A systematic review of randomised clinical trials (RCTs) comparing computer-aided detection (CADe) system-enhanced colonoscopy and conventional colonoscopy found that CADe (also known as artificial Intelligence- or AI-assisted) colonoscopies may increase overall detection of colonic polyps and adenomas, or precancerous growths, with a small increase in procedure time.

Equivocal results were found regarding detection of advanced colonic neoplasia (ACN), with a small increase in ACN detection rate but no difference in ACN detected per colonoscopy.

The findings are published in Annals of Internal Medicine.

Researchers from Yale University and Mass General Brigham, Harvard School of Medicine comprehensively searched several large scientific research databases for RCTs comparing colonic lesion detection with standard colonoscopy versus AI-assisted colonoscopy with polyp detection (CADe) systems.

The authors compared average adenoma per colonoscopy (APC) and ACN per colonoscopy for both screening methods.

Secondarily, they compared adenoma detection rate (ADR), adenoma miss rate (AMR), and ACN detection rate between the two colonoscopy types.

They found that AI-assisted colonoscopy found more polyps and precancerous growths in the colon than conventional colonoscopy.

However, AI-assisted colonoscopy detected marginally more serious growths (ACNs) than conventional colonoscopy but was no better than the conventional method at finding ACNs per colonoscopy.

The researchers note that there are no clear differences in benefit for detecting adenomas across different AI systems for CADe, and that there was an increase in benefit for providers with lower adenoma detection rate or those without a prior faecal immunochemical test result.

They suggest that future studies focus on interval post colonoscopy colorectal cancer and may consider a study design that randomises colonoscopists rather than patients.

Study suggests FIT may be an efficient way to screen younger patients for colorectal cancer

A retrospective cohort study found that younger patients will complete colorectal cancer screening using faecal immunochemical tests (FIT) and follow up with a colonoscopy as well as people who are 50 years old or older.

These findings suggest that FIT is a very efficient way to get people screened and support newer guidelines recommending that patients start screening for colorectal cancer at age 45.

The study is published in Annals of Internal Medicine.

Researchers from Kaiser Permanente Northern California, Washington and Colorado studied patient health records for 213,928 patients aged 45 to 49 and 53,804 patients aged 50 to compare FIT screening completion and outcomes between the two groups.

Patients included in the analysis had no underlying bowel condition or previous cancer diagnosis and were undergoing FIT for the first time.

The researchers analysed the data for FIT completion within 3 months, FIT positivity, follow-up colonoscopy completion within 3 months of positive FIT result, findings at the follow-up colonoscopy, and false-positive FIT results for both age groups.

They found that overall FIT completion was slightly higher in patients aged 45 to 49 versus 50.

For all health systems combined, FIT positivity was slightly lower in patients in the younger age group, and the frequency of completion of a follow-up colonoscopy after a positive FIT test was not substantially different between age groups.

For those who completed a follow-up colonoscopy, detection of any adenoma was lower among those aged 45 to 49 than 50.

The authors note that this is the largest population-based report to date of FIT screening completion and yield among patients aged 45 to 49 years.

The findings show that the yield of colonoscopy after a positive FIT are similar between both groups, despite an overall risk of CRC that is lower among those aged 45-49.

Source: American College of Physicians