Masatake Kuroha et al.

Summary: This study found that pretreatment biopsy can lead to severe fibrosis during colorectal ESD, resulting in prolonged procedure times and incomplete resection.

DIGESTION (2021)

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Artificial intelligence can increase the detection rate of colorectal polyps and adenomas: a systematic review and meta-analysis

Jianglei Li et al.

Summary: This study found that artificial intelligence improves polyp and adenoma detection rates in colonoscopy, and better bowel preparation and training for detecting small polyps and adenomas can also enhance detection rates.

EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY (2021)

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Artificial intelligence-assisted colonic endocytoscopy for cancer recognition: a multicenter study

Yuichi Mori et al.

Summary: An artificial intelligence tool was developed to identify colorectal cancer pathology with high specificity using endocytoscopic images, achieving an overall accuracy of 91.9% in differentiating cancer during validation testing.

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Artificial Intelligence-Assisted Colonoscopy for Detection of Colon Polyps: a Prospective, Randomized Cohort Study

Yuchen Luo et al.

Summary: This study examined whether a high-performance, real-time automatic polyp detection system could improve the polyp detection rate in the actual clinical setting. Results showed that the AI system significantly increased the PDR and detection of smaller polyps, indicating potential for improving early detection of colorectal cancer. However, further research with a larger sample size is needed to confirm these findings.

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Artificial Intelligence-Aided Colonoscopy for Polyp Detection: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Yuanchuan Zhang et al.

Summary: The study showed that AI-aided colonoscopy significantly improved the polyp detection rate and adenoma detection rate, especially for smaller polyps. However, further improvement is needed for the shape and pathology recognition of the AI technique.

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Comparison of diagnostic performance between convolutional neural networks and human endoscopists for diagnosis of colorectal polyp: A systematic review and meta-analysis

Yixin Xu et al.

Summary: This study found through meta-analysis that the CNN system based on artificial intelligence technology has satisfactory diagnostic performance in detecting and classifying colorectal polyps, showing comparability with experts and superiority over non-experts.

PLOS ONE (2021)

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Seong Ji Choi et al.

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Boris Jansen-Winkeln et al.

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Artificial intelligence (AI) real-time detection vs. routine colonoscopy for colorectal neoplasia: a meta-analysis and trial sequential analysis

Smit S. Deliwala et al.

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INTERNATIONAL JOURNAL OF COLORECTAL DISEASE (2021)

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