BowelSys: an AI tool to enhance FIT diagnostic yield and improve bowel cancer detection in symptomatic patients

粪便免疫化学测试（FIT）测量粪便血红蛋白浓度（f-Hb）JIT可用于管理在初级保健中呈现的具有不明原因的下胃肠道（GI）症状的患者，所述症状可指示在施用前的初级保健中的肠癌。（或同时）紧急转介，或用于二级护理中的分诊，以指导转诊患者的管理。有症状患者FIT阳性结果的阈值为10µg Hb/g粪便。任何超过该预设FIT阈值的参与者都被转诊接受内窥镜服务（例如，乙状结肠镜检查或结肠镜检查）以确定任何医学上可操作的出血原因即，再加上FIT相对于传统的基于愈创木脂的f-Hb检测的灵敏度增加，从初级保健转诊进行内窥镜手术的数量正在增加。2021年的一项研究确定，FIT在低风险症状人群中的阳性预测值为7.0%。这表明假阳性率为93%，这意味着13名f-Hb>10 µg Hb/g粪便的患者接受了乙状结肠镜或结肠镜检查以确定一个CRC。这将减少内窥镜转诊，保护患者免受可能导致肠穿孔（可能致命的严重不良事件）的不必要的侵入性筛查，每例手术的费用为322英镑 **-** 548英镑。本项目的临床合作者已经收集的数据显示，可以根据特定的个体数据变量调整症状性患者的个性化FIT阈值，这可能有助于改进后续转诊。解决方案：** 高级专家系统有限公司（AES）与考文垂和沃里克郡米德兰NHS信托大学医院、约克和斯卡伯勒教学医院NHS基金会信托（约克）以及莱斯特NHS信托大学医院（莱斯特）的临床专家合作，开发了一个基于人工智能的软件平台“BowelSys”，用于在与肠癌发展相关的其他临床和非临床风险因素的背景下解释FIT结果。作为一个多变量分层模型，BowelSys能够对FIT结果进行个性化解释，并根据风险优化临床资源。高风险患者被快速跟踪以进行进一步调查，而低风险至无风险的患者则被推迟进一步调查。这将使临床资源得到更有效的利用，高风险患者可以快速跟踪内窥镜检查，从而更早更好地检测肿瘤。及时性：** 由于新冠肺炎，现在有额外的动力减少不必要的内窥镜转诊，以遵守感染控制措施，解决漫长的等待名单，提高NHS效率，并降低成本。

Faecal immunochemical testing (FIT) measures faecal haemoglobin concentration (f-Hb).FIT can be used to manage patients presenting in primary care with unexplained lower gastrointestinal (GI) symptoms that may be indicative of bowel cancer in primary care prior to (or alongside) an urgent referral, or for triaging in secondary care to guide the management of referred patients.The threshold for a positive FIT result in symptomatic patients is 10µg Hb/g faeces. Any participant exceeding this pre-set FIT threshold value is referred for endoscopic services (e.g., sigmoidoscopy or colonoscopy) to identify any medically actionable cause of bleeding i.e., colorectal cancer (CRC) or a precancerous adenoma (polyp).Coupled to increased sensitivity of FIT vs. traditional guaiac-based f-Hb detection, the number of referrals from primary care for endoscopic procedures is rising.A 2021 study determined the positive predictive value of FIT in a low-risk symptomatic population was 7.0%. This indicates a false-positive rate of 93%, meaning 13 patients with f-Hb \>10 µg Hb/g faeces underwent sigmoidoscopy or colonoscopy to identify one CRC.There is an immediate and pressing **unmet need** to improve FIT's diagnostic yield for detecting bowel cancer. This will reduce endoscopy referrals, protecting patients from unnecessary invasive screening that can cause bowel perforation (a serious adverse event that can be lethal), and costs £322**-**£548 per procedure. Data already collected by the clinical collaborators to this project has revealed scope to modulate personalised FIT thresholds for symptomatic patients based on specific individual data variables that could help to refine onward referrals.**SOLUTION:** Advanced Expert Systems Ltd (AES) have joined clinical specialists from University Hospitals Coventry & Warwickshire Midlands NHS Trust, York and Scarborough Teaching Hospital NHS Foundation Trust (York), and University Hospitals of Leicester NHS Trust (Leicester) to develop an AI-based software platform 'BowelSys' to interpret FIT result in the context of other clinical and non-clinical risk factors associated with the development of bowel cancer.As a multivariate stratification model, BowelSys enables a personalised interpretation of FIT result and optimises clinical resources by risk. High-risk patients are fast-tracked for further investigation, whilst patients with low-to-no risk have further investigations delayed. This will enable clinical resources to be used more efficiently, with high-risk patients fast-tracked for endoscopy, enabling earlier and better detection of neoplasias.**TIMELINESS:** Due to Covid-19, there is now additional impetus to reduce unnecessary endoscopy referrals to comply with infection control measures, tackle long waiting lists, improve NHS efficiency, and reduce costs.