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Area of Science:

  • Gastroenterology
  • Medical Imaging
  • Diagnostic Technology

Background:

  • Computer-aided diagnosis (CADx) aims to predict polyp histology during colonoscopy, potentially reducing unnecessary removal of nonneoplastic polyps.
  • The actual clinical benefits and harms associated with CADx in colonoscopy remain uncertain.

Purpose of the Study:

  • To quantify the clinical benefit and harm of using CADx for the optical diagnosis of small (≤5-mm) rectosigmoid polyps during colonoscopy.

Main Methods:

  • A systematic review and meta-analysis of histologically verified diagnostic accuracy studies evaluating real-time physician performance with and without CADx assistance.
  • Searched Medline, Embase, and Scopus databases for relevant studies published before December 22, 2023.
  • Clinical benefit and harm were estimated using accuracy values, with histology as the reference standard. The GRADE framework assessed the certainty of evidence.

Main Results:

  • Ten studies analyzed 4103 small rectosigmoid polyps in 3620 patients. CADx alone showed 87.3% sensitivity and 88.9% specificity for predicting neoplastic change.
  • Comparing performance before and after CADx assistance, there was no significant difference in avoiding removal of nonneoplastic polyps (55.4% vs. 58.4%) or in erroneously leaving neoplastic polyps in situ (8.2% vs. 7.5%).
  • Evidence certainty for these outcomes was moderate.

Conclusions:

  • Computer-aided diagnosis (CADx) provided no incremental benefit or harm in the management of small rectosigmoid polyps during colonoscopy.
  • The simulated application of optical diagnosis in studies may have influenced operator decision-making, representing a limitation.