Real-time automatic detection system increases colonoscopic polyp and adenoma detection rates: a prospective randomised controlled study

Pu Wang, Tyler M Berzin, Jeremy Romek Glissen Brown, Shishira Bharadwaj, Aymeric Becq, Xun Xiao, Peixi Liu, Liangping Li, Yan Song, Di Zhang, Yi Li, Guangre Xu, Mengtian Tu, Xiaogang Liu, Pu Wang, Tyler M Berzin, Jeremy Romek Glissen Brown, Shishira Bharadwaj, Aymeric Becq, Xun Xiao, Peixi Liu, Liangping Li, Yan Song, Di Zhang, Yi Li, Guangre Xu, Mengtian Tu, Xiaogang Liu

Abstract

Objective: The effect of colonoscopy on colorectal cancer mortality is limited by several factors, among them a certain miss rate, leading to limited adenoma detection rates (ADRs). We investigated the effect of an automatic polyp detection system based on deep learning on polyp detection rate and ADR.

Design: In an open, non-blinded trial, consecutive patients were prospectively randomised to undergo diagnostic colonoscopy with or without assistance of a real-time automatic polyp detection system providing a simultaneous visual notice and sound alarm on polyp detection. The primary outcome was ADR.

Results: Of 1058 patients included, 536 were randomised to standard colonoscopy, and 522 were randomised to colonoscopy with computer-aided diagnosis. The artificial intelligence (AI) system significantly increased ADR (29.1%vs20.3%, p<0.001) and the mean number of adenomas per patient (0.53vs0.31, p<0.001). This was due to a higher number of diminutive adenomas found (185vs102; p<0.001), while there was no statistical difference in larger adenomas (77vs58, p=0.075). In addition, the number of hyperplastic polyps was also significantly increased (114vs52, p<0.001).

Conclusions: In a low prevalent ADR population, an automatic polyp detection system during colonoscopy resulted in a significant increase in the number of diminutive adenomas detected, as well as an increase in the rate of hyperplastic polyps. The cost-benefit ratio of such effects has to be determined further.

Trial registration number: ChiCTR-DDD-17012221; Results.

Keywords: colonoscopy; colorectal cancer screening; computerised image analysis.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Deep learning architecture. The detection algorithm is a deep convolutional neural network (CNN) based on SegNet architecture. Data flow is from left to right: a colonoscopy image is sequentially warped into a binary image, with 1 representing polyp pixels and 0 representing no polyp in probability a map. This is then displayed, as showed in the output, with a hollow tracing box on the CADe monitor.
Figure 2
Figure 2
Flow Diagram of Enrollment. 1130 patients met the inclusion criteria, and 72 of them were exclude because of failed procedures, diagnosed IBD or CRC. CRC, colorectal cancer; IBD, inflammatory bowel disease.

