The importance of quality in measurement

By Prof Cesare Hassan

In endoscopy, we often talk about the importance of accurate detection, and keeping detection rates high. It’s also important that we can characterise lesions properly.

The goal in detection is to reduce the risk of error; the goal of characterisation is to make a clinical application possible; the goal of sizing and measurement is to determine whether surveillance is needed and appropriate. It’s about keeping an eye on something and seeing how it develops so you can act accordingly.

Technological developments like artificial intelligence (AI) – of which Fujifilm’s technology like CAD EYE is an example – enable us to do this more accurately, by applying machine learning. For detection, AI is very powerful, though we do sometimes have to overcome barriers to accessing this type of innovative technology before it can become widely available.

And of course, AI does not replace the role of the clinician, but it can aid you in detecting and characterising lesions and increase confidence in your decision-making. With CAD EYE, characterisation is fast. When it comes to sizing, we are still in the early stages of AI and the evidence is very preliminary.

In colonoscopy, we need to be able to find the lesion but also to treat it, remove it and work to prevent cancer. This is the advantage of providing endoscopy solutions from screening to treatment.

While the possibilities of AI have increased over the last few years and are well-known, measuring the polyp to decide on the correct treatment for the patient has been a challenge, and we don’t always discuss it enough.

We know that measurement of polyps is really important to set appropriate surveillance intervals; it’s also very important to select the appropriate treatment for polyps.

When it comes to morphology of a lesion, we have a lot of classification guidelines to help us. We have all the knowledge as well as the technology, such as CAD EYE, that can help us make a diagnosis.

When it comes to understanding the size of a lesion, there is no objective measure, so you are relying on your own judgement. In theory, you can use biopsy, or a snare to assess size, but even if you do, it’s down to your judgement; it’s relative, not absolute. So, we tend to overestimate the small, and underestimate the big, which can affect diagnosis and surveillance decisions.

Fujifilm’s new laser technology, SCALE EYE, helps you make objective measurements of the lesion you are facing. With that measurement function, we hope that clinicians are better able to perform their endoscopies by estimating the size of a polyp.

With SCALE EYE, you have a laser that accurately measures the distance between the tip of the endoscope and the mucosa. On the base of this distance, the system calibrates the part of scale that appears at the centre of the visual field.

SCALE EYE is an innovative technology, as prior to this, we were not able to measure the lesion in the colon with such accuracy. This is also highly interesting from a clinical perspective because it tells us whether this patient needs post-polypectomy surveillance.

So, with the augmentation of CAD EYE and SCALE EYE, we have a full pathway in colonoscopy – from screening through to treatment.