LAUSR

BACKGROUND Optical diagnosis of colorectal polyps (CRPs) remains challenging. Imaging enhancement techniques such as narrow band imaging and blue light imaging (BLI) can improve optical diagnosis. We developed and prospectively validated a computer-aided diagnosis system (CADx) using high definition white light (HDWL) and BLI images, and compared it with the optical diagnosis of expert and novice endoscopists. METHODS The CADx characterized CRPs by exploiting artificial neural networks. Six experts and thirteen novices optically diagnosed 60 CRPs based on intuition. After a washout period of four weeks, the same set of CRPs was permuted and optically diagnosed using BASIC (BLI Adenoma Serrated International Classification). RESULTS The CADx had a diagnostic accuracy of 88.3% using HDWL images and 86.7% using BLI images. The overall diagnostic accuracy, combining HDWL and BLI (multimodal imaging), was 95.0% and significantly higher compared to experts (81.7%, p=0.031) and novices (66.5%, p<0.001). Sensitivity (95.6% vs. 61.1% and 55.4%) was also higher for CADx, while specificity was higher for experts compared to CADx and novices (94.1% vs 93.3% and 92.1%). For endoscopists, diagnostic accuracy did not increase using BASIC, neither for experts (Intuition 79.5% vs BASIC 81.7%, p=0.140) nor for novices (Intuition 66.7% vs BASIC 66.5%, p=0.953). CONCLUSION The CADx had a significantly higher diagnostic accuracy than experts and novices for the optical diagnosis of CRPs. Multimodal imaging, incorporating both HDWL and BLI, improved the diagnostic accuracy of the CADx. BASIC did not increase the diagnostic accuracy of endoscopists compared to intuitive optical diagnosis.