Defining Benchmarks for Adenoma Detection Rate and Adenomas Per Colonoscopy in Patients Undergoing Colonoscopy Due to a Positive Fecal Immunochemical Test
| Autor: | Ronald Bridges, S. Elizabeth McGregor, Alaa Rostom, Christopher Naugler, Catherine Dubé, Sarah M Rose, Robert J. Hilsden, Steven J. Heitman |
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| Rok vydání: | 2016 |
| Předmět: |
Adenoma
Male medicine.medical_specialty endocrine system diseases MEDLINE Colonoscopy Gastroenterology Alberta Cohort Studies Feces 03 medical and health sciences fluids and secretions 0302 clinical medicine Internal medicine mental disorders medicine Humans In patient Early Detection of Cancer Aged Hepatology medicine.diagnostic_test business.industry Immunochemistry Middle Aged medicine.disease digestive system diseases Benchmarking stomatognathic diseases Fecal Immunochemical Test 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology Detection rate Colorectal Neoplasms business Cohort study |
| Zdroj: | American Journal of Gastroenterology. 111:1743-1749 |
| ISSN: | 0002-9270 |
| DOI: | 10.1038/ajg.2016.449 |
| Popis: | Although there is an accepted benchmark for adenoma detection rate (ADR) in average risk screening colonoscopy, a benchmark for ADR or the associated quality indicator, adenomas per colonoscopy (APC), for colonoscopies performed for a positive fecal immunochemical test (FIT+) has not been established. The purpose of this study was to propose methods for establishing a benchmark ADR and APC for FIT+ patients.In this historical cohort study, we included 15,329 patients aged 50-74 years who underwent a colonoscopy at Alberta Health Services' Colon Cancer Screening Centre, Calgary, Canada, from 1 January 2014 to 30 June 2015 for either investigation of a positive FIT or average risk screening. Using meta-regression, we estimated for FIT+ patients the ADR and APC that corresponded to (Method #1: minimally acceptable) an ADR of 25% in average risk individuals, (Method #2: standard of care) the average ADR or APC in all FIT+ patients, and (Method #3: aspirational) the average FIT+ ADR or APC in colonoscopies performed by endoscopists with an ADR of ≥35% in average risk patients.At least one adenoma was detected in 30% of average risk patients and 58% of FIT+ patients. The calculated benchmark FIT+ ADRs for the three methods were 55, 60, and 65%, respectively. The calculated benchmarks for FIT+ APC were 1.2, 1.4, and 1.7, respectively. To account for expected random variation in individual endoscopists' ADR or APC, we propose using the upper bound of the 95% confidence interval of an endoscopist's ADR or APC to determine if they fall below a given benchmark.We have proposed methods of defining benchmarks for ADR and APC in FIT+ patients that go beyond the current "minimally acceptable" threshold currently recommended in average risk patients. These new thresholds represent results obtained by all peers and by a group of expert adenoma detectors defined in an independent patient cohort (average risk). Because the true adenoma burden in FIT+ patients could vary based on factors such as the threshold used to define a positive FIT, screening programs or endoscopy units may need to calculate their own benchmarks using local data. |
| Databáze: | OpenAIRE |
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