Background & aims: Computer-Aided Diagnosis (CADx) assists endoscopists in differentiating between neoplastic and non-neoplastic polyps during colonoscopy. This study aimed to evaluate the impact of polyp location (proximal vs. distal colon) on the diagnostic performance of CADx for ≤5mm polyps. Methods: We searched for studies evaluating the performance of real-time CADx alone (i.e., independently of endoscopist judgement) for predicting the histology of colorectal polyps ≤5mm. The primary endpoints were CADx sensitivity and specificity in the proximal and distal colon. Secondary outcomes were the negative predictive value (NPV), positive predictive value (PPV), and the accuracy of the CADx alone. Distal colon was limited to the rectum and sigmoid. Results: We included 11 studies for analysis with a total of 7,782 <5mm polyps. CADx specificity was significantly lower in the proximal colon compared to the distal colon (62% versus 85%; Risk ratio (RR): 0.74 [95% CI: 0.72-0.84]). Conversely, sensitivity was similar (89% vs 87% (EC-1); RR: 1.00 [95% CI: 0.97-1.03]. The NPV (64% versus 93%; RR: 0.71 [95% CI: 0.64-0.79]) and accuracy (81% vs 86%; RR: 0.95 [95% CI: 0.91-0.99]) were significantly lower in the proximal than distal colon, while PPV was higher in the proximal colon (87% vs 76%; RR: 1.11 [95% CI: 1.06-1.17]). Conclusion: The diagnostic performance of CADx for polyps in the proximal colon is inadequate, exhibiting significantly lower specificity compared to its performance for distal polyps. While current CADx systems are suitable for use in the distal colon, they should not be employed for proximal polyps until more performant systems are developed specifically for these lesions.
Accuracy of Computer-aided Diagnosis in Colonoscopy Varies according to Polyp Location. A Systematic Review and Meta-analysis
Facciorusso, Antonio;
2024-01-01
Abstract
Background & aims: Computer-Aided Diagnosis (CADx) assists endoscopists in differentiating between neoplastic and non-neoplastic polyps during colonoscopy. This study aimed to evaluate the impact of polyp location (proximal vs. distal colon) on the diagnostic performance of CADx for ≤5mm polyps. Methods: We searched for studies evaluating the performance of real-time CADx alone (i.e., independently of endoscopist judgement) for predicting the histology of colorectal polyps ≤5mm. The primary endpoints were CADx sensitivity and specificity in the proximal and distal colon. Secondary outcomes were the negative predictive value (NPV), positive predictive value (PPV), and the accuracy of the CADx alone. Distal colon was limited to the rectum and sigmoid. Results: We included 11 studies for analysis with a total of 7,782 <5mm polyps. CADx specificity was significantly lower in the proximal colon compared to the distal colon (62% versus 85%; Risk ratio (RR): 0.74 [95% CI: 0.72-0.84]). Conversely, sensitivity was similar (89% vs 87% (EC-1); RR: 1.00 [95% CI: 0.97-1.03]. The NPV (64% versus 93%; RR: 0.71 [95% CI: 0.64-0.79]) and accuracy (81% vs 86%; RR: 0.95 [95% CI: 0.91-0.99]) were significantly lower in the proximal than distal colon, while PPV was higher in the proximal colon (87% vs 76%; RR: 1.11 [95% CI: 1.06-1.17]). Conclusion: The diagnostic performance of CADx for polyps in the proximal colon is inadequate, exhibiting significantly lower specificity compared to its performance for distal polyps. While current CADx systems are suitable for use in the distal colon, they should not be employed for proximal polyps until more performant systems are developed specifically for these lesions.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
