Abstract
BackgroundMost colorectal polyps are diminutive and benign, especially those in the rectosigmoid colon, and the resection of these polyps is not cost-effective. Advancements in image-enhanced endoscopy have improved the optical prediction of colorectal polyp histology. However, subjective interpretability and inter- and intraobserver variability prohibits widespread implementation. The number of studies on computer-aided diagnosis (CAD) is increasing; however, their small sample sizes limit statistical significance.ObjectiveThis review aims to evaluate the diagnostic test accuracy of CAD models in predicting the histology of diminutive colorectal polyps by using endoscopic images.MethodsCore databases were searched for studies that were based on endoscopic imaging, used CAD models for the histologic diagnosis of diminutive colorectal polyps, and presented data on diagnostic performance. A systematic review and diagnostic test accuracy meta-analysis were performed.ResultsOverall, 13 studies were included. The pooled area under the curve, sensitivity, specificity, and diagnostic odds ratio of CAD models for the diagnosis of diminutive colorectal polyps (adenomatous or neoplastic vs nonadenomatous or nonneoplastic) were 0.96 (95% CI 0.93-0.97), 0.93 (95% CI 0.91-0.95), 0.87 (95% CI 0.76-0.93), and 87 (95% CI 38-201), respectively. The meta-regression analysis showed no heterogeneity, and no publication bias was detected. Subgroup analyses showed robust results. The negative predictive value of CAD models for the diagnosis of adenomatous polyps in the rectosigmoid colon was 0.96 (95% CI 0.95-0.97), and this value exceeded the threshold of the diagnosis and leave strategy.ConclusionsCAD models show potential for the optical histological diagnosis of diminutive colorectal polyps via the use of endoscopic images.Trial RegistrationPROSPERO CRD42021232189; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=232189
Highlights
Colorectal cancer (CRC) is the third most common cancer based on incidence statistics and the second leading cause of cancer-related deaths worldwide [1]
Colonoscopy with the identification and removal of these neoplastic polyps is a standard screening method for CRC, which has been proven to reduce cancer-related mortality [2,3]. This is because polyp removal through colonoscopy prevents the development of CRCs by interrupting the adenoma-carcinoma sequence, which is the most reliable stepwise pathogenesis of CRC development [4]
This study aims to evaluate the diagnostic test accuracy (DTA) of computer-aided diagnosis (CAD) models used for the histologic diagnosis of diminutive colorectal polyps (DCPs) using endoscopic images
Summary
Colorectal cancer (CRC) is the third most common cancer based on incidence statistics and the second leading cause of cancer-related deaths worldwide [1]. Colonoscopy with the identification and removal of these neoplastic polyps is a standard screening method for CRC, which has been proven to reduce cancer-related mortality [2,3]. Current practice points out the removal of all detected polyps and sending them for histologic evaluation [10] This may help determine the surveillance interval for CRC screening with per-patient risk stratification [8]. Objective: This review aims to evaluate the diagnostic test accuracy of CAD models in predicting the histology of diminutive colorectal polyps by using endoscopic images. Methods: Core databases were searched for studies that were based on endoscopic imaging, used CAD models for the histologic diagnosis of diminutive colorectal polyps, and presented data on diagnostic performance.
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