Colonoscopic cancer detection rate: a new performance measure – is it FIT for purpose?

IF 2.4 Q3 GASTROENTEROLOGY & HEPATOLOGY
Khalid Bashir, Iosif Beintaris, Linda Sharp, Julia Newton, Katherine Elliott, Jon Rees, Peter Rogers, Matt Rutter
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引用次数: 0

Abstract

Introduction Gastrointestinal symptoms correlate poorly with cancer diagnosis. A faecal immunochemical test (FIT) result of ≥10 µg has high sensitivity and negative predictive value for colorectal cancer (CRC) detection. An FIT-based diagnostic pathway may lead to more effective resource utilisation. We aimed to use National Endoscopy Database (NED) data to create a new colonoscopy performance measure, cancer detection rate (CDR) to assess the appropriate identification of target populations for colonoscopy; then to use CDR to assess the impact of implementing an FIT-based referral pathway locally. Methods NED data were analysed to compare local diagnostic colonoscopic CDR in 2019 (prepathway revision) and 2021 (postpathway revision), benchmarked against overall national CDR for the same time frames. Results 1, 123, 624 NED diagnostic colonoscopies were analysed. Locally, there was a significant increase in CDR between 2019 and 2021, from 3.01% (2.45%–3.47%) to 4.32% (3.69%–4.95%), p=0.003. The CDR increase was due to both a 10% increase in the number of CRCs detected and a 25% reduction in the number of diagnostic colonoscopies performed. Nationally, there was a smaller, but significant, increase in CDR from 2.02% (1.99%–2.07%) to 2.33% (2.29%–2.37%), p<0.001. The rate of increase in CDR% between 2019 and 2021 was significantly different locally compared with nationally. Conclusion Our study indicates that the introduction of a robustly vetted FIT-based algorithm to determine whether diagnostic colonoscopy is required, is effective in increasing the colonoscopic CDR. Moreover, CDR appears to be a meaningful performance metric that can be automatically calculated through NED, enabling monitoring of the quality of referral and vetting pathways. All data relevant to the study are included in the article or uploaded as online supplemental information.
结肠镜癌症检出率:新的绩效衡量标准--是否符合目的?
导言 胃肠道症状与癌症诊断的相关性很低。粪便免疫化学检验(FIT)结果≥10 µg对大肠癌(CRC)的检测具有较高的灵敏度和阴性预测值。基于粪便免疫化学检验的诊断路径可提高资源利用效率。我们旨在利用国家内镜数据库(NED)数据创建一个新的结肠镜检查绩效指标--癌症检出率(CDR),以评估结肠镜检查目标人群的适当识别;然后利用CDR评估在当地实施基于FIT的转诊途径的影响。方法 对 NED 数据进行分析,比较 2019 年(路径修订前)和 2021 年(路径修订后)的地方结肠镜诊断 CDR,并与相同时间段内的全国总体 CDR 进行比较。结果 分析了 1 123 624 例非急诊结肠镜诊断。从本地来看,2019 年至 2021 年的 CDR 有了显著增长,从 3.01% (2.45%-3.47%) 增长到 4.32% (3.69%-4.95%),P=0.003。CDR增加的原因是检测出的CRC数量增加了10%,而进行的诊断性结肠镜检查数量减少了25%。在全国范围内,CDR 的增幅较小,但也很显著,从 2.02% (1.99%-2.07%) 增至 2.33% (2.29%-2.37%),P<0.001。2019 年至 2021 年期间,当地 CDR% 的增长率与全国相比有显著差异。结论 我们的研究表明,采用经过严格审核的基于 FIT 的算法来确定是否需要进行诊断性结肠镜检查,能有效提高结肠镜检查 CDR。此外,CDR 似乎是一个有意义的绩效指标,可以通过 NED 自动计算,从而监控转诊和审核路径的质量。该研究的所有相关数据均包含在文章中或作为在线补充信息上传。
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来源期刊
Frontline Gastroenterology
Frontline Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.70
自引率
11.50%
发文量
93
期刊介绍: Frontline Gastroenterology publishes articles that accelerate adoption of innovative and best practice in the fields of gastroenterology and hepatology. Frontline Gastroenterology is especially interested in articles on multidisciplinary research and care, focusing on both retrospective assessments of novel models of care as well as putative future directions of best practice. Specifically Frontline Gastroenterology publishes articles in the domains of clinical quality, patient experience, service provision and medical education.
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