• Cesare Hassan, Masashi Misawa, Tommy Rizkala, Yuichi Mori, Shahnaz Sultan, Antonio Facciorusso, Giulio Antonelli, Marco Spadaccini, Britt B S L Houwen, Emanuele Rondonotti, Harsh Patel, Kareem Khalaf, James Weiquan Li, Gloria M Fernandez, Pradeep Bhandari, Evelien Dekker, Seth Gross, Tyler Berzin, Per Olav Vandvik, Loredana Correale, Shin-Ei Kudo, Prateek Sharma, Douglas K Rex, Alessandro Repici, Farid Foroutan, and CADx Analysis Study Group.
• Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, and Humanitas Clinical and Research Center IRCCS, Endoscopy Unit, Rozzano, Italy (C.H., M.S., A.R.).
• Ann. Intern. Med. 2024 Jul 1; 177 (7): 919928919-928.

BackgroundComputer-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.PurposeTo quantify the benefit and harm of using CADx in colonoscopy for the optical diagnosis of small (≤5-mm) rectosigmoid polyps.Data SourcesMedline, Embase, and Scopus were searched for articles published before 22 December 2023.Study SelectionHistologically 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 ExtractionThe 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 SynthesisTen 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).LimitationThe application of optical diagnosis was only simulated, potentially altering the decision-making process of the operator.ConclusionComputer-aided diagnosis provided no incremental benefit or harm in the management of small rectosigmoid polyps during colonoscopy.Primary Funding SourceEuropean Commission. (PROSPERO: CRD42023402197).

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