Abstract
INTRODUCTION: Colorectal cancer (CRC) ranks as the second deadliest cancer globally, impacting patients' quality of life. Colonoscopy is the primary screening method for detecting adenomas and polyps, crucial for reducing long-term CRC risk, but it misses about 30% of cases. Efforts to improve detection rates include using AI to enhance colonoscopy. This study assesses the effectiveness and accuracy of a real-time AI-assisted polyp detection system during colonoscopy. MATERIALS AND METHODS: The study included 390 patients aged 40 to 75 undergoing colonoscopies for either colorectal cancer screening (risk score ≥ 4) or clinical diagnosis. Participants were randomly assigned to an experimental group using software-assisted diagnosis or a control group with physician diagnosis. The software, a medical image processing tool with B/S and MVC architecture, operates on Windows 10 (64-bit) and supports real-time image handling and lesion identification via HDMI, SDI, AV, and DVI outputs from endoscopy devices. Expert evaluations of retrospective video lesions served as the gold standard. Efficacy was assessed by polyp per colonoscopy (PPC), adenoma per colonoscopy (APC), adenoma detection rate (ADR), and polyp detection rate (PDR), while accuracy was measured using sensitivity and specificity against the gold standard. RESULTS: In this multicenter, randomized controlled trial, computer-aided detection (CADe) significantly improved polyp detection rates (PDR), achieving 67.18% in the CADe group versus 56.92% in the control group. The CADe group identified more polyps, especially those 5 mm or smaller (61.03% vs. 56.92%). In addition, the CADe group demonstrated higher specificity (98.44%) and sensitivity (95.19%) in the FAS dataset, and improved sensitivity (95.82% vs. 77.53%) in the PPS dataset, with both groups maintaining 100% specificity. These results suggest that the AI-assisted system enhances PDR accuracy. CONCLUSION: This real-time computer-aided polyp detection system enhances efficacy by boosting adenoma and polyp detection rates, while also achieving high accuracy with excellent sensitivity and specificity.