The role of AI-assisted cytoscope in gastrointestinal polyps

Article by Master, Doctor Mai Vien Phuong - Gastrointestinal endoscopist - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital.

In the past few years, new approaches have emerged in endoscopic imaging technology, which help in the high-quality assessment of lesions found in the gastrointestinal tract. Artificial intelligence-assisted cytology diagnostics in gastrointestinal polyps can accurately highlight the presence of mucosal lesions.

New approaches emerge in endoscopic imaging technology for the high quality assessment of lesions found in the gastrointestinal tract, such as gastrointestinal polyps. Cystoscopy is a new tool in endoscopy, which helps to more accurately evaluate the superficial mucosal surface. This article aims to present the most relevant information regarding cytoskeletal cytoreduction technology and its clinical application in the diagnosis of gastrointestinal diseases.
The article also discusses the diagnostic ability of computer endoscopic cytology to differentiate between noncancerous and cancerous lesions, in order to provide a closer look at in-vivo. However, AI-assisted cytology diagnostics can also be used with benefit in patients with inflammatory bowel disease (IBD), by accurately highlighting the presence of lesions. mucosal injury.
2. Real-Time Cystoscopy – The Role of Technology Over the past decade, the improvement in endoscopic detection of lower gastrointestinal (GI) lesions has improved dramatically. Advances in endoscopic imaging technology lead to high-quality evaluation of lesions found in the gastrointestinal tract. One of the new tools in endoscopy is cytoscopy, which is based on the principle of ultra-high magnification with intra-procedural electron staining. This innovative endoscopic technique facilitates more precise evaluation of the superficial mucosal surface. It allows real-time examination to distinguish normal from abnormal mucosa, cytology allows the "in vivo" assessment of the histological structure of the colon epithelium by differentiating colonic polyps from cancer. invasive carcinoma with adenoma.
The purpose of "real-time" endoscopic diagnosis is to save time and reduce costs for medical patients. Cytoscopy is a promising tool for the detection of gastrointestinal abnormalities (eg, gastrointestinal polyps), which involves a contact light microscopy system with a magnifying capacity. poles (380 times of super magnifying endoscope), integrated into the distal end of the endoscope. Using cytoscope, we can perform "virtual histology" with high precision, allowing visualization of tissue and nuclei, making it the perfect tool for diagnosing colorectal lesions.
3. The role of AI-assisted cytoscope in gastrointestinal polyps The ability to obtain "real-time histology" by cytoscope provides a high-quality, time-saving endoscopy. time and low cost. Cytoscopy determines the extent of neoplastic cell transformation by visualizing changes in cell size, dyspolarization, and nuclear deformation. Another significant contribution of cytoskeletal systems is the assessment of the depth of cancer invasion and the prediction of treatment outcome. An interesting study published by Kudo et al in 2011, demonstrated data on the feasibility of a new cytoreductive endoscopic classification in colorectal lesions. This classification is specifically indicated to distinguish cancer from noncancerous colorectal lesions

The endoscopic classification of cytology has five categories, showing the lumen and cytoplasmic changes of the target lesions. This evaluation system includes cytoscopy 1a (shows normal mucosa), EC1b cytology (shows non-neoplastic polyps), EC2 cytology - adenomas with dysplasia. low-grade dysplasia, endoscopy EC3a (indicates high-grade dysplastic adenoma - HGD), endoscopy EC3b (stands for invasive cancer). Histological findings verified the above classification according to the Vienna classification.
Utsumi et al performed a study to differentiate small tumors from small non-neoplastic (DP) tumors. They compared the results from EC 1b and EC 2 DP cytology with those obtained by histopathology. The data suggest that cytoscopy could be a potential tool for real-time histology in differentiating benign from malignant colorectal lesions.
Over the past few years, a new understanding of colorectal carcinogenesis has emerged. Previously, lesions were diagnosed as hyperplastic polyps (HPs) with no potential for malignancy. Today, these allegations have changed. In this context, HP can lead to cancer because of its ability to transform into serrated lesions. These lesions can occur anywhere in the colon, but they are predominantly located in the distal colon (70%-80%). It was found that HP with the right localization was more likely to be malignancy.
4. Artificial intelligence-assisted colonoscopy for diagnosing cancerous colon polyps Although there are insufficient data on different microRNAs (miRNAs) expression profiles, they may contribute some role in serrated adenomas with varying degrees of dysplasia. Compared with traditional colorectal carcinogens, the important role of miRNAs and related signaling mechanisms in the sawtooth pathway of carcinogenesis, awaits elucidation. With that, artificial intelligence-assisted endoscopy can be a great complementary tool to make a correct and timely diagnosis.
According to the 5th edition of the WHO classification of colorectal polyps and lesions, they are classified into three histopathological subtypes: HP (hyperplastic polyps), sessile serrated lesions ( SSL) and traditional serrated adenomas (TSAs). TSA is extremely rare, <1% of all colorectal polyps; while HP is the most common type, accounting for about 75% of all serrated polyps. SSL (formerly known as sessile serrate adenomas or sessile serrate polyps) causes nearly 25% of serrated polyps. Thus, the management of serrated lesions depends on accurate endoscopic diagnosis.

5. What do the studies say? To better understand saw-tooth carcinogenesis and therapeutic strategies for these lesions, Kutsukawa et al elucidated the precise EC (cytoscopy) criteria for diagnosis. In their study, which included 785 SLs, 712 was not observed with EC, because of its smaller size (<5 mm). The remaining 73 lesions detected 12 mixed serrated polyps, 3 of which had a carcinoma component, resulting in their exclusion from the study. The remaining 58 gastrointestinal polyps were divided into 27 HP, 12 SSL and 19 TSA. There were no high-grade dysplastic polyps among the samples obtained. The subdivided serrated polyps are characterized by cytoscopy as follows:
HP has a star-like glandular hole and a rounded nucleus; SSL has oval glandular holes and round cores; TSA has a serrated nuclei or villi-shaped glandular foramen. The results indicate that cytoscopy could be a viable diagnostic tool in the management of treatment options for SL. Therefore, the study concluded that SSL and TSA should be completely resected endoscopically.

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