Real‐time use of artificial intelligence (CADEYE) in colorectal cancer surveillance of patients with Lynch syndrome—A randomized controlled pilot trial (CADLY)

Hüneburg, Robert; Bucksch, Karolin; Schmeißer, Friederike; Heling, Dominik; Marwitz, T; Aretz, Stefan; Kaczmarek, Dominik J.; Kristiansen, Glen; Hommerding, Oliver; Strassburg, Christian P.; Engel, Christoph; Nattermann, Jacob

doi:10.1002/ueg2.12354

Cited by 16 publications

(8 citation statements)

References 40 publications

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“…More recent and sophisticated colonoscopy techniques may detect smaller adenomas and/or adenomas with different morphological patterns. Staining/chromoendscopy might visualise dMMR crypts and guided or unguided machine learning (arti cial intelligence) may provide new ways of interpreting digitalized colonoscopy images [40,41]. The effects of these advances may be a longer mean sojourn time which could increase the probability of colonoscopy preventing CRC.…”

Section: Discussionmentioning

confidence: 99%

Incidences of colorectal adenomas and cancers under colonoscopy surveillance suggest an accelerated “Big Bang” pathway to CRC in three of the four Lynch syndromes

Møller,

Haupt,

Ahadova

et al. 2024

Preprint

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Background: Colorectal cancers (CRCs) in the Lynch syndromes have been assumed to emerge through an accelerated adenoma-carcinoma pathway. In this model adenomas with deficient mismatch repair have an increased probability of acquiring additional cancer driver mutation(s) resulting in more rapid progression to malignancy. If this model was accurate, the success of colonoscopy in preventing CRC would be a function of the intervals between colonoscopies and mean sojourn time of detectable adenomas. Contrary to expectations, colonoscopy did not decrease incidence of CRC in the Lynch syndromes and shorter colonoscopy intervals have not been effective in reducing CRC incidence. The prospective Lynch Syndrome Database [PLSD) was designed to examine these issues in carriers of pathogenic variants of the mis-match repair [path_MMR) genes. Material and methods: We examined the CRC and colorectal adenoma incidences in 3,574 path_MLH1, path_MSH2, path_MSH6 and path_PMS2 carriers subjected to regular colonoscopy with polypectomy, and considered the results based on sojourn times and stochastic probability paradigms. Results: Most of the path_MMR carriers in each genetic group had no adenomas. There was no association between incidences of CRC and the presence of adenomas. There was no CRC observed in path_PMS2 carriers. Conclusions: Colonoscopy prevented CRC in path_PMS2 carriers but not in the others. The findings are consistent with colonoscopy surveillance blocking the adenoma-carcinoma pathway by removing adenomas which might otherwise become CRCs. However, in carriers other than path_PMS2, most CRCs observed in carriers subjected to colonoscopy likely arise from dMMR cells in the crypts that have an increased mutation rate with increased stochastic chaotic probabilities for mutations. This mechanism, that may be associated with no or only a short sojourn time of MSI tumours as adenomas, could explain the findings in our previous and current reports.

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Section: Discussionmentioning

confidence: 99%

Incidences of colorectal adenomas and cancers under colonoscopy surveillance suggest an accelerated “Big Bang” pathway to CRC in three of the four Lynch syndromes

Møller,

Haupt,

Ahadova

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…More recent and sophisticated colonoscopy techniques may detect smaller adenomas and/or adenomas with different morphological patterns. Staining/chromoendscopy might visualise dMMR crypts and guided or unguided machine learning (artificial intelligence) may provide new ways of interpreting digitalized colonoscopy images [ 40 , 41 ]. The effects of these advances may be a longer mean sojourn time which could increase the probability of colonoscopy preventing CRC.…”

Section: Discussionmentioning

confidence: 99%

Incidences of colorectal adenomas and cancers under colonoscopy surveillance suggest an accelerated “Big Bang” pathway to CRC in three of the four Lynch syndromes

Møller,

Haupt,

Ahadova

et al. 2024

Hered Cancer Clin Pract

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Background Colorectal cancers (CRCs) in the Lynch syndromes have been assumed to emerge through an accelerated adenoma-carcinoma pathway. In this model adenomas with deficient mismatch repair have an increased probability of acquiring additional cancer driver mutation(s) resulting in more rapid progression to malignancy. If this model was accurate, the success of colonoscopy in preventing CRC would be a function of the intervals between colonoscopies and mean sojourn time of detectable adenomas. Contrary to expectations, colonoscopy did not decrease incidence of CRC in the Lynch syndromes and shorter colonoscopy intervals have not been effective in reducing CRC incidence. The prospective Lynch Syndrome Database (PLSD) was designed to examine these issues in carriers of pathogenic variants of the mis-match repair (path_MMR) genes. Materials and methods We examined the CRC and colorectal adenoma incidences in 3,574 path_MLH1, path_MSH2, path_MSH6 and path_PMS2 carriers subjected to regular colonoscopy with polypectomy, and considered the results based on sojourn times and stochastic probability paradigms. Results Most of the path_MMR carriers in each genetic group had no adenomas. There was no association between incidences of CRC and the presence of adenomas. There was no CRC observed in path_PMS2 carriers. Conclusions Colonoscopy prevented CRC in path_PMS2 carriers but not in the others. Our findings are consistent with colonoscopy surveillance blocking the adenoma-carcinoma pathway by removing identified adenomas which might otherwise become CRCs. However, in the other carriers most CRCs likely arised from dMMR cells in the crypts that have an increased mutation rate with increased stochastic chaotic probabilities for mutations. Therefore, this mechanism, that may be associated with no or only a short sojourn time of MSI tumours as adenomas, could explain the findings in our previous and current reports.

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“…5 On the other hand, the CADEYE study, a pilot randomized trial, revealed real-time AI-assisted colonoscopy as a promising tool to optimize endoscopic surveillance in Lynch Syndrome patients compared to conventional colonoscopy, with similar examination times and higher detection rates of flat adenomas. 3 As recently stated by the World Health Organization, AI has the potential to "enhance health outcomes by strengthening clinical trials, improving medical diagnosis, treatment, self-care and patientcentred care, and supplementing health care professionals' knowledge, skills and competencies". We, as the UEG Journal community, are strongly involved in contributing to reporting evidence on this promising tool.…”

Section: Reflecting On 2023mentioning

confidence: 99%

UEG Journal's impact and vision for the future

Elshaarawy,

Balduzzi,

Burelli

et al. 2024

UEG Journal

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Real‐time use of artificial intelligence (CADEYE) in colorectal cancer surveillance of patients with Lynch syndrome—A randomized controlled pilot trial (CADLY)

Cited by 16 publications

References 40 publications

Incidences of colorectal adenomas and cancers under colonoscopy surveillance suggest an accelerated “Big Bang” pathway to CRC in three of the four Lynch syndromes

Incidences of colorectal adenomas and cancers under colonoscopy surveillance suggest an accelerated “Big Bang” pathway to CRC in three of the four Lynch syndromes

Incidences of colorectal adenomas and cancers under colonoscopy surveillance suggest an accelerated “Big Bang” pathway to CRC in three of the four Lynch syndromes

UEG Journal's impact and vision for the future

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