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Failures in lesion detection at colonoscopy deliver imperfect protection against colorectal cancer. Minimally elevated lesions are more likely to contain high-grade dysplasia or invasive carcinoma, but are frequently undetected during conventional two-dimensional (2D) colonoscopy. We performed a randomised, complete, across-subjects counterbalanced study of 3D versus 2D imaging for lesion detection during simulated colonoscopy in a simulation laboratory. Thirty-six gastroenterology fellows, comprising 50% of the nationwide pool in Australia, were tested on their ability to detect a 1 mm lesion that was similar in colour and surface texture to its surroundings in 20 simulated colonoscopy withdrawal videos, half of which contained a lesion and the other half were lesion-free. Testing difficulty was maximised to accommodate for ceiling effects, and experimental validity was confirmed by pilot testing using international experts in colonoscopy. We found a 25.1% absolute improvement in detection rates for 3D over 2D imaging. The sensitivity of 3D viewing was approximately twice that of 2D, and the false-positive rates with both technologies were not significantly different. This is the first study to highlight the large and immediate impact of 3D displays in the colonoscopic detection of diminutive, minimally elevated lesions, and the significant potential for the application of 3D technology to colonoscopy.
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Minimally elevated or depressed lesions that are more likely to contain high-grade dysplasia or invasive …