Endoscopic screening for oesophageal cancer: empowering artificial intelligence with a high-quality examination

Oesophageal squamous cell carcinoma, the predominant oesophageal cancer subtype in the world, has a poor prognosis when diagnosed at a late stage. 1 Abnet CC Arnold M Wei W-Q Epidemiology of esophageal squamous cell carcinoma. Gastroenterology. 2018; 154: 360-373 Summary Full Text Full Text PDF PubMed Google Scholar Data to support the practice of endoscopic screening for oesophageal squamous cell carcinoma in populations at risk come from prospective cohort studies and randomised controlled trials that show a significant improvement in early detection and treatment, with an associated reduction in all-cause mortality. 2 Li H Teng Y Yan X et al. Profiles and findings of population-based esophageal cancer screening with endoscopy in China: systematic review and meta-analysis. JMIR Public Health Surveill. 2023; 9e45360 Crossref Scopus (1) Google Scholar A high-quality endoscopic screening examination for oesophageal squamous cell carcinoma involves systematic visualisation of the entire oesophagus, preferentially with the use of high-definition white light endoscopy in combination with digital chromoendoscopy. Unfortunately, in clinical practice, endoscopic screening for oesophageal squamous cell carcinoma is associated with a misdiagnosis rate of 6·4% (95% CI 4·4–9·3), in part due to the subtle appearance of early lesions. 3 Rodríguez de Santiago E Hernanz N Marcos-Prieto HM et al. Rate of missed oesophageal cancer at routine endoscopy and survival outcomes: a multicentric cohort study. United European Gastroenterol J. 2019; 7: 189-198 Crossref PubMed Scopus (37) Google Scholar Strategies to improve diagnostic performance include the use of iodine staining, a technique associated with longer procedural times and a slightly higher risk of adverse events compared with standard-of-care endoscopy. 4 Codipilly DC Qin Y Dawsey SM et al. Screening for esophageal squamous cell carcinoma: recent advances. Gastrointest Endosc. 2018; 88: 413-426 Summary Full Text Full Text PDF PubMed Scopus (147) Google Scholar The use of magnified endoscopy in combination with digital chromoendoscopy has also been shown to improve the diagnosis of early oesophageal squamous cell carcinoma but requires special equipment and technical expertise. 4 Codipilly DC Qin Y Dawsey SM et al. Screening for esophageal squamous cell carcinoma: recent advances. Gastrointest Endosc. 2018; 88: 413-426 Summary Full Text Full Text PDF PubMed Scopus (147) Google Scholar Advances in artificial intelligence (AI) have led to the development of advanced computer-aided detection algorithms, which promise to improve early detection of oesophageal squamous cell carcinoma and reduce lesion misdiagnosis. An advantage of computer-aided detection systems compared with adjunct screening modalities is their ability to provide automated real-time lesion identification with minimal training for use. Several published computer-aided detection models show high accuracy in detecting early-stage oesophageal squamous cell carcinoma, but few have truly been put through rigorous testing. 5 Pan Y He L Chen W Yang Y The current state of artificial intelligence in endoscopic diagnosis of early esophageal squamous cell carcinoma. Front Oncol. 2023; 131198941 Crossref Scopus (1) Google Scholar Effect of an artificial intelligence-assisted system on endoscopic diagnosis of superficial oesophageal squamous cell carcinoma and precancerous lesions: a multicentre, tandem, double-blind, randomised controlled trialThe observed effect of AI-assisted endoscopy on the per-lesion and per-patient miss rates of superficial oesophageal squamous cell carcinoma and precancerous lesions under WLE and non-magnified NBI was consistent with substantial benefit through to a neutral or small negative effect. The effectiveness and cost–benefit of this AI system in real-world clinical settings remain to be further assessed. Full-Text PDF