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Endocystoscopy for colonic polyps: Is there a future for this diagnostic modality in routine practice?
In this issue, Mori et al. reported that a brand-new AI-CADx system (EndoBRAIN-Plus, OLYMPUS) using endocytoscopy showed sufficient diagnostic capability in the discrimination of invasive cancer and its high specificity may contribute to a reduction in unnecessary surgeries for large adenomas. I have read this article with great interest. The history of endocytoscopy and CADx began with a pilot trial conducted on the esophagus by Kodashima et al . Thereafter, there have been many reports concerning the usefulness thereof in the identification of tumors and invasion depth diagnosis when applied in colon    . We have great interest in a part of this paper by Mori, which indicated that it is possible to use AI diagnosis to check for the presence of invasive cancer in colorectal lesions 2 cm or larger that are susceptible to overtreatment. However, they wrote that, “Apparently, identification of the histologically worst area in a lesion is a prerequisite of using EndoBRAIN-Plus in an appropriate way. We did not assess how endoscopists identify these areas in the study, which will be an important research topic in the future.” In other words, when actual EndoBRAIN-Plus-CADx is assumed, it is necessary to identify the area of interest of the deepest part of the cancer infiltration in the lesion. Therefore, endoscopists need to have sufficient understanding of the fundamental diagnosis of colorectal lesions along with the methods of approaching them, with beginners left with the question of how this is possible. This approach suggests that, for the time being, it is realistic to apply CADx as an educational training tool to support beginners in getting better at fundamental diagnostic endoscopy. Also, because CADx cannot show the processes that led to a diagnosis (black box diagnosis), research should also be conducted into whether it is possible to actually provide this kind of education to beginners in a logical manner.
17 June 2021 (online)
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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