Luisa F. Sánchez-Peralta ^1* Benjamin Glover ^2* Debesh Jha ^3* J. Blas Pagador ^1*

• ¹ Bioengineering and Health Technologies Unit, Jesus Uson Minimally Invasive Surgery Centre, Cáceres, Spain
• ² Imperial College London, London, England, United Kingdom
• ³ Northwestern University, Evanston, Illinois, United States

The integration of Artificial Intelligence (AI) technologies into healthcare is revolutionising early diagnostic processes for diseases, also for CRC, enhancing both the effectiveness and efficiency of traditional diagnostic methods (4).Fortunately, early detection of CRC increases the 5-year survival rate from 18% when detected at the most advanced stage to 88.5% when detected at an early symptomatic stage (5). Screening programs are implemented for such early detection, as tumours detected in symptomatic patients are larger and at more advanced stages than tumours detected in asymptomatic patients in a screening programme (6). Thus, the detection of colorectal cancer is critical yet challenging, often requiring operatordependant endoscopic procedures, followed by accurate histological assessment of tissue biopsies. AI offers promising enhancements to these traditional methods, providing tools that are less invasive, more accurate, faster, and consistent.In the field of CRC, AI can be applied to different stages of the process, since evaluation of the bowel preparation, before the colonoscopy itself, to histopathology classification, once the lesion has been removed (Figure 1). Following tissue retrieval, Yuan et al. demonstrate an AI algorithm developed through transfer learning from a polyp segmentation model. This localises colorectal cancer regions within precise grids on whole slide imaging (WSI). The method boasts high sensitivity and specificity, and addresses challenges related to AI use and applicability, by accurately labelling cancer presence in histological slides, thus demonstrating reliability and efficacy in histology applications.Regarding to post-colonoscopy stage, Doğan et al. present a study that evaluates the role of artificial intelligence in histopathological image analysis, notably using convolutional neural networks (CNNs) for classifying diverse tissue types within digital pathology. By comparing AI-based algorithms against manual machine learning models, the research demonstrates the superior performance of CNNs in both binary and multi-class classifications of tissues, achieving accuracies of 0.91 and 0.97, respectively. Utilizing over 100,000 images for training and 7,180 for testing, the study highlights AI's potential to enhance diagnostic accuracy and efficiency in identifying tumour tissues and other types, marking a significant advancement over traditional methods.These studies demonstrate how AI can significantly enhance diagnostic accuracy and efficiency in clinical settings. However, integrating AI tools into healthcare systems will further involve overcoming challenges related to ethical and societal implications, workflow integration and interoperability or interpretability (7).Addressing integration challenges and expanding research to include diverse, multicentre trials will be crucial. This will help validate AI tools' efficacy and safety in real-world settings, ensuring AI tools meet the diverse needs of global populations.The emergence of AI in early CRC diagnosis signifies a significant advance toward more proactive, individualised, and minimally invasive healthcare. Continued research and development are essential to harness the full potential of AI, promising to transform CRC diagnosis and improve patient outcomes and experience.