计算机辅助检测系统对胃癌前病变和瘤变检出率影响的单中心自身对照研究

A single‑center self‑controlled study on the impact of a computer‑aided detection system on the detection rate of gastric precancerous lesions and neoplasms

摘要:

目的 分析计算机辅助检测（computer‑aided detection，CADe）系统使用前后胃癌前病变及胃瘤变的检出差异，探究其在真实临床环境下的使用效果。方法 回顾性收集2018年1—6月和2021年1—6月在武汉大学人民医院消化内镜中心检查室1和检查室2内行胃镜检查患者的临床数据。根据检查时段、检查室和使用CADe系统与否分为CADe组（引入CADe系统后，2021年于检查室2行检查患者）、Pre‑CADe组（引入CADe系统前，2018年于检查室2行检查患者）、18‑Con组（2018年于检查室1使用传统系统检查患者）和21‑Con组（2021年于检查室1使用传统系统检查患者）。比较不同组别之间肠上皮化生检出率以及胃瘤变检出率差异。结果 CADe组肠上皮化生检出率明显高于Pre‑CADe组［5.76%（198/3 437）比3.23%（100/3 092），χ2=23.856，P<0.001］，也明显高于21‑Con组［5.76%（198/3 437）比 2.73%（131/4 796），χ2=47.895，P<0.001］。CADe组胃瘤变检出率明显高于Pre‑CADe组［3.23%（111/3 437）比1.58%（49/3 092），χ2=18.421，P<0.001］和21‑Con组［3.23%（111/3 437）比1.79%（86/4 796），χ2=17.687，P<0.001］。结论 CADe系统能够在临床真实环境中提升胃肠上皮化生和胃瘤变的检出率，在实现胃癌的早诊早治方面发挥作用。

Abstract:

Objective To analyze differences in detection rates for gastric precancerous lesions and neoplasms before versus after implementing a computer-aided detection (CADe) system in real-world clinical practice. Methods Clinical data of patients who underwent gastroscopic examinations in two examination rooms (Room 1 and 2) in the Digestive Endoscopy Center of Renmin Hospital of Wuhan University were retrospectively collected during two periods: from January to June 2018 and from January to June 2021. Patients were stratified into four groups: CADe group (Room 2, 2021, using CADe), Pre-CADe group (Room 2, 2018, without CADe), 18-Con group (Room 1, 2018, without CADe), and 21-Con group (Room 1, 2021, without CADe). The differences in the detection rates of intestinal metaplasia and neoplasms between different groups were compared. Results The detection rate of intestinal metaplasia in the CADe group was significantly higher than that in the Pre-CADe group [5.76% (198/3 437) VS 3.23% (100/3 092), χ2=23.856, P<0.001]. It was also significantly higher than that in the 21-Con group [5.76% (198/3 437) VS 2.73% (131/4 796), χ2=47.895, P<0.001]. The detection rate of neoplasms in the CADe group was significantly higher than that in the Pre-CADe group [3.23% (111/3 437) VS 1.58% (49/3 092), χ2=18.421, P<0.001] and the 21-Con group [3.23% (111/3 437) VS 1.79% (86/4 796), χ2=17.687, P<0.001]. Conclusion The CADe system can significantly improve the detection rates of gastric intestinal metaplasia and neoplasms in clinical settings, potentially facilitating early diagnosis and treatment.