Background

Computer-aided detection (CADe) techniques based on artificial intelligence algorithms can assist endoscopists in detecting colorectal neoplasia. CADe has been associated with an increased adenoma detection rate, a key quality indicator, but the utility of CADe compared with existing advanced imaging techniques and distal attachment devices is unclear.

Methods

For this systematic review and network meta-analysis, we did a comprehensive search of PubMed/Medline, Embase, and Scopus databases from inception to Nov 30, 2020, for randomised controlled trials investigating the effectiveness of the following endoscopic techniques in detecting colorectal neoplasia: CADe, high definition (HD) white-light endoscopy, chromoendoscopy, or add-on devices (ie, systems that increase mucosal visualisation, such as full spectrum endoscopy [FUSE] or G-EYE balloon endoscopy). We collected data on adenoma detection rates, sessile serrated lesion detection rates, the proportion of large adenomas detected per colonoscopy, and withdrawal times. A frequentist framework, random-effects network meta-analysis was done to compare artificial intelligence with chromoendoscopy, increased mucosal visualisation systems, and HD white-light endoscopy (the control group). We estimated odds ratios (ORs) for the adenoma detection rate, sessile serrated lesion detection rate, and proportion of large adenomas detected per colonoscopy, and calculated mean differences for withdrawal time, with 95% CIs. Risk of bias and certainty of evidence were assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Findings

50 randomised controlled trials, comprising 34 445 participants, were included in our main analysis (six trials of CADe, 18 of chromoendoscopy, and 26 of increased mucosal visualisation systems). HD white-light endoscopy was the control technique in all 50 studies. Compared with the control technique, the adenoma detection rate was 7·4% higher with CADe (OR 1·78 [95% CI 1·44–2·18]), 4·4% higher with chromoendoscopy (1·22 [1·08–1·39]), and 4·1% higher with increased mucosal visualisation systems (1·16 [1·04–1·28]). CADe ranked as the superior technique for adenoma detection (with moderate confidence in hierarchical ranking); cross-comparisons of CADe with other imaging techniques showed a significant increase in the adenoma detection rate with CADe versus increased mucosal visualisation systems (OR 1·54 [95% CI 1·22–1·94]; low certainty of evidence) and with CADe versus chromoendoscopy (1·45 [1·14–1·85]; moderate certainty of evidence). When focusing on large adenomas (≥10 mm) there was a significant increase in the detection of large adenomas only with CADe (OR 1·69 [95% CI 1·10–2·60], moderate certainty of evidence) when compared to HD white-light endoscopy; CADe ranked as the superior strategy for detection of large adenomas. CADe also seemed to be the superior strategy for detection of sessile serrated lesions (with moderate confidence in hierarchical ranking), although no significant increase in the sessile serrated lesion detection rate was shown (OR 1·37 [95% CI 0·65–2·88]). No significant difference in withdrawal time was reported for CADe compared with the other techniques.

Interpretation

Based on the published literature, detection rates of colorectal neoplasia are higher with CADe than with other techniques such as chromoendoscopy or tools that increase mucosal visualisation, supporting wider incorporation of CADe strategies into community endoscopy services.

Funding

None.

中文翻译：

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计算机辅助检测与先进成像检测结直肠肿瘤：系统评价和网络荟萃分析

背景

基于人工智能算法的计算机辅助检测 (CADe) 技术可以帮助内窥镜医师检测结直肠肿瘤。CADe 与提高的腺瘤检出率有关，这是一个关键的质量指标，但与现有的先进成像技术和远端附着装置相比，CADe 的效用尚不清楚。

方法

在本系统评价和网络荟萃分析中，我们对 PubMed/Medline、Embase 和 Scopus 数据库从成立到 2020 年 11 月 30 日进行了全面搜索，以进行随机对照试验，以研究以下内窥镜技术在检测结直肠肿瘤方面的有效性： CADe、高清 (HD) 白光内窥镜、色素内窥镜或附加设备（即增加粘膜可视化的系统，例如全光谱内窥镜 [FUSE] 或 G-EYE 球囊内窥镜）。我们收集了有关腺瘤检出率、无蒂锯齿状病变检出率、每次结肠镜检查检测到的大腺瘤比例和停药时间的数据。一个频率论框架、随机效应网络荟萃分析被用来比较人工智能与色素内窥镜、增加的粘膜可视化系统、和高清白光内窥镜（对照组）。我们估计了腺瘤检出率、无柄锯齿状病变检出率和每次结肠镜检查检测到的大腺瘤比例的优势比 (OR)，并计算了停药时间的平均差异，具有 95% 的 CI。使用推荐分级评估、制定和评估 (GRADE) 方法评估偏倚风险和证据的确定性。

