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Variability in computer-aided detection effect on adenoma detection rate in randomized controlled trials: A
Marco Spadaccini1, Cesare Hassan1, Yuichi Mori2
1Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy.
Summary
Computer-aided detection (CADe) systems improve adenoma detection rate (ADR) during colonoscopy. Factors like patient age, ADR in control groups, and withdrawal time influence CADe
Area of Science:
- Gastroenterology
- Medical Imaging
- Health Technology Assessment
Background:
- Computer-aided detection (CADe) systems are utilized in colonoscopy to enhance adenoma detection rates (ADR).
- Previous randomized controlled trials (RCTs) have shown variable results regarding the efficacy of CADe systems.
- Investigating the factors contributing to this heterogeneity is crucial for optimizing CADe implementation.
Purpose of the Study:
- To identify and analyze variables that influence the effectiveness of CADe-assisted colonoscopy.
- To understand how patient and procedural factors impact the adenoma detection rate (ADR) when using CADe systems.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, EMBASE, Scopus) up to July 2023.
- A random-effects meta-analysis of 23 RCTs involving 19,077 patients was performed to pool adenoma detection rates (ADR).
- Meta-regression analyses (univariable and multivariable) were employed to explore heterogeneity, examining factors such as patient demographics, colonoscopy indication, ADR in control arms, and withdrawal time.
Main Results:
- CADe-assisted colonoscopy resulted in a higher pooled ADR (46%) compared to standard colonoscopy (38%), with a risk ratio of 1.22.
- Significant heterogeneity was observed (I² = 67.69%), indicating variability in CADe's impact across studies.
- Meta-regression identified patient age, ADR in control arms, and withdrawal time as significant predictors of CADe's effect on ADR.
Conclusions:
- The heterogeneity in CADe's effectiveness is linked to variations in colonoscopy quality indicators.
- Adenoma detection rate in the control group and withdrawal time were identified as key factors influencing the performance of CADe systems.
- Optimizing colonoscopy quality may enhance the benefits of CADe-assisted procedures.
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