计算机辅助检测(CADe)与普通肠镜比较识别结直肠腺瘤和息肉效果的Meta分析  

Efficacy and safety of computer-aided detection(CADe)in colonoscopy for colorectal neoplasia detection:a meta-analysis

作　　者：马艳玲 文曰[1,2] 卢春燕 廖婧[1,2] MA Yanling;WEN Yue;LU Chunyan;LIAO Jing(Division of Gastrointestinal Surgery,Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;West China School of Nursing,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院普外科胃肠外科病房,成都610041 [2]四川大学华西护理学院,成都610041

出　　处：《中国循证医学杂志》2024年第11期1270-1277,共8页Chinese Journal of Evidence-based Medicine

基　　金：成都市医学科研课题(编号:202314023382)。

摘　　要：目的系统评价计算机辅助检测(computer-aided detection,CADe)与普通肠镜比较识别结直肠腺瘤和息肉的有效性和安全性。方法计算机检索PubMed、Cochrane Library、Web of Science、Embase、CNKI、WanFang Data和VIP数据库,搜集CADe辅助肠镜和常规肠镜比较检测结直肠肿瘤有效性和安全性的随机对照试验(randomized controlled-trials,RCT),检索时限均为2014年至2023年4月,由两名研究员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果纳入9个RCT,共6393例受试者。Meta分析结果显示,与常规肠镜检查相比,CADe系统明显提高了腺瘤检出率[RR=1.22,95%CI(1.10,1.35),P<0.01]和息肉检出率[RR=1.19,95%CI(1.04,1.36),P=0.01];降低了腺瘤漏诊率[RR=0.48,95%CI(0.34,0.67),P<0.01]及息肉漏诊率[RR=0.39,95%CI(0.25,0.59),P<0.01]。CADe系统对近端息肉的检出率明显增加,≤5mm息肉的检出率轻度增加,但>10mm及有蒂息肉检出率明显降低;盲肠、横结肠、降结肠及乙状结肠的漏诊率明显降低。两组在退镜时间上无统计学差异。结论CADe可以增加腺瘤及息肉检出率。并降低漏诊率,息肉检出率与其位置、大小及形态相关,腺瘤漏诊率与其位置相关。Objective To systematically evaluate the efficacy and safety of computer-aided detection(CADe)and conventional colonoscopy in identifying colorectal adenomas and polyps.Methods The PubMed,Embase,Cochrane Library,Web of Science,WanFang Data,VIP,and CNKI databases were electronically searched to collect randomized controlled trials(RCTs)comparing the effectiveness and safety of CADe assisted colonoscopy and conventional colonoscopy in detecting colorectal tumors from 2014 to April 2023.Two reviewers independently screened the literature,extracted data,and evaluated the risk of bias of the included literature.Meta-analysis was performed by RevMan 5.3 software.Results A total of 9 RCTs were included,with a total of 6393 patients.Compared with conventional colonoscopy,the CADe system significantly improved the adenoma detection rate(ADR)(RR=1.22,95%CI 1.10 to 1.35,P<0.01)and polyp detection rate(PDR)(RR=1.19,95%CI 1.04 to 1.36,P=0.01).It also reduced the missed diagnosis rate(AMR)of adenomas(RR=0.48,95%CI 0.34 to 0.67,P<0.01)and the missed diagnosis rate(PMR)of polyps(RR=0.39,95%CI 0.25 to 0.59,P<0.01).The PDR of proximal polyps significantly increased,while the PDR of≤5 mm polyps slightly increased,but the PDR of>10mm and pedunculated polyps significantly decreased.The AMR of the cecum,transverse colon,descending colon,and sigmoid colon was significantly reduced.There was no statistically significant difference in the withdrawal time between the two groups.Conclusion The CADe system can increase the detection rate of adenomas and polyps,and reduce the missed diagnosis rate.The detection rate of polyps is related to their location,size,and shape,while the missed diagnosis rate of adenomas is related to their location.

关 键 词：计算机辅助检测 人工智能 深度学习模型 结肠镜 息肉 腺瘤 诊断 META分析 

分 类 号：R735.34[医药卫生—肿瘤]