发现

我们的主要分析包括 50 项随机对照试验，包括 34 445 名参与者（6 项 CADe 试验、18 项色素内镜试验和 26 项增加的粘膜可视化系统试验）。高清白光内窥镜检查是所有 50 项研究的对照技术。与对照技术相比，CADe 的腺瘤检出率高 7·4%（OR 1·78 [95% CI 1·44–2·18]），色素内镜检查的检出率高 4·4%（1·22 [1 ·08-1·39]），并且随着粘膜可视化系统的增加（1·16 [1·04-1·28]）增加4·1％。CADe 被评为腺瘤检测的优越技术（对分级排序具有中等信心）；CADe 与其他成像技术的交叉比较显示，与增加的粘膜可视化系统相比，CADe 的腺瘤检出率显着提高（OR 1·54 [95% CI 1·22–1·94]；低质量证据）和 CADe 与色素内镜检查（1·45 [1·14–1·85]；中等质量证据）。当关注大腺瘤（≥10 mm）时，仅使用 CADe 检测大腺瘤的几率显着增加（OR 1·69 [95% CI 1·10–2·60]，证据质量中等）与高清白光内窥镜；CADe 被列为检测大腺瘤的优越策略。CADe 似乎也是检测无蒂锯齿状病变的优越策略（对分级排序具有中等置信度），尽管未显示无蒂锯齿状病变检出率显着增加（OR 1·37 [95% CI 0·65-2 ·88]）。与其他技术相比，CADe 的停药时间没有显着差异。中等质量证据）。当关注大腺瘤（≥10 mm）时，仅使用 CADe 检测大腺瘤的几率显着增加（OR 1·69 [95% CI 1·10–2·60]，证据质量中等）与高清白光内窥镜；CADe 被列为检测大腺瘤的优越策略。CADe 似乎也是检测无蒂锯齿状病变的优越策略（对分级排序具有中等置信度），尽管未显示无蒂锯齿状病变检出率显着增加（OR 1·37 [95% CI 0·65-2 ·88]）。与其他技术相比，CADe 的停药时间没有显着差异。中等质量证据）。当关注大腺瘤（≥10 mm）时，仅使用 CADe 检测大腺瘤的几率显着增加（OR 1·69 [95% CI 1·10–2·60]，证据质量中等）与高清白光内窥镜；CADe 被列为检测大腺瘤的优越策略。CADe 似乎也是检测无蒂锯齿状病变的优越策略（对分级排序具有中等置信度），尽管未显示无蒂锯齿状病变检出率显着增加（OR 1·37 [95% CI 0·65-2 ·88]）。与其他技术相比，CADe 的停药时间没有显着差异。中等质量证据）与 HD 白光内窥镜相比；CADe 被列为检测大腺瘤的优越策略。CADe 似乎也是检测无蒂锯齿状病变的优越策略（对分级排序具有中等置信度），尽管未显示无蒂锯齿状病变检出率显着增加（OR 1·37 [95% CI 0·65-2 ·88]）。与其他技术相比，CADe 的停药时间没有显着差异。中等质量证据）与 HD 白光内窥镜相比；CADe 被列为检测大腺瘤的优越策略。CADe 似乎也是检测无蒂锯齿状病变的优越策略（对分级排序具有中等置信度），尽管未显示无蒂锯齿状病变检出率显着增加（OR 1·37 [95% CI 0·65-2 ·88]）。与其他技术相比，CADe 的停药时间没有显着差异。尽管无蒂锯齿状病变检出率没有显着增加（OR 1·37 [95% CI 0·65–2·88]）。与其他技术相比，CADe 的停药时间没有显着差异。尽管无蒂锯齿状病变检出率没有显着增加（OR 1·37 [95% CI 0·65–2·88]）。与其他技术相比，CADe 的停药时间没有显着差异。

解释

根据已发表的文献，CADe 的结直肠肿瘤检出率高于其他技术，如染色内镜检查或增加粘膜可视化的工具，支持更广泛地将 CADe 策略纳入社区内窥镜检查服务。

资金

没有任何。