CAD-EYE System for the Detection of Neoplastic Lesions in Patients With Lynch Syndrome

Not Applicable

Recruiting

• Conditions: Lynch Syndrome
• Interventions: Device: Colorectal cancer screening with CAD EYE colonoscopy

• Registration Number: NCT05963191
• Lead Sponsor: PERROD Guillaume

Brief Summary

Lynch syndrome (LS) is the most common genetic predisposition syndrome for colorectal cancer (CRC), responsible for around 2-4% of cancers. It is characterized by a pathogenic germline mutation in one of the DNA mismatch repair genes (path_MMR) MLH1, MSH2, MSH6, PMS2 or a deletion in the 3' region of the Epcam gene. Patients followed up for LS are at high risk of developing CRC at an early age, and have a high cumulative CRC risk. In this context, CRC screening by colonoscopy is of major importance, as it is associated with a reduction in both CRC incidence and mortality.

In France, the Institut National du Cancer (INCa) recommends colonoscopy with indigo carmine chromoendoscopy (CE), as it is associated with a significant increase in the adenoma detection rate (ADR) compared with white light. However, EC is not routinely performed in clinical practice, as it is a time-consuming technique requiring a dedicated slot with a trained operator.

Recent years have seen the emergence of artificial intelligence techniques for real-time polyp detection aids or CADe devices. These easy-to-use systems have shown very promising results compared with high-definition (HD) white light. Indeed, data from the first meta-analysis of 5 randomized controlled trials (4354 patients) confirmed a significantly higher ADD in the CADe group than in the HD group (36.6% vs. 25.2%; 95% CI\], 1.27-1.62; P \< 0.01; I2 Z 42%) 10. The CAD EYE system (Fujifilm) is a CADe device supporting both detection (sensitivity \> 95%) and characterization of colonic polyps in real time.

To date, artificial intelligence has never been evaluated for CRC screening in patients followed up for LS. The aim of this work is to evaluate the effectiveness of the CAD EYE system in this specific population. To this end, we intend to conduct a randomized, controlled, non-inferiority trial comparing CAD EYE with CE in patients with LS.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2023-07-10
• Study First Submitted QC: 2023-07-18
• Study First Posted: 2023-07-27
• Study Start: 2024-04-18
• Status Verified: 2025-02
• Last Update Submitted: 2025-02-25
• Last Update Posted: 2025-02-26
• Primary Completion: 2025-04-18
• Study Completion: 2025-04-18

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 272

Inclusion Criteria

• Confirmed pathogenic mutation (path_MLH1, path_MSH2, path_MSH6, path_PMS2, path_EpCAM)
• Male or female of legal age at time of colonoscopy prescription.
• Patient agreeing to participate in the study
• Person affiliated with or benefiting from a social security scheme
• Free, informed and express consent

Exclusion Criteria

• Patient undergoing total colectomy with ileoanal or ileosigmoid anastomosis
• Patient with a history of Crohn's disease or ulcerative colitis
• Patients with a known allergy or intolerance to polyethylene glycol and ascorbic acid.
• Patients unable to undergo fractionated colonic preparation
• Inadequate colonic preparation: Boston sub-score <2 per segment
• Patient under guardianship or protected person
• Patient who does not understand French or cannot read
• Person not affiliated to a Social Security system.
• Pregnant women

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
CAD-EYE group: Colorectal cancer screening with CAD EYE colonoscopy	Colorectal cancer screening with CAD EYE colonoscopy	The colonoscopy procedure for each patient will be no different from a conventional colonoscopy examination. In the CAD EYE group, descent is performed under white light, with the CAD EYE system switched on (device with CE mark). When polyps are detected, they are rigorously described and histological predictions of endoscopist and CAD EYE will be reported separately.

Primary Outcome Measures

Name	Time	Method
to evaluate the effectiveness of the CAD EYE system in screening for neoplastic lesions in Lynch syndrome.	Through study completion, an average of 2 years	Comparison of the adenoma detection rate (ADR) between the CAD-EYE group and the indigo carmin chromoendoscopy (CE) group (reference technique).

Secondary Outcome Measures

Name	Time	Method
Rate of resect and discard strategy	Through study completion, an average of 2 years	Evaluation of the feasibility of a "resect and discard" strategy in Lynch Syndrome. Retrospective analysis comparing CAD-EYE histological prediction vs. endoscopist prediction, using histological report as reference examination (Sensitivity and negative predictive value).
Detection rates of specific lesions	Through study completion, an average of 2 years	Mean number of adenomas and serrated lesions per patient
Diagnostic performance of CAD EYE	Through study completion, an average of 2 years	Comparison of the diagnostic performance of CAD EYE assessed by specificity, negative predictive value and positive predictive value for the characterization (adenoma/hyperplastic) of colonic polyps with the CAD EYE automated detection system. The anatomopathology of polyps was taken as the diagnostic reference.
Time of Colonoscopies	Through study completion, an average of 2 years	Comparison of different procedure times between the 2 groups. Total procedure time will be defined as the time from endoscope insertion to extraction through the anus. Withdrawal time will be defined as the time spent on inspection, from the cecum to extraction of the endoscope through the anus, excluding the time required for polypectomy.

Trial Locations

Locations (1)

Hôpital Européen Georges-Pompidou HEGP; 🇫🇷 Paris, France