Computer-Aided Detection Improves Adenoma Detection Rate and Adenomas Per Colonoscopy in Fecal Immunochemical Test-Positive Patients
Douglas K. Rex, MD, MASGE, reviewing Rondonotti E, et al. Endoscopy 2022 May 11.
In parallel-arm randomized trials involving mostly primary screening and surveillance colonoscopy patients, computer-aided detection (CADe) has increased the adenoma detection rate (ADR) by about 10%. No prior study has had sufficient numbers of fecal immunochemical test (FIT)-positive patients to demonstrate benefit in this group. Because of the higher prevalence of adenomas in FIT-positive patients, the benefit of CADe-assisted colonoscopy could be blunted.
In a randomized trial involving 800 FIT-positive patients, patients underwent high-definition white-light colonoscopy or CADe-assisted colonoscopy with Fujifilm CAD EYE (Tokyo, Japan). Fujifilm colonoscopes were used in all colonoscopies.
The ADR was higher with CADe than without (53.6% vs 45.3%), as were adenomas per colonoscopy (APC; 1.13 vs 0.90) and advanced-ADR (18.5% vs 15.9%), but the difference in advanced-ADR was not significant. At least one sessile serrated lesion was detected in 5.6% of patients when CADe was used versus 4.8% when it was not, although this was also not significantly different.
When endoscopists were separated into 3 predefined baseline ADR groups, there were comparable gains in ADR, ranging from 7% to 11% among the 3 groups.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Rondonotti E, Di Paolo D, Rosa Rizzotto E, et al. Efficacy of a Computer Aided Detection (CADe) system in a FIT-based organized colorectal cancer screening program: a randomized controlled trial (AIFIT study). Endoscopy 2022 May 11. (Epub ahead of print) (https://doi.org/10.1055/a-1849-6878)