计算机辅助检测在结肠镜检查中的争议
Martin Putera1,2, Frederick Hong Xiang Koh2,3, James Weiquan Li4,5
1Department of General Medicine, Sengkang General Hospital, Singapore, Singapore.
计算机辅助检测 (CADe) 提高了结肠镜检查中的腺瘤检测率 (ADR),主要是用于小的息肉. 然而,现实世界的好处是不一致的,引发了对有效性和潜在危害的担忧.
科学领域:
- 胃肠病学 胃肠病学
- 医疗成像医学成像
- 人工智能在医学中的应用
背景情况:
- 在内镜中,计算机辅助检测 (CADe) 在随机对照试验 (RCT) 中显示出改善腺瘤检测率 (ADR) 的前景.
- 尽管RCT有好处,但在常规结肠镜检查中采用CADe仍在争论中,国际指导方针建议相互矛盾.
研究的目的:
- 评估CADe在结肠镜检查中的有效性和有效性.
- 分析CADe对腺瘤检测,成本效益和潜在危害的影响.
主要方法:
- 从随机对照试验 (RCT) 和现实世界实施研究中获得的证据的审查.
- 分析成本效益研究,并考虑潜在的伤害,如失业.
主要成果:
- 在RCT中,CADe显著增加了ADR,主要检测小腺瘤,对晚期腺瘤的影响有限.
- 现实研究表明,与RCT相比,CADe的益处减少了,这可能是由于霍桑效应和息肉管理等因素.
- 成本效益通常是有利的,但取决于关于ADR改进和CADe成本的假设.
结论:
- 在现实世界中,CADe的有效性是不一致的,主要是在微小腺瘤中获得的益处,对显著的临床结果的影响不确定.
- 潜在的危害包括非新发性病变的多样性增加和内镜医生的脱训.
- 需要进一步的研究来弥合试验有效性和现实世界的有效性之间的差距,优化监测,并在广泛实施CADe之前解决人与人工智能的相互作用.
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