References

    1. American Cancer Society American Cancer Society. Cancer Facts and Figures: 2017. Atlanta, Georgia, 2017.
    1. Bibbins-Domingo K, Grossman DC, Curry SJ, et al. . Screening for colorectal cancer: US preventive services task force recommendation statement. JAMA 2016;315:2564–75. 10.1001/jama.2016.5989
    1. Rex DK, Boland CR, Dominitz JA, et al. . Colorectal cancer screening: recommendations for physicians and patients from the u.s. multi-society task force on colorectal cancer. Am J Gastroenterol 2017;112:1016–30. 10.1038/ajg.2017.174
    1. Brenner H, Chang-Claude J, Jansen L, et al. . Reduced risk of colorectal cancer up to 10 years after screening, surveillance, or diagnostic colonoscopy. Gastroenterology 2014;146:709–17. 10.1053/j.gastro.2013.09.001
    1. Doubeni CA, Corley DA, Quinn VP, et al. . Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study. Gut 2018;67:291–8. 10.1136/gutjnl-2016-312712
    1. Zauber AG, Winawer SJ, O’Brien MJ, et al. . Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012;366:687–96. 10.1056/NEJMoa1100370
    1. Winawer SJ, Zauber AG, Ho MN, et al. . Prevention of colorectal cancer by colonoscopic polypectomy. The national polyp study workgroup. N Engl J Med 1993;329:1977–81. 10.1056/NEJM199312303292701
    1. Doubeni CA, Weinmann S, Adams K, et al. . Screening colonoscopy and risk for incident late-stage colorectal cancer diagnosis in average-risk adults: a nested case-control study. Ann Intern Med 2013;158:312–20. 10.7326/0003-4819-158-5-201303050-00003
    1. Corley DA, Jensen CD, Marks AR, et al. . Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014;370:1298–306. 10.1056/NEJMoa1309086
    1. Kaminski MF, Regula J, Kraszewska E, et al. . Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010;362:1795–803. 10.1056/NEJMoa0907667
    1. Mahmud N, Cohen J, Tsourides K, et al. . Computer vision and augmented reality in gastrointestinal endoscopy. Gastroenterol Rep 2015;3:179–84. 10.1093/gastro/gov027
    1. Ahn SB, Han DS, Bae JH, et al. . The miss rate for colorectal adenoma determined by quality-adjusted, back-to-back colonoscopies. Gut Liver 2012;6:64–70. 10.5009/gnl.2012.6.1.64
    1. Aslanian HR, Shieh FK, Chan FW, et al. . Nurse observation during colonoscopy increases polyp detection: a randomized prospective study. Am J Gastroenterol 2013;108:166–72. 10.1038/ajg.2012.237
    1. Lee CK, Park DI, Lee SH, et al. . Participation by experienced endoscopy nurses increases the detection rate of colon polyps during a screening colonoscopy: a multicenter, prospective, randomized study. Gastrointest Endosc 2011;74:1094–102. 10.1016/j.gie.2011.06.033
    1. Buchner AM, Shahid MW, Heckman MG, et al. . Trainee participation is associated with increased small adenoma detection. Gastrointest Endosc 2011;73:1223–31. 10.1016/j.gie.2011.01.060
    1. Tajbakhsh N, Gurudu SR, Liang J. Automated polyp detection in colonoscopy videos using shape and context information. IEEE Trans Med Imaging 2016;35:630–44. 10.1109/TMI.2015.2487997
    1. Misawa M, Kudo SE, Mori Y, et al. . Artificial intelligence-assisted polyp detection for colonoscopy: initial experience. Gastroenterology 2018;154:2027–9. 10.1053/j.gastro.2018.04.003
    1. Wang P, Xiao X, Glissen Brown JR, et al. . Development and validation of a deep-learning algorithm for the detection of polyps during colonoscopy. Nat Biomed Eng 2018;2:741–8. 10.1038/s41551-018-0301-3
    1. Bailey CE, Hu CY, You YN, et al. . Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975-2010. JAMA Surg 2015;150:17–22. 10.1001/jamasurg.2014.1756
    1. Burke C, Kaul V, Pohl H. Polyp resection and removal procedures: insights from the 2017 digestive disease week. Gastroenterol Hepatol 2017;13:1–24.
    1. Rex DK, Chadalawada V, Helper DJ. Wide angle colonoscopy with a prototype instrument: impact on miss rates and efficiency as determined by back-to-back colonoscopies. Am J Gastroenterol 2003;98:2000–5. 10.1111/j.1572-0241.2003.07662.x
    1. Adler A, Aminalai A, Aschenbeck J, et al. . Latest generation, wide-angle, high-definition colonoscopes increase adenoma detection rate. Clin Gastroenterol Hepatol 2012;10:155–9. 10.1016/j.cgh.2011.10.026
    1. Halpern Z, Gross SA, Gralnek IM, et al. . Comparison of adenoma detection and miss rates between a novel balloon colonoscope and standard colonoscopy: a randomized tandem study. Endoscopy 2015;47:238–44. 10.1055/s-0034-1391437
    1. Leufkens AM, DeMarco DC, Rastogi A, et al. . Third Eye Retroscope Randomized Clinical Evaluation [TERRACE] Study Group. Effect of a retrograde-viewing device on adenoma detection rate during colonoscopy: the TERRACE study. Gastrointest Endosc 2011;73:480–9. 10.1016/j.gie.2010.09.004
