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Real-life Implementering af en AI-baseret optisk diagnose (AI-OD)

Real-life implementering af en kunstig intelligens baseret optisk diagnosestrategi for diminutive kolorektale polypper

This is a prospective study that is the first to implement resect and discard and diagnose and leave strategies in real-time practice using stringent documentation and adjudication by 2 expert endoscopists as the gold standard.

The primary aim of this study is to show the accuracy of intracolonoscopy AI-assisted optical diagnosis (CADx; autonomous or with human input) when the AI-assisted optical diagnosis made by the expert endoscopists is used as the reference standard. The specific aims are:

  1. To evaluate the accuracy of intracolonoscopy AI-assisted optical polyp diagnosis (autonomous or with human input) by comparing it to the obtained optical histology diagnoses provided by two independent expert endoscopists as the reference standard.
  2. To evaluate the agreement between the intracolonoscopy AI-assisted optical polyp diagnosis (autonomous or with human input) and the AI-assisted optical diagnosis performed by two independent expert endoscopists.
  3. To determine whether AI-assisted optical polyp diagnosis for diminutive (1-5 mm) polyps can be implemented in routine clinical practice by demonstrating that at least 70% of the approached patients are interested in undergoing AI-assisted optical diagnosis (autonomous or with human input).
  4. To evaluate the cost savings resulting from replacing pathology with AI-assisted optical diagnosis.

Studieoversigt

Status

Aktiv, ikke rekrutterende

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

All patients who meet the inclusion criteria can be enrolled. Eligible patients will be informed about the study through a consent form that includes information on optical diagnosis (resect and discard, diagnose and leave) and AI/CADx systems. We will ask the patients' willingness to undergo AI-assisted optical diagnosis with endoscopists' input (the first 102 patients) and automomous AI-assisted optical diagnosis (from patient 103 to 204). Subsequently, patients will be asked if they are willing to participate in the study, using AI-assisted optical diagnosis and the "resect and discard" and "diagnose and leave" strategy. If a patient declines to undergo optical diagnosis, they will be asked about the reason for their refusal to participate in the study. The options for their response include:

  1. Concerns regarding undergoing an optical diagnosis.
  2. Reluctance to participate in research projects in general.
  3. Other reasons.
  4. Preference not to answer the question.

Patients who agree to participate in the study will undergo standard colonoscopy procedures with AI-assisted optical diagnosis for all diminutive colorectal polyps identified. High-definition colonoscopes with a joint computer-assisted classification (CADx) support (CAD-EYE software EW10-EC02) will be used.

For the first 102 patients (i.e., the CAD-assisted optical diagnosis with endoscopist's input), the endoscopists will use the CAD-EYE blue light imaging (BLI) mode to enhance the visualization of polyp features. During the optical diagnosis using CADx, the most probable diagnosis (neoplastic or hyperplastic) will be displayed on the endoscopy screen. If the serrated pathology subtype is determined as the most probable histology, the endoscopists will make the final decision. They will also indicate whether their optical diagnosis was made with low or high confidence.

For the second group of 102 patients (i.e., autonomous CADx-assisted optical diagnosis), endoscopists will use CADx and BLI mode to perform optical diagnosis. Based on the CADx diagnosis, all 1-5 mm polyps diagnosed as hyperplastic or neoplastic will be resected and discarded, while those located in the rectosigmoid and diagnosed as hyperplastic will be left in the colon. When high-risk histology features are observed using BLI, in any patient, the endoscopists will inform the research assistant to document them, and the polyp will be sent for pathology examination in accordance with the ASGE PIVI guidelines recommendations. All polyps >5mm will be send for pathology evaluation. Polyp size will be measured using virtual scale technology integrated in the computer-assisted system (CAD) to ensure an accurate polyp sizing.18 A research assistant will document the characteristics of the detected polyps (i.e., location, size, morphology, AI-assisted intracolonoscopy and endoscopists optical diagnoses). All identified colorectal polyps will be removed following standard polypectomy practices. The entire colonoscopy procedures will be video recorded for quality assurance purposes. All diminutive polyps will be resected and discarded as part of the resect and discard strategy. Additionally, diminutive polyps located in the rectosigmoid colon will be detected and left in situ (diagnose and leave strategy) if no high-risk features are present.

