Association Between Adenoma Detection Rate and Prevalent Colorectal Cancer Detection Rate in a National Colonoscopy Registry Subtitle: Association Between Adenoma and Colorectal Cancer Detection

IF 25.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterology Pub Date : 2025-06-14 DOI:10.1053/j.gastro.2025.06.009

Jason A. Dominitz, Uri Ladabaum, Jennifer L. Holub, Rachel B. Issaka, Cynthia W. Ko, Douglas J. Robertson

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引用次数: 0

Abstract

BACKGROUND

While the adenoma detection rate (ADR) is associated with post-colonoscopy colorectal cancer (PCCRC) risk, it is unknown to what extent this reflects missed colorectal cancer (CRC) versus missed pre-cancerous lesions. We evaluated the association between physician ADR and prevalent CRC detection during colonoscopy.

METHODS

We used cross-sectional 2019-2022 GI Quality Improvement Consortium (GIQuIC) data for >1.73 million colonoscopies performed by 3567 endoscopists for screening or abnormal fecal test (AFT) follow-up from 683 US endoscopy units. Endoscopist ADR and sessile serrated lesion detection rate (SSLDR) were determined based on screening exams.

RESULTS

CRC was detected in 0.3% of screening and 1.5% of follow-up colonoscopies. From lowest to highest endoscopist ADR quintile, CRC detection increased from 26.6 (95% confidence interval (CI) 24.4-27.9) to 33.1 (95%CI 29.7-33.7), and from 107.8 (95%CI 96.2–129.4) to 164.7 (95% CI 140.8–188.6) per 10,000 screening and AFT follow-up colonoscopies, respectively. In multivariable models with lowest ADR quintile as reference, the odds ratios (ORs) of CRC detection in the highest ADR quintile were 1.27 (95% CI 1.14-1.41) for screening and 1.50 (95% CI 1.16-1.93) for AFT follow-up colonoscopies. Compared to high-ADR/high-SSLDR endoscopists, the ORs of CRC detection were lower for low-ADR endoscopists irrespective of SSLDR (high-SSLDR, 0.87, 95% CI 0.80-0.96; low-SSLDR 0.92, 95% CI 0.85-0.98), but similar for high-ADR/low-SSLDR endoscopists.

CONCLUSIONS

ADR reflects prevalent CRC detection as well as detection and removal of CRC precursors. Our findings suggest that PCCRC is not uncommonly due to missed CRC, especially among endoscopists with low ADR.

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国家结肠镜检查登记中腺瘤检出率与结直肠癌检出率的关系（副标题：腺瘤与结直肠癌检出率的关系）

虽然腺瘤检出率（ADR）与结肠镜检查后结直肠癌（PCCRC）风险相关，但尚不清楚这在多大程度上反映了结直肠癌（CRC）和癌前病变的漏诊。我们评估了医生不良反应与结肠镜检查中CRC检出率之间的关系。方法：我们使用2019-2022年胃肠道质量改善联盟（GIQuIC）的横断面数据，收集了来自683个美国内镜单位的3567名内镜医师进行的173万次结肠镜检查，用于筛查或异常粪便试验（AFT）随访。通过筛查检查确定内镜下不良反应和无根锯齿病变检出率（SSLDR）。结果scrc检出率为0.3%，结肠镜随访检出率为1.5%。从最低到最高的内镜不良反应五分位数，结直肠癌检出率分别从26.6（95%可信区间（CI） 24.4-27.9）增加到33.1(95%可信区间（CI） 29.7-33.7)，从107.8 （95%CI 96.