Impact of an automated system for endocytoscopic diagnosis of small colorectal lesions: an international web-based study

Yuichi Mori; Shin-ei Kudo; Philip Wai Yan Chiu; Rajvinder Singh; Masashi Misawa; Kunihiko Wakamura; Toyoki Kudo; Takemasa Hayashi; Atsushi Katagiri; Hideyuki Miyachi; Fumio Ishida; Yasuharu Maeda; Haruhiro Inoue; Yukitaka Nimura; Masahiro Oda; Kensaku Mori

doi:10.1055/s-0042-113609

Endoscopy, Table of Contents

Endoscopy 2016; 48(12): 1110-1118
DOI: 10.1055/s-0042-113609

Original article

Impact of an automated system for endocytoscopic diagnosis of small colorectal lesions: an international web-based study

Yuichi Mori

¹Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

,

Shin-ei Kudo

¹Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

,

Philip Wai Yan Chiu

²Department of Surgery, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong

,

Rajvinder Singh

³Endoscopy Unit, Lyell McEwin Hospital and University of Adelaide, Adelaide, Australia

,

Masashi Misawa

¹Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

,

Kunihiko Wakamura

¹Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

,

Toyoki Kudo

¹Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

,

Takemasa Hayashi

¹Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

,

Atsushi Katagiri

¹Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

,

Hideyuki Miyachi

¹Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

,

Fumio Ishida

¹Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

,

Yasuharu Maeda

¹Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan

⁴Tokyo Endoscopic Academy, Tokyo, Japan

,

Haruhiro Inoue

⁵Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan

,

Yukitaka Nimura

⁶Locus Logic, Inc., Nagoya, Japan

,

Masahiro Oda

⁷Graduate School of Information Science, Nagoya University, Nagoya, Japan

,

Kensaku Mori

⁸Information and Communications, Nagoya University, Nagoya, Japan

› Author Affiliations

Abstract

Background and study aims: Optical diagnosis of colorectal polyps is expected to improve the cost-effectiveness of colonoscopy, but achieving a high accuracy is difficult for trainees. Computer-aided diagnosis (CAD) is therefore receiving attention as an attractive tool. This study aimed to validate the efficacy of the latest CAD model for endocytoscopy (380-fold ultra-magnifying endoscopy).

Patients and methods: This international web-based trial was conducted between August and November 2015. A web-based test comprising one white-light and one endocytoscopic image of 205 small colorectal polyps (≤ 10 mm) from 123 patients was undertaken by both CAD and by endoscopists (three experts and ten non-experts from three countries). Outcome measures were accuracy in identifying neoplastic change in diminutive (≤ 5 mm) and small (≤ 10 mm) polyps, and accuracy in predicting post-polypectomy surveillance intervals according to current guidelines for high confidence optical diagnoses of diminutive polyps.

Results: Of the 205 small polyps (147 neoplastic and 58 non-neoplastic), 139 were diminutive. CAD was accurate for 89 % (95 % confidence interval [CI] 83 % – 94 %) of diminutive polyps and 89 % (84 % – 93 %) of small polyps, which was significantly greater than results for the non-experts (73 % [71 % – 76 %], P < 0.001; and 76 % [74 % – 78 %], P < 0.001, respectively) and comparable with the experts’ results (90 % [87 % – 93 %], P = 0.703; and 91 % [89 % – 93 %], P = 0.106, respectively). The surveillance interval predicted by CAD provided 98 % (93 % – 100 %) and 96 % (91 % – 99 %) agreement with pathology-directed intervals of the European and American guidelines, respectively.

Conclusions: The use of CAD in endocytoscopy can be effective in the management of diminutive/small colorectal polyps.

UMIN Clinical Trial Registry: UMIN000018185.

Full Text

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