Abstract
BackgroundThe high incidence and mortality rate of colorectal cancer require new technologies to improve its early diagnosis. This study aims at extracting the medical needs related to the endoscopic technology and the colonoscopy procedure currently used for colorectal cancer diagnosis, essential for designing these demanded technologies.MethodsSemi-structured interviews and an online survey were used.ResultsSix endoscopists were interviewed and 103 were surveyed, obtaining the demanded needs that can be divided into: a) clinical needs, for better polyp detection and classification (especially flat polyps), location, size, margins and penetration depth; b) computer-aided diagnosis (CAD) system needs, for additional visual information supporting polyp characterization and diagnosis; and c) operational/physical needs, related to limitations of image quality, colon lighting, flexibility of the endoscope tip, and even poor bowel preparation.ConclusionsThis study shows some undertaken initiatives to meet the detected medical needs and challenges to be solved. The great potential of advanced optical technologies suggests their use for a better polyp detection and classification since they provide additional functional and structural information than the currently used image enhancement technologies. The inspection of remaining tissue of diminutive polyps (< 5 mm) should be addressed to reduce recurrence rates. Few progresses have been made in estimating the infiltration depth. Detection and classification methods should be combined into one CAD system, providing visual aids over polyps for detection and displaying a Kudo-based diagnosis suggestion to assist the endoscopist on real-time decision making. Estimated size and location of polyps should also be provided. Endoscopes with 360° vision are still a challenge not met by the mechanical and optical systems developed to improve the colon inspection. Patients and healthcare providers should be trained to improve the patient’s bowel preparation.
Highlights
The high incidence and mortality rate of colorectal cancer require new technologies to improve its early diagnosis
Almost 30% of the polyps are not detected [6], so it is important to improve the adenoma detection rates (ADR), as every 1% of its increase is associated to a 3% decrease of Colorectal cancer (CRC) risk, and 5% decrease of mortality related to CRC [7]
Results from interviews and questionnaires revealed that needs might be clustered into three different groups: (a) clinical needs, mainly related to problems in polyp detection and classification, especially flats polyps, as well as their location, size, margins and penetration depth or invasiveness more precisely during colonoscopy; (b) Computer Aided Diagnosis (CAD) system needs, demanding visual information/ alarms for assisting on the polyp characterization and diagnosis, and (c) operational/physical needs, especially in terms of equipment limitations related to image quality and colon lighting, poor bowel preparation or the flexibility of the endoscope tip
Summary
The high incidence and mortality rate of colorectal cancer require new technologies to improve its early diagnosis. In the current gold standard procedure (Fig. 1), all polyps (both hyperplastic and neoplastic) are resected and sent to histopathological analysis for diagnosis, strategies as “diagnose and leave” for hyperplastic polyps or “resect and discard” for neoplastic polyps could be followed, depending on the used diagnostic technique and the experience of the endoscopist [8, 9] This standard diagnostic clinical procedure still depends on biopsy, tissue sample preparation and detailed analysis by an expert pathologist, which includes extraction, preparation, cutting, and staining with Hematoxylin-Eosine to assess the morphological pattern. This protocol implies high diagnostic time and costs and may unnecessarily expose patients to the risks associated to polypectomy, besides the high psychological impact that the waiting time might cause [10]. While adenomatous polyps have malignant potential and must be resected to protect against CRC, hyperplastic polyps have not and can be left
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