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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: A computer-aided detection system improved adenoma detection rate and had higher adenomas per colonoscopy among FIT-positive patients. The improvement was mostly driven by diminutive adenoma detection. AI-assisted colonoscopy could detect diminutive adenomas at higher rates than standard colonoscopy, which could be beneficial to populations at high risk for colorectal cancer. A randomized trial of more than 1,300 individuals in Taiwan showed computer-aided detection (CAD) was noninferior to standard colonoscopy for adenoma detection in the general population, but had a 39% higher likelihood of detecting adenomas among patients with positive fecal immunochemical test (FIT) results.
Data derived from Hsu WF, et al. JAMA Netw Open. 2026;doi:10.1001\/jamanetworkopen.2026.4881.
\u201cCAD should be strategically deployed as a precision tool for high-risk cohorts and as a quality-standardization asset within organized screening programs,\u201d Han-Mo Chiu, MD, PhD, attending physician at National Taiwan University Hospital, told Healio. \u201cIn FIT-positive patients, more is not just more. Finding more diminutive adenomas is clinically vital. Because these small lesions in high-risk patients have a higher propensity for advanced histology like [high-grade dysplasia (HGD)], using AI to maximize their detection directly addresses the risk of interval cancers that might otherwise be overlooked in a manual exam. Crucially, this enhanced detection is achieved without over-resection.\u201d \u2018A unique high-risk cohort\u2019 Adenoma detection rate has a significant association with interval colorectal cancer, according to study background. Prior studies have shown every 1% increase in detection decreases risk for colorectal cancer 3%, but up to 26% of adenomas and 27% of serrated polyps are missed on standard colonoscopy, most of which are classified as diminutive ( 5 mm) or small (6-9 mm). CAD has been shown to increase detection of smaller adenomas. \u201cA major critique is that CAD primarily increases the detection of adenomas less than 1 cm, which some argue may have limited clinical impact in the general population,\u201d Chiu said. \u201cHowever, we recognized that FIT-positive individuals represent a unique high-risk cohort. They tend to have a higher multiplicity of adenomas, and importantly, even adenomas smaller than 1 cm in this population carry a substantially higher likelihood of advanced histology, such as HGD. \u201cOur previous study in Taiwan comparing adenomas detected in FIT-positive individuals with those identified in the general population undergoing direct colonoscopy demonstrated that the former have a significantly higher risk of HGD and invasive cancer, even within the same size category of less than 1 cm. This raises the question of whether the common criticism \u2014 that CAD mainly increases detection of small adenomas and therefore has limited impact on future colorectal cancer risk \u2014 is applicable in the FIT-screening setting.\u201d Chiu and colleagues conducted a multicenter trial in Taiwan to investigate. They randomly assigned 1,356 adults aged 40 to 79 years (mean age, 60 years; standard deviation, 9.4; 50% women) undergoing colonoscopy for positive FIT results, gastrointestinal symptoms, screening or surveillance for a history of polyps, to receive either CAD-assisted (n = 675) or standard colonoscopy (n = 681). Adenoma detection rate served as the primary endpoint. Researchers defined detection rate as the proportion of patients who had at least one histologically confirmed adenoma. Adenomas per colonoscopy, postpolypectomy surveillance intervals, and sessile serrated lesion detection rate served as secondary endpoints. \u2018Critical finding\u2019 Overall, researchers observed noninferiority in adenoma detection rate between CAD (58.5%) and standard colonoscopy (53.1%; P = .01), but the difference did not reach statistical significance (P = .05). However, among patients with positive FIT results, the CAD cohort had a significantly higher adenoma detection rate (65.3% vs. 57.4%; adjusted OR = 1.39; 95% CI, 1.05-1.86). \u201cThis is a critical finding,\u201d Chiu said. \u201cThe AI\u2019s ability to detect more of these subcentimeter adenomas in this trial will hopefully translate into a highly meaningful clinical benefit for this specific group.\u201d CAD helped identify significantly more adenomas per colonoscopy overall (mean, 1.41 vs. 1.2; P = .01) and in the FIT subgroup (mean, 1.64 vs. 1.39; P = .01), the difference stemming from detection of diminutive adenomas. The CAD group also had significantly more polyps per colonoscopy (mean, 1.97 vs. 1.71; P = .005). The CAD and standard colonoscopy groups had similar advanced adenomas per colonoscopy, nonneoplastic polypectomy rates, and sessile serrated lesion detection rates. However, withdrawal time was significantly longer with CAD than standard colonoscopy (mean, 9.14 minutes vs. 8.32 minutes; P < .001). Patients who underwent CAD-assisted colonoscopy had a significantly higher likelihood of being assigned to U.S. Multi-Society Task Force intensive surveillance of 3 to 5 years (10.4% vs. 7.2%; aOR = 1.5; 95% CI, 1.01-2.21). Patients in the FIT subgroup had even greater odds (13.2% vs. 7.3%; aOR = 1.94; 95% CI, 1.22-3.09). \u201cWhat surprised us the most was how the AI acted as a great equalizer among physicians,\u201d Chiu said. \u201cThe benefit of CAD was most pronounced among junior endoscopists, significantly improving their performance, while senior experts saw numerical, but nonsignificant, gains. Furthermore, we were pleased to see that CAD did not increase the nonneoplastic polypectomy rate. This means the AI did not cause our endoscopists to over-resect normal tissue, proving that clinical judgment remained intact alongside the AI assistance.\u201d Researchers acknowledged study limitations, including use of a single CAD system and not being able to blind endoscopists in the study arm. \u201cI would like to emphasize the rigorous, high-ceiling setting of our trial,\u201d Chiu said. \u201cWe conducted this study across centers where the baseline adenoma detection rate was already exceptionally high \u2014 over 50% for all indications of colonoscopy. Demonstrating that AI can still provide measurable clinical benefits in such an optimized environment \u2014 specifically by catching high-risk subcentimeter lesions in FIT-positive patients<\/p>\n","protected":false},"author":1,"featured_media":2334,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2333","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/2333","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2333"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/2333\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/2334"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2333"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2333"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2333"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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