Role of Artificial Intelligence in Colonoscopy Detection of Advanced Neoplasias : A Randomized Trial.

Abstract

The role of computer-aided detection in identifying advanced colorectal neoplasia is unknown. To evaluate the contribution of computer-aided detection to colonoscopic detection of advanced colorectal neoplasias as well as adenomas, serrated polyps, and nonpolypoid and right-sided lesions. Multicenter, parallel, randomized controlled trial. (ClinicalTrials.gov: NCT04673136). Spanish colorectal cancer screening program. 3213 persons with a positive fecal immunochemical test. Enrollees were randomly assigned to colonoscopy with or without computer-aided detection. Advanced colorectal neoplasia was defined as advanced adenoma and/or advanced serrated polyp. The 2 comparison groups showed no significant difference in advanced colorectal neoplasia detection rate (34.8% with intervention vs. 34.6% for controls; adjusted risk ratio [aRR], 1.01 [95% CI, 0.92 to 1.10]) or the mean number of advanced colorectal neoplasias detected per colonoscopy (0.54 [SD, 0.95] with intervention vs. 0.52 [SD, 0.95] for controls; adjusted rate ratio, 1.04 [99.9% CI, 0.88 to 1.22]). Adenoma detection rate also did not differ (64.2% with intervention vs. 62.0% for controls; aRR, 1.06 [99.9% CI, 0.91 to 1.23]). Computer-aided detection increased the mean number of nonpolypoid lesions (0.56 [SD, 1.25] vs. 0.47 [SD, 1.18] for controls; adjusted rate ratio, 1.19 [99.9% CI, 1.01 to 1.41]), proximal adenomas (0.94 [SD, 1.62] vs. 0.81 [SD, 1.52] for controls; adjusted rate ratio, 1.17 [99.9% CI, 1.03 to 1.33]), and lesions of 5 mm or smaller (polyps in general and adenomas and serrated lesions in particular) detected per colonoscopy. The high adenoma detection rate in the control group may limit the generalizability of the findings to endoscopists with low detection rates. Computer-aided detection did not improve colonoscopic identification of advanced colorectal neoplasias. Medtronic.