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期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-2865

摘要内容如下：

背景

计算机辅助诊断（CADx）可以在结肠镜检查中预测息肉的组织学，这可以减少不必要的非肿瘤性息肉的切除。然而，CADx的潜在益处和危害仍不清楚。

目的

量化在结肠镜检查中使用CADx对小型（≤5 mm）直肠乙状结肠息肉进行光学诊断的益处和危害。

数据源

在MEDLINE、EMBASE和Scopus中搜索2023年12月22日之前发表的文章。

研究选择

经组织学验证的诊断准确性研究，评估了医生在结肠镜检查期间在无或有CADx辅助的情况下预测直肠乙状结肠小息肉的肿瘤性改变的实时表现。

数据提取

根据内镜医师在CADx辅助前和辅助后的正确值，评估临床益处和危害。使用GRADE（建议评估、开发和评价的分级）框架评估证据的确定性。受益的结果指标是预测为非肿瘤性的息肉的比例，这将避免使用CADx进行切除。损害的结果测量是由于使用CADx的错误诊断而未被切除并留在原位的肿瘤性息肉的比例。组织学作为两种结果的参考标准。

数据综合

分析了10项研究，包括3620例4103个小的直肠乙状结肠息肉患者。评估单独CADx性能的研究（9项研究；3237个息肉）显示，预测肿瘤变化的敏感性为87.3%（95%CI，79.2%-92.5%），特异性为88.9%（CI，81.7%-93.5%）。在比较CADx辅助治疗前后组织学预测性能的研究中（4项研究；2503个息肉），预测为非肿瘤性且可避免切除的息肉比例没有差异（55.4%对58.4%；风险比[RR]，1.06[CI，0.96至1.17]；中等确定性证据）或将被错误地留在原位的肿瘤性息肉的比例（8.2%对7.5%；RR为0.95[CI为0.69~1.33]；中等确定性证据）。

局限性

仅模拟了光学诊断的应用，潜在地改变了操作者的决策过程。

结论

在结肠镜检查中，计算机辅助诊断对直肠乙状结肠小息肉的处理没有增加益处或危害。

主要资金来源

欧洲委员会。（普洛斯彼罗：CRD42023402197）。

英文原文如下：

Abstracts

BACKGROUND  Computer-aided diagnosis (CADx) allows prediction of polyp histology during colonoscopy, which may reduce unnecessary removal of nonneoplastic polyps. However, the potential benefits and harms of CADx are still unclear.

PURPOSE  To quantify the benefit and harm of using CADx in colonoscopy for the optical diagnosis of small (≤5-mm) rectosigmoid polyps.

DATA SOURCES  Medline, Embase, and Scopus were searched for articles published before 22 December 2023.

STUDY SELECTION  Histologically verified diagnostic accuracy studies that evaluated the real-time performance of physicians in predicting neoplastic change of small rectosigmoid polyps without or with CADx assistance during colonoscopy.

DATA EXTRACTION  The clinical benefit and harm were estimated on the basis of accuracy values of the endoscopist before and after CADx assistance. The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. The outcome measure for benefit was the proportion of polyps predicted to be nonneoplastic that would avoid removal with the use of CADx. The outcome measure for harm was the proportion of neoplastic polyps that would be not resected and left in situ due to an incorrect diagnosis with the use of CADx. Histology served as the reference standard for both outcomes.

DATA SYNTHESIS  Ten studies, including 3620 patients with 4103 small rectosigmoid polyps, were analyzed. The studies that assessed the performance of CADx alone (9 studies; 3237 polyps) showed a sensitivity of 87.3% (95% CI, 79.2% to 92.5%) and specificity of 88.9% (CI, 81.7% to 93.5%) in predicting neoplastic change. In the studies that compared histology prediction performance before versus after CADx assistance (4 studies; 2503 polyps), there was no difference in the proportion of polyps predicted to be nonneoplastic that would avoid removal (55.4% vs. 58.4%; risk ratio [RR], 1.06 [CI, 0.96 to 1.17]; moderate-certainty evidence) or in the proportion of neoplastic polyps that would be erroneously left in situ (8.2% vs. 7.5%; RR, 0.95 [CI, 0.69 to 1.33]; moderate-certainty evidence).

LIMITATION  The application of optical diagnosis was only simulated, potentially altering the decision-making process of the operator.

CONCLUSION  Computer-aided diagnosis provided no incremental benefit or harm in the management of small rectosigmoid polyps during colonoscopy.

PRIMARY FUNDING SOURCE  European Commission. (PROSPERO: CRD42023402197).

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