    1. Chin M, Karnes W, Jamal MM, et al. . Use of the Endocuff during routine colonoscopy examination improves adenoma detection: A meta-analysis. World J Gastroenterol 2016;22:9642–9. 10.3748/wjg.v22.i43.9642
    1. Cohen J, Grunwald D, Grossberg LB, et al. . The effect of right colon retroflexion on adenoma detection: a systematic review and meta-analysis. J Clin Gastroenterol 2017;51:818–24. 10.1097/MCG.0000000000000695
    1. Barclay RL, Vicari JJ, Doughty AS, et al. . Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006;355:2533–41. 10.1056/NEJMoa055498
    1. Sanchez W, Harewood GC, Petersen BT. Evaluation of polyp detection in relation to procedure time of screening or surveillance colonoscopy. Am J Gastroenterol 2004;99:1941–5. 10.1111/j.1572-0241.2004.40569.x
    1. Siddiki HA, Fath AR, Ravi S, et al. . Comparison of ADR and SSP detection rate (SSP-DR) between small volume split dose preparation (SDP) and large volume SDP [DDW abstract 553]. Gastrointest Endosc 2017;85.
    1. Horton N, Garber A, Hasson H, et al. . Impact of single- vs. split-dose low-volume bowel preparations on bowel movement kinetics, patient inconvenience, and polyp detection: a prospective trial. Am J Gastroenterol 2016;111:1330–7. 10.1038/ajg.2016.273
    1. Rex DK, Cutler CS, Lemmel GT, et al. . Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 1997;112:24–8. 10.1016/S0016-5085(97)70214-2
    1. Rex DK. Maximizing detection of adenomas and cancers during colonoscopy. Am J Gastroenterol 2006;101:2866–77. 10.1111/j.1572-0241.2006.00905.x
    1. Rogart JN, Siddiqui UD, Jamidar PA, et al. . Fellow involvement may increase adenoma detection rates during colonoscopy. Am J Gastroenterol 2008;103:2841–6. 10.1111/j.1572-0241.2008.02085.x
    1. Wolfe JM, Reinecke A, Brawn P. Why don’t we see changes?: The role of attentional bottlenecks and limited visual memory. Vis cogn 2006;14:749–80. 10.1080/13506280500195292
    1. Memmert D, Unkelbach C, Ganns S. The impact of regulatory fit on performance in an inattentional blindness paradigm. J Gen Psychol 2010;137:129–39. 10.1080/00221301003645061
    1. Simons DJ, Chabris CF. Gorillas in our midst: sustained inattentional blindness for dynamic events. Perception 1999;28:1059–74. 10.1068/p281059
    1. Simons DJ, Rensink RA. Change blindness: past, present, and future. Trends Cogn Sci 2005;9:16–20. 10.1016/j.tics.2004.11.006
    1. Chen PJ, Lin MC, Lai MJ, et al. . Accurate classification of diminutive colorectal polyps using computer-aided analysis. Gastroenterology 2018;154:568–75. 10.1053/j.gastro.2017.10.010
    1. Byrne MF, Chapados N, Soudan F, et al. . Real-time differentiation of adenomatous and hyperplastic diminutive colorectal polyps during analysis of unaltered videos of standard colonoscopy using a deep learning model. Gut 2019;68:gutjnl-2017-314547:94–100. 10.1136/gutjnl-2017-314547
    1. Bernal J, Tajkbaksh N, Sanchez FJ, et al. . Comparative validation of polyp detection methods in video colonoscopy: results from the MICCAI 2015 endoscopic vision challenge. IEEE Trans Med Imaging 2017;36:1231–49. 10.1109/TMI.2017.2664042
    1. Mori Y, Kudo SE, Berzin TM, et al. . Computer-aided diagnosis for colonoscopy. Endoscopy 2017;49:813–9. 10.1055/s-0043-109430
    1. Alagappan M, Brown JRG, Mori Y, et al. . Artificial intelligence in gastrointestinal endoscopy: the future is almost here. World J Gastrointest Endosc 2018;10:239–49. 10.4253/wjge.v10.i10.239
    1. Mori Y, Kudo SE, Misawa M, et al. . Real-time use of artificial intelligence in identification of diminutive polyps during colonoscopy: a prospective study. Ann Intern Med 2018;169:357–66. 10.7326/M18-0249
    1. Jia H, Pan Y, Guo X, et al. . Water Exchange Method Significantly improves adenoma detection rate: a multicenter, randomized controlled trial. Am J Gastroenterol 2017;112:568–76. 10.1038/ajg.2016.501
    1. Bai Y, Fang J, Zhao SB, et al. . Impact of preprocedure simethicone on adenoma detection rate during colonoscopy: a multicenter, endoscopist-blinded randomized controlled trial. Endoscopy 2018;50:128–36. 10.1055/s-0043-119213
    1. Xu Y, Chen K, Xu L, et al. . Diagnostic yield is not influenced by the timing of screening endoscopy: morning versus afternoon. Scand J Gastroenterol 2018;53:365–9. 10.1080/00365521.2018.1433230
    1. Cai B, Liu Z, Xu Y, et al. . Adenoma detection rate in 41,010 patients from Southwest China. Oncol Lett 2015;9:2073–7. 10.3892/ol.2015.3005
    1. Zhou H, Shen Z, Zhao J, et al. . [Distribution characteristics and risk factors of colorectal adenomas]. Zhonghua Wei Chang Wai Ke Za Zhi 2018;21:678–84.

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