Artificial intelligence-assisted optical diagnosis for the resect-and-discard strategy in clinical practice: the Artificial intelligence BLI Characterization (ABC) study

医学 结肠镜检查 息肉切除术 置信区间 内窥镜检查 内科学 放射科 外科 普通外科 结直肠癌 癌症
作者
Emanuele Rondonotti,Cesare Hassan,Giacomo Tamanini,Giulio Antonelli,Gianluca Andrisani,G Léonetti,Silvia Paggi,Arnaldo Amato,Giulia Scardino,Dhanai Di Paolo,Giovanna Mandelli,Nicoletta Lenoci,Natalia Terreni,Alida Andrealli,Roberta Maselli,Marco Spadaccini,P.A. Galtieri,Loredana Correale,Alessandro Repici,Francesco Maria Di Matteo,Luciana Ambrosiani,Emanuela Filippi,Prateek Sharma,Franco Radaelli
出处
期刊:Endoscopy [Thieme Medical Publishers (Germany)]
卷期号:55 (01): 14-22 被引量:67
标识
DOI:10.1055/a-1852-0330
摘要

Optical diagnosis of colonic polyps is poorly reproducible outside of high volume referral centers. The present study aimed to assess whether real-time artificial intelligence (AI)-assisted optical diagnosis is accurate enough to implement the leave-in-situ strategy for diminutive (≤ 5 mm) rectosigmoid polyps (DRSPs).Consecutive colonoscopy outpatients with ≥ 1 DRSP were included. DRSPs were categorized as adenomas or nonadenomas by the endoscopists, who had differing expertise in optical diagnosis, with the assistance of a real-time AI system (CAD-EYE). The primary end point was ≥ 90 % negative predictive value (NPV) for adenomatous histology in high confidence AI-assisted optical diagnosis of DRSPs (Preservation and Incorporation of Valuable endoscopic Innovations [PIVI-1] threshold), with histopathology as the reference standard. The agreement between optical- and histology-based post-polypectomy surveillance intervals (≥ 90 %; PIVI-2 threshold) was also calculated according to European Society of Gastrointestinal Endoscopy (ESGE) and United States Multi-Society Task Force (USMSTF) guidelines.Overall 596 DRSPs were retrieved for histology in 389 patients; an AI-assisted high confidence optical diagnosis was made in 92.3 %. The NPV of AI-assisted optical diagnosis for DRSPs (PIVI-1) was 91.0 % (95 %CI 87.1 %-93.9 %). The PIVI-2 threshold was met with 97.4 % (95 %CI 95.7 %-98.9 %) and 92.6 % (95 %CI 90.0 %-95.2 %) of patients according to ESGE and USMSTF, respectively. AI-assisted optical diagnosis accuracy was significantly lower for nonexperts (82.3 %, 95 %CI 76.4 %-87.3 %) than for experts (91.9 %, 95 %CI 88.5 %-94.5 %); however, nonexperts quickly approached the performance levels of experts over time.AI-assisted optical diagnosis matches the required PIVI thresholds. This does not however offset the need for endoscopists' high level confidence and expertise. The AI system seems to be useful, especially for nonexperts.
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