Computer aided detection and diagnosis of polyps in adult patients undergoing colonoscopy: a living clinical practice guideline.

context_and_current_practice

Colorectal cancer (CRC), the third most common cancer and the second leading cause of cancer-related death globally, typically arises from adenomatous polyps.

结直肠癌（CRC），是全球第三大常见癌症和第二大癌症相关死亡原因，通常由腺瘤性息肉发展而来。

Detection and removal of polyps during colonoscopy can reduce the risk of cancer.

在结肠镜检查期间检测并移除息肉可以降低癌症风险。

CADe systems use artificial intelligence (AI) to assist endoscopists by analysing real-time colonoscopy images to detect potential polyps.

计算机辅助检测(CADe)系统利用人工智能(AI)通过分析实时结肠镜图像来帮助内镜医生检测潜在的息肉。

Despite their increasing use in clinical practice, guideline recommendations that carefully balance all patient-important outcomes remain unavailable.

尽管在临床实践中越来越多地使用，但仔细权衡所有患者重要结果的指南建议仍然不可用。

In this first iteration of a living guideline, we address the use of CADe at the level of an individual patient.

在这份活指南的首次迭代中，我们针对个体患者层面的CADe使用进行了讨论。

evidence

Evidence for this recommendation is drawn from a living systematic reviewof 44 randomised controlled trials (RCTs) involving more than 30 000 participants and a companion microsimulation study simulating 10 year follow-up for 100 000 individuals aged 60-69 years to assess the impact of CADe on patient-important outcomes.

这一推荐的证据来自于一项包含44项随机对照试验（RCTs）的活系统综述，涉及超过30,000名参与者，以及一项模拟研究，模拟了10万名60-69岁个体的10年随访，以评估CADe对患者重要结果的影响。

While no direct evidence was found for critical outcomes of colorectal cancer incidenceand post-colonoscopy cancer incidence, low certainty data from the trials indicate that CADe may increase positive endoscopy findings.

尽管没有找到结直肠癌发病率和结肠镜后癌症发病率的关键结果的直接证据，但来自试验的低确定性数据表明，CADe可能会增加阳性内镜检查发现。

The microsimulation modelling, however, suggests little to no effect on CRC incidence, CRC-related mortality, or colonoscopy-related complications (perforation and bleeding) over the 10 year follow-up period, although low certainty evidence indicates CADe may increase the number of colonoscopies performed per patient.

然而，微模拟建模显示，在10年的随访期内，计算机辅助检测（CADe）对结直肠癌（CRC）发病率、CRC相关死亡率或结肠镜检查相关的并发症（穿孔和出血）几乎没有影响或没有影响，尽管低质量的证据表明CADe可能会增加每位患者进行的结肠镜检查次数。

A review of values and preferences identified that patients value mortality reduction and quality of care but worry about increased anxiety, overdiagnosis, and more frequent surveillance.

对价值观和偏好的回顾发现，患者重视死亡率降低和护理质量，但担心增加焦虑、过度诊断和更频繁的监测。

recommendation

For adults who have agreed to undergo colonoscopy, we suggest against the routine use of CADe (weak recommendation).

对于已同意进行结肠镜检查的成年人，我们建议不要常规使用计算机辅助检测（CADe）（弱推荐）。

how_this_guideline_was_created

An international panel, including three patient partners, 11 healthcare providers, and seven methodologists, deemed by MAGIC and The BMJ to have no relevant competing interests, developed this recommendation.

一个由三名患者伙伴、11名医疗保健提供者和七名方法学家组成的国际小组，被MAGIC和《英国医学杂志》认为没有相关利益冲突，制定了这一建议。

For this guideline the panel took an individual patient approach.

在制定本指南时，专家组采取了个案患者的方法。

The panel started by defining the clinical question in PICO format, and prioritised outcomes including CRC incidenceand mortality.

专家组首先以PICO格式定义了临床问题，并优先考虑了包括结直肠癌发病率和死亡率在内的结果。

Based on the linked systematic reviewand microsimulation study, the panel sought to balance the benefits, harms, and burdens of CADe and assumed patient preferences when making this recommendation UNDERSTANDING THE RECOMMENDATION: The guideline panel found the benefits of CADe on critical outcomes, such as CRC incidenceand post-colonoscopy cancer incidence, over a 10 year follow up period to be highly uncertain.

基于相关系统评价和微模拟研究，专家组在制定此建议时，力求平衡CADe的利弊和负担，并考虑了患者的偏好。理解这些建议：指南专家组发现，在10年的随访期间，CADe对关键结果，如结直肠癌（CRC）发病率和结肠镜后癌症发病率的影响高度不确定。

Low certainty evidence suggests little to no impact on CRC-related mortality, while the potential burdens-including more frequent surveillance colonoscopies-are likely to affect many patients.

低质量的证据表明，CADe对CRC相关死亡率的影响很小或没有影响，而潜在的负担——包括更频繁的监测结肠镜检查——可能会影响许多患者。

Given the small and uncertain benefits and the likelihood of burdens, the panel issued a weak recommendation against routine CADe use.The panel acknowledges the anticipated variability in values and preferences among patients and clinicians when considering these uncertain benefits and potential burdens.

鉴于计算机辅助检测（CADe）使用的益处小且不确定，以及可能出现的负担，该小组发出了一个弱推荐，反对常规使用CADe。小组承认，在考虑这些不确定的益处和潜在负担时，患者和临床医生的价值观和偏好可能存在预期的差异。

In healthcare settings where CADe is available, individual decision making may be appropriate.

在计算机辅助检测（CADe）可用的医疗环境中，个体决策可能是适当的。

updates

This is the first iteration of a living practice guideline.

这是活指南的首次迭代。

The panel will update this living guideline if ongoing evidence surveillance identifies new CADe trial data that substantially alters our conclusions about CRC incidence, mortality, or burdens, or studies that increase our certainty in values and preferences of individual patients.

如果持续的证据监测发现了新的CADe试验数据，这些数据显著改变了我们对CRC发病率、死亡率或负担的结论，或者增加了我们对个别患者价值观和偏好的确定性，那么委员会将更新这个活指南。

Updates will provide recommendations on the use of CADe from a healthcare systems perspective (including resource use, acceptability, feasibility, and equity), as well as the combined use of CADe and computer aided diagnosis (CADx).

更新将提供从医疗系统角度使用计算机辅助检测（CADe）的建议（包括资源使用、可接受性、可行性及公平性），以及CADe与计算机辅助诊断（CADx）的联合使用建议。

Users can access the latest guideline version and supporting evidence on MAGICapp, with updates periodically published in The BMJ.

用户可以访问MAGICapp上的最新指南版本和相关证据，定期在《英国医学杂志》（The BMJ）上发布更新。