title: Impact of an automated system for endocytoscopic diagnosis of small colorectal lesions: an international web-based study.
abstract: Background and study aims:Optical diagnosis of colorectal polyps is expected to improve the cost-effectiveness of colonoscopy, but achieving a high accuracy is difficult for trainees. Computer-aided diagnosis (CAD) is therefore receiving attention as an attractive tool. This study aimed to validate the efficacy of the latest CAD model for endocytoscopy (380-fold ultra-magnifying endoscopy).Patients and methods:This international web-based trial was conducted between August and November 2015. A web-based test comprising one white-light and one endocytoscopic image of 205 small colorectal polyps (≤ 10 mm) from 123 patients was undertaken by both CAD and by endoscopists (three experts and ten non-experts from three countries). Outcome measures were accuracy in identifying neoplastic change in diminutive (≤ 5 mm) and small (≤ 10 mm) polyps, and accuracy in predicting post-polypectomy surveillance intervals according to current guidelines for high confidence optical diagnoses of diminutive polyps.Results:Of the 205 small polyps (147 neoplastic and 58 non-neoplastic), 139 were diminutive. CAD was accurate for 89 % (95 % confidence interval [CI] 83 % - 94 %) of diminutive polyps and 89 % (84 % - 93 %) of small polyps, which was significantly greater than results for the non-experts (73 % [71 % - 76 %],P< 0.001; and 76 % [74 % - 78 %],P< 0.001, respectively) and comparable with the experts' results (90 % [87 % - 93 %],P= 0.703; and 91 % [89 % - 93 %],P= 0.106, respectively). The surveillance interval predicted by CAD provided 98 % (93 % - 100 %) and 96 % (91 % - 99 %) agreement with pathology-directed intervals of the European and American guidelines, respectively.Conclusions:The use of CAD in endocytoscopy can be effective in the management of diminutive/small colorectal polyps.UMIN Clinical Trial Registry: UMIN000018185.
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors: Yuichi
authors: Y
authors: Mori
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors: Shin-Ei
authors: SE
authors: Kudo
authors: Department of Surgery, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong.
authors: Philip Wai Yan
authors: PW
authors: Chiu
authors: Endoscopy Unit, Lyell McEwin Hospital and University of Adelaide, Adelaide, Australia.
authors: Rajvinder
authors: R
authors: Singh
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors: Masashi
authors: M
authors: Misawa
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors: Kunihiko
authors: K
authors: Wakamura
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors: Toyoki
authors: T
authors: Kudo
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors: Takemasa
authors: T
authors: Hayashi
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors: Atsushi
authors: A
authors: Katagiri
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors: Hideyuki
authors: H
authors: Miyachi
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors: Fumio
authors: F
authors: Ishida
authors: Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors: Yasuharu
authors: Y
authors: Maeda
authors: Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
authors: Haruhiro
authors: H
authors: Inoue
authors: Locus Logic, Inc., Nagoya, Japan.
authors: Yukitaka
authors: Y
authors: Nimura
authors: Graduate School of Information Science, Nagoya University, Nagoya, Japan.
authors: Masahiro
authors: M
authors: Oda
authors: Information and Communications, Nagoya University, Nagoya, Japan.
authors: Kensaku
authors: K
authors: Mori
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology; D000368:Aged; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003111:Colonic Polyps / Q000000981:diagnostic imaging* / Q000473:pathology; D003113:Colonoscopy; D003936:Diagnosis, Computer-Assisted; D005260:Female; D006801:Humans; D038622:Internationality; D020407:Internet; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D061848:Optical Imaging; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D047368:Tumor Burden