Adenoma Detection Rate and Risk for Interval Postcolonoscopy Colorectal Cancer in Fecal Immunochemical Test-Based Screening : A Population-Based Cohort Study.

Autor:	Wisse PHA; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.H.A.W., E.J.K., M.C.W.S.)., Erler NS; Department of Biostatistics and Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands (N.S.E.)., de Boer SY; Regional Organization for Population Screening Mid-West Netherlands, Amsterdam, the Netherlands (S.Y.B.)., den Hartog B; Regional Organization for Population Screening East Netherlands, Deventer, the Netherlands (B.H.)., Oudkerk Pool M; Regional Organization for Population Screening North Netherlands, Groningen, the Netherlands (M.O.P.)., Terhaar Sive Droste JS; Regional Organization for Population Screening South Netherlands, Eindhoven, the Netherlands (J.S.T.)., Verveer C; Regional Organization for Population Screening South-West Netherlands, Rotterdam, the Netherlands (C.V.)., Meijer GA; Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands (G.A.M.)., Lansdorp-Vogelaar I; Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands (I.L.)., Kuipers EJ; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.H.A.W., E.J.K., M.C.W.S.)., Dekker E; Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands (E.D.)., Spaander MCW; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.H.A.W., E.J.K., M.C.W.S.).
Jazyk:	angličtina
Zdroj:	Annals of internal medicine [Ann Intern Med] 2022 Oct; Vol. 175 (10), pp. 1366-1373. Date of Electronic Publication: 2022 Sep 27.
DOI:	10.7326/M22-0301
Abstrakt:	Background: The adenoma detection rate (ADR) is an essential quality indicator for endoscopists performing colonoscopies for colorectal cancer (CRC) screening as it is associated with postcolonoscopy CRCs (PCCRCs). Currently, data on ADRs of endoscopists performing colonoscopies in fecal immunochemical testing (FIT)-based screening, the most common screening method, are scarce. Also, the association between the ADR and PCCRC has not been demonstrated in this setting. Objective: To evaluate the association between the ADR and PCCRC risk in colonoscopies done after a positive FIT result. Design: Population-based cohort. Setting: Dutch, FIT-based, CRC screening program. Participants: Patients undergoing colonoscopy, done by accredited endoscopists, after a positive FIT result. Measurements: Quality indicator performance and PCCRC incidence for colonoscopies in FIT-positive screenees were assessed. The PCCRCs were classified as interval, a cancer detected before recommended surveillance, or noninterval. The association between ADR and interval PCCRC was evaluated with a multivariable Cox regression model and PCCRC incidence was determined for different ADRs. Results: 362 endoscopists performed 116 360 colonoscopies with a median ADR of 67%. In total, 209 interval PCCRCs were identified. The ADR was associated with interval PCCRC, with an adjusted hazard ratio of 0.95 (95% CI, 0.92 to 0.97) per 1% increase in ADR. For every 1000 patients undergoing colonoscopy, the expected number of interval PCCRC diagnoses after 5 years was approximately 2 for endoscopists with ADRs of 70%, compared with more than 2.5, almost 3.5, and more than 4.5 for endoscopists with ADRs of 65%, 60%, and 55%, respectively. Limitation: The relative short duration of follow-up (median, 52 months) could be considered a limitation. Conclusion: The ADR of endoscopists is inversely associated with the risk for interval PCCRC in FIT-positive colonoscopies. Endoscopists performing colonoscopy in FIT-based screening should aim for markedly higher ADRs compared with primary colonoscopy. Primary Funding Source: None.
Databáze:	MEDLINE
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