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

204

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

    • Quebec
      • Montreal, Quebec, Canada
        • Centre Hospitalier de l'Université de Montréal

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

45 år til 80 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Age 45-80 years
  • Undergoing an outpatient colonoscopy at the Centre Hospitalier de l'Université de Montréal (CHUM)
  • Signed informed consent form

Exclusion Criteria:

  • Inflammatory Bowel Disease;
  • Active colitis;
  • Hereditary CRC syndrome;
  • Coagulopathy;
  • American Society of Anesthesiologists (ASA) status >3

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Diagnostisk
  • Tildeling: Ikke-randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Andet: AI-assisted classification with endoscopist's input

AI-assisted classification for diminutive polyps during a colonoscopy procedure using the CAD-eye detection and classification system, with input from the endoscopist in the case of serrated polyps, for patients who agree to undergo optical diagnosis of diminutive colorectal polyps.

CADeye (Fujifilm, Japan) is a joint detection (CADe) and classification (CADx) AI-supported system, which has been developed utilising AI deep learning technology to support endoscopic lesion detection and characterisation in the colon.

Andre navne:
  • CAD-øje
Andet: Autonomous AI-assisted classification

AI-assisted classification for diminutive polyps during a colonoscopy procedure using the CAD-eye detection and classification system, with no input from the endoscopist, for patients who agree to undergo optical diagnosis of diminutive colorectal polyps.

CADeye (Fujifilm, Japan) is a joint detection (CADe) and classification (CADx) AI-supported system, which has been developed utilising AI deep learning technology to support endoscopic lesion detection and characterisation in the colon.

Andre navne:
  • CAD-øje

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Accuracy of the intracolonoscopy AI-assisted optical diagnosis
Tidsramme: 120 days

Using the optical diagnosis obtained from 2 experts as the reference, the accuracy of the intracolonoscopy AI-assisted optical diagnosis (OD, with endoscopist input or autonomous) is measured as the number of correct ODs out of all ODs (%).

120 days

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Proportion of patients who accept study participation
Tidsramme: 120 days

Number of patients who accept to participate out of all patients approached

120 days
Proportion of the patients unwilling to participate due to concerns regarding undergoing an optical diagnosis
Tidsramme: 120 days

The proportion of the patients unwilling to participate in the study due to the concerns of resect and discard or diagnose and leave strategies (with endoscopist input or autonomous) and preference upon histopathological evaluation of all detected polyps

120 days
Agreement between the intracolonoscopy AI-assisted optical diagnosis and the AI-assisted optical diagnosis by experts
Tidsramme: 120 days

The agreement between AI-assisted OD (with and without endoscopist's input) and the experts' OD is measured as the number of cases where both ODs are the same out of all cases (%).

120 days
Diagnostic characteristics of AI-assisted optical diagnosis using adjudication by two expert endoscopists as the reference standard
Tidsramme: 120 days

To calculate the accuracy, sensitivity, specificity, positive predictive value, negative predictive value of (CADx) assisted optical diagnosis (resect and discard) strategy using adjudication by two expert endoscopists as the reference standard.

120 days
Proportion of polyps with a low-confidence diagnosis
Tidsramme: 120 days

Proportion of polyps with a low-confidence diagnosis intracolonoscopy and later by the expert independent reviewers

120 days
Assessing cost savings through AI-assisted optical diagnosis
Tidsramme: 120 days

The reduction in costs of the supplies and the pathology assessments according to the expenses reported by the CHUM gastroenterology and pathology departments including the expenses related to the supplies (e.g., snares, containers), immediate and delayed complications, specimen processing and equipment and physician fees.

120 days

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Efterforskere

  • Ledende efterforsker: Daniel von Renteln, MD, Centre hospitalier de l'Université de Montréal (CHUM)

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

1. september 2023

Primær færdiggørelse (Faktiske)

1. maj 2025

Studieafslutning (Anslået)

31. august 2027

Datoer for studieregistrering

Først indsendt

22. september 2023

Først indsendt, der opfyldte QC-kriterier

22. september 2023

Først opslået (Faktiske)

28. september 2023

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

21. september 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

17. september 2026

Sidst verificeret

1. februar 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • 2024-11557/23.095

Plan for individuelle deltagerdata (IPD)

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