Improvement of adenoma detection rate by two computer-aided colonic polyp detection systems in high adenoma detectors: a randomized multicenter trial

Abstract

Objective: This study aimed to evaluate the benefits of a self-developed computer-aided polyp detection system (SD-CADe) and a commercial CADe (CM-CADe) in high adenoma detectors compared to white-light colonoscopy (WLE) as a control. Methods: Average-risk 50–75-year-old individuals who underwent screening colonoscopy at five referral centers were randomized to SD-CADe, CM-CADe, or WLE groups (1:1:1 ratio). Trainees and staff with recorded ADR>35% were recruited. The primary outcome was the adenoma detection rate (ADR). Secondary outcomes were the proximal adenoma detection rate (pADR), advanced adenoma detection rate (AADR), and the number of adenomas, proximal and advanced adenomas per colonoscopy (APC, pAPC, and AAPC, respectively). Results: The study enrolled 1,200 participants. The ADR in the control, CM-CADe, and SD-CADe groups was 38.3%, 50%, and 54.8%, respectively. pADR was 23%, 32.3%, and 38.8%, respectively. AADR was 6%, 10.3%, and 9.5%, respectively. After imbalance factor adjustments, ADR and pADR in both intervention groups were significantly higher than controls (p<0.001 all). The APC found in the control, CM-CADe, and SD-CADe groups was 1.05, 1.63, and 1.51, respectively. The pAPC was 0.69, 1.03, 1.06, respectively, and the AAPC was 0.07, 0.12, and 0.10, respectively. Both CADe systems showed significantly higher APC and pAPC. AADR and AAPC were improved in both CADe groups versus control, although not statistically significant. Conclusion: Even in high adenoma detectors, CADes significantly improved ADR and APC. The AADR tended to be improved by both systems, and this may enhance colorectal cancer prevention.