Deep learning computer-aided polyp detection reduces adenoma miss rate: a United States multi-center randomized tandem colonoscopy study (CADeT-CS Trial)
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BACKGROUND & AIMS: Artificial intelligence-based computer-aided polyp detection (CADe) systems are intended to address the issue of missed polyps during colonoscopy. The effect of CADe during screening and surveillance colonoscopy has not previously been studied in a United States (U.S.) population. METHODS: We conducted a prospective, multi-center, single-blind randomized tandem colonoscopy study to evaluate a deep-learning based CADe system (EndoScreener, Shanghai Wision AI, China). Patients were enrolled across 4 U.S. academic medical centers from 2019 through 2020. Patients presenting for colorectal cancer screening or surveillance were randomized to CADe colonoscopy first or high-definition white light (HDWL) colonoscopy first, followed immediately by the other procedure in tandem fashion by the same endoscopist. The primary outcome was adenoma miss rate (AMR), and secondary outcomes included sessile serrated lesion (SSL) miss rate and adenomas per colonoscopy (APC). RESULTS: A total of 232 patients entered the study, with 116 patients randomized to undergo CADe colonoscopy first and 116 patients randomized to undergo HDWL colonoscopy first. After the exclusion of 9 patients, the study cohort included 223 patients. AMR was lower in the CADe-first group compared with the HDWL-first group (20.12% [34/169] vs 31.25% [45/144]; odds ratio [OR], 1.8048; 95% confidence interval [CI], 1.0780-3.0217; P = .0247). SSL miss rate was lower in the CADe-first group (7.14% [1/14]) vs the HDWL-first group (42.11% [8/19]; P = .0482). First-pass APC was higher in the CADe-first group (1.19 [standard deviation (SD), 2.03] vs 0.90 [SD, 1.55]; P = .0323). First-pass ADR was 50.44% in the CADe-first group and 43.64 % in the HDWL-first group (P = .3091). CONCLUSION: In this U.S. multicenter tandem colonoscopy randomized controlled trial, we demonstrate a decrease in AMR and SSL miss rate and an increase in first-pass APC with the use of a CADe-system when compared with HDWL colonoscopy alone.
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In Glissen Brown et al. 2022, the CADe group had a lower PMR (20.7%) than the control group (33.71%) (p=0.0007).
“PMR was also lower (20.7%) than the control group (33.71%) (p=0.0007).”
From Advancing Colorectal Cancer Screening: A Comprehensive Systematic Review of Artificial Intelligence (AI)-Assisted Versus Routine Colonoscopy (2023) · cites this paper as [22]
In Glissen Brown et al. 2022, the CADe group had a lower AMR (20.12%) than the control group (31.25%) (p=0.0247).
“The study involved 223 participants, with the CADe group showing a significantly lower AMR (20.12%) compared to the control group (31.25%) (p=0.0247).”
From Advancing Colorectal Cancer Screening: A Comprehensive Systematic Review of Artificial Intelligence (AI)-Assisted Versus Routine Colonoscopy (2023) · cites this paper as [22]
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“Among the 13 studies, eight were conducted in China, two in Japan, one in France, one in Italy, and one in the USA; three out of 13 trials were non-blinded [8,14,15], eight trials were single-blinded RCTs [16,17,19,20,22-25], and two were double-blinded RCTs [18,21].”
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- Authors
- Glissen Brown, J. R., Mansour, N. M., Wang, P., Chuchuca, M. A., Minchenberg, S. B., Chandnani, M., Liu, L., Gross, S. A., Sengupta, N., & Berzin, T. M.
- Affiliations
- Baylor College of Medicine (US)
- Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (CN)
- Beth Israel Deaconess Medical Center (US)
- Shanghai Jiao Tong University (CN)
- NYU Langone Health (US)
- University of Chicago (US)
- ORCID
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2022-07
- Volume
- 20
- Issue
- 7
- Pages
- 1499-1507.e4
- ISSN
- 1542-3565 (ISSN-L)
- OpenAlex
- W3199688237
- Cited by
- 235
- References
- 29
- Citations by year
- 2026: 43 · 2025: 65 · 2024: 46 · 2023: 49 · 2022: 32
- FWCI
- 11.57
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (12090024)
- Science and Technology Commission of Shanghai Municipality (2021SHZDZX0102)
- Natural Science Foundation of Shanghai (21ZR1431000)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Physical Sciences › Computer Science › Artificial Intelligence › AI in cancer detection
- Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
- Keywords
- deep learning, colonoscopy, adenoma miss rate, colorectal cancer screening, surveillance colonoscopy, sessile serrated lesions, adenoma detection rate, tandem colonoscopy, artificial intelligence in endoscopy, colorectal adenoma, polyp detection, United States population
- MeSH terms
- Deep Learning, Missed Diagnosis, Adenoma, Artificial Intelligence, Colonic Polyps, Colonoscopy, Diagnosis, Computer-Assisted, Humans, Prospective Studies, United States, Colorectal Neoplasms, Single-Blind Method
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