计算机辅助检测系统提高腺瘤检出率的回顾性研究

A retrospective study of computer-aided detection system for detection improvement of adenomas

目的探讨基于双流算法开发的新型息肉检测系统在结肠镜检查中的作用。方法研究回顾性纳入2023年3月至6月解放军总医院第一医学中心在计算机辅助检测(computer-aided detection,CADe)系统辅助下行结肠镜检查的833例受试者为试验组,2022年3月至6月在同一操作间接受常规结肠镜检查的770例受试者为对照组。主要观察指标是腺瘤检出率,次要观察指标包括息肉检出率、腺瘤检出数和息肉检出数。结果试验组腺瘤检出率[29.3%(244/833)比21.7%(167/770),χ^(2)=12.133,P<0.001]和息肉检出率[47.9%(399/833)比37.9%(292/770),χ^(2)=16.241,P<0.001]显著高于对照组。对于≤5 mm的腺瘤[23.5%(196/833)比16.1%(124/770),χ^(2)=13.808,P<0.001]和平坦型腺瘤[15.1%(126/833)比7.3%(56/770),χ^(2)=24.519,P<0.001],试验组检出率显著高于对照组。试验组每例腺瘤检出数[0(0,1)枚比0(0,1)枚,Z=-3.698,P<0.001]和每例息肉检出数[0(0,1)枚比0(0,1)枚,Z=-4.424,P<0.001]与对照组相比差异有统计学意义。与无CADe系统辅助相比,CADe系统显著提高低年资医师腺瘤检出率[29.5%(167/566)比18.9%(89/472),χ^(2)=15.709,P<0.001]和息肉检出率[47.3%(268/566)比33.3%(157/472),χ^(2)=21.123,P<0.001];在高年资医师中,有无CADe系统辅助的腺瘤检出率[28.8%(77/267)比26.2%(78/298),χ^(2)=0.502,P=0.479]和息肉检出率[49.1%(131/267)比45.3%(135/298),χ^(2)=0.800,P=0.371]差异无统计学意义。结论CADe系统可显著提高腺瘤和息肉的检出率,尤其对于微小和平坦型病变检出具有明显优势。低年资医师相较于高年资医师使用CADe系统的获益更大。

Objective To assess the efficacy of a novel spatial-temporal polyp detection system in colonoscopy.Methods This research was a retrospective comparative study.Eight hundred and thirty-three participants who underwent computer-aided detection(CADe)colonoscopy at the First Medical Center of Chinese PLA General Hospital between March and June 2023 were enrolled to the experimental group,while 770 individuals who received conventional colonoscopy from March to June 2022,in the identical operation room were to the control group.The primary outcome was the adenoma detection rate(ADR),and the secondary outcomes were the polyp detection rate(PDR),adenomas per colonoscopy(APC),and polyps per colonoscopy(PPC).Results The ADR[29.3%(244/833)VS 21.7%(167/770),χ^(2)=12.133,P<0.001]and PDR[47.9%(399/833)VS 37.9%(292/770),χ^(2)=16.241,P<0.001]were significantly higher in the experimental group than those in the control group.Adenomas≤5 mm[23.5%(196/833)VS 16.1%(124/770),χ^(2)=13.808,P<0.001]and flat-type adenomas[15.1%(126/833)VS 7.3%(56/770),χ^(2)=24.519,P<0.001]were detected in a significantly higher proportion of subjects in the experimental group than those in the control group.There were significant difference in APC[0(0,1)VS 0(0,1),Z=-3.698,P<0.001]and PPC[0(0,1)VS 0(0,1),Z=-4.424,P<0.001]between the experimental and control groups.The use of CADe system significantly increased both ADR[29.5%(167/566)VS 18.9%(89/472),χ^(2)=15.709,P<0.001]and PDR[47.3%(268/566)VS 33.3%(157/472),χ^(2)=21.123,P<0.001]in junior endoscopists.However,in senior endoscopists,there was no statistical significant difference in ADR[28.8%(77/267)VS 26.2%(78/298),χ^(2)=0.502,P=0.479]or PDR[49.1%(131/267)VS 45.3%(135/298),χ^(2)=0.800,P=0.371]with or without CADe system.Conclusion The use of CADe system significantly increases overall polyp and adenoma detection in clinical practice,especially in the detection of diminutive and flat-type lesions.Junior endoscopists gain greater advantages from the use of CADe system than their senior peers.