Background and Aims

False positive (FP) results by computer-aided detection (CADe) hamper the efficiency of colonoscopy by extending examination time. Our aim was to develop a classification of the causes and clinical relevance of CADe FPs, and to assess the relative distribution of FPs in a real-life setting.

Methods

In a post-hoc analysis of a randomized trial comparing colonoscopy with and without CADe (NCT: 04079478), we extracted 40 CADe colonoscopy videos. Using a modified Delphi process, 4 expert endoscopists identified the main domains for the reasons and clinical relevance of FPs. Then, 2 expert endoscopists manually examined each FP and classified it according to the proposed domains. The analysis was limited to the withdrawal phase.

Results

The 2 main domains for the causes of CADe FPs were identified as artifacts due to either the mucosal wall or bowel content, and clinical relevance was defined as the time spent on FPs and the FP rate per minute. The mean number of FPs per colonoscopy was 27.3 ± 13.1, of which 24 ± 12 (88%) and 3.2 ± 2.6 (12%) were due to artifacts in the bowel wall and bowel content, respectively. Of the 27.3 FPs per colonoscopy, 1.6 (5.7%) required additional exploration time of 4.8 ± 6.2 seconds per FP (ie, 0.7% of the mean withdrawal time). In detail, 15 (24.2%), 33 (53.2%), and 14 (22.6%) FPs were classified as being of mild, moderate, or severe clinical relevance. The rate of FPs per minute of withdrawal time was 2.4 ± 1.2, and was higher for FPs due to artifacts from the bowel wall than for those from bowel content (2.4 ± 0.6 vs 0.3 ± 0.2, P < .001).

Conclusions

FPs by CADe are primarily due to artifacts from the bowel wall. Despite a high frequency, FPs result in a negligible 1% increase in the total withdrawal time because most of them are immediately discarded by the endoscopist.

中文翻译：

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计算机辅助检测辅助结肠镜检查：假阳性的分类和相关性。

背景和目标

计算机辅助检测（CADe）产生的假阳性（FP）结果通过延长检查时间而影响了结肠镜检查的效率。我们的目的是对CADe FP的原因和临床相关性进行分类，并评估在现实生活中FP的相对分布。

方法

在一项随机试验的事后分析中，比较了有无CADe的结肠镜检查（NCT：04079478），我们提取了40篇CADe结肠镜检查视频。使用改进的Delphi程序，4名内镜专家根据FP的原因和临床相关性确定了主要领域。然后，由两名内镜专家对每个FP进行手动检查，并根据提议的领域对其进行分类。分析仅限于退出阶段。

结果

由于粘膜壁或肠内容物，将导致CADe FPs的两个主要领域确定为伪影，并且将临床相关性定义为花费在FPs上的时间和每分钟的FP率。每次结肠镜检查平均FP数为27.3±13.1，其中24±12（88％）和3.2±2.6（12％）分别是由于肠壁和肠内容物中的伪影所致。每个结肠镜检查中的27.3个FP中，有1.6个（5.7％）需要每个FP额外的探索时间4.8±6.2秒（即平均撤药时间的0.7％）。详细地，将15个（24.2％），33个（53.2％）和14个（22.6％）FP归为轻度，中度或严重临床相关性。撤离时间每分钟FP的速率为2.4±1.2，并且由于来自肠壁的伪影而导致的FP高于来自肠内容物的FP（2.4±0.6 vs 0.3±0.2，P  <.001）。

结论

CADe的FP主要归因于肠壁的伪影。尽管频率很高，但FP导致总退出时间增加了1％，几乎可以忽略不计，因为大多数内镜医师会立即将其丢弃。