Autonomous Artificial Intelligence versus AI Assisted Human optical diagnosis of colorectal polyps: A randomized controlled trial

Aims Artificial intelligence-based optical diagnosis systems (CADx) have been developed to allow pathology prediction of colorectal polyps during colonoscopies. However, CADx systems have not yet been validated for autonomous performance. Therefore, we conducted a trial comparing Autonomous AI (AI-A) to AI assisted human (AI-H) optical diagnosis.

Methods Artificial intelligence-based optical diagnosis systems (CADx) have been developed to allow pathology prediction of colorectal polyps during colonoscopies. However, CADx systems have not yet been validated for autonomous performance. Therefore, we conducted a trial comparing Autonomous AI (AI-A) to AI assisted human (AI-H) optical diagnosis.

Results 467 patients were randomized (229 in the AI-A group, 238 in the AI-H). Overall accuracy for optical diagnosis was 77.2% (95%Confidence Interval [CI] 69.7-84.7) in the AI-A group and 72.1% (95% CI 65.5-78.6) in the AI-H group (p=0.86). Sensitivity, specificity, PPV and NPV for adenoma diagnosis were 84.8%, 64.4%, 85.6%, and 63.0% respectively in the AI-A group vs 83.6%, 63.8%, 78.6%, and 71.0% in the AI-H group. Diagnostic performance did not differ significantly between the two groups. AI-A had statistically significant higher agreement with pathology-based surveillance intervals compared to AI-H (91.5% [95% CI 86.9-96.1] vs 82.1% [95% CI 76.5-87.7]; p=0.016).

Conclusions Autonomous AI-based optical diagnosis had non-inferior accuracy to endoscopist-based diagnosis but achieved higher agreement with pathology-based surveillance intervals. Resect-and-discard and diagnose-and-leave strategies can therefore be considered with current CADx versions without requiring human input.

Conflicts of interest

Daniel von Renteln has received research funding from ERBE Elektromedizin GmbH, Ventage, Pendopharm, Fujifilm and Pentax, and has received consultant or speaker fees from Boston Scientific Inc., ERBE Elektromedizin GmbH, and Pendopharm. The remaining authors declare that they have no conflict of interest.

Publication History

Article published online:
15 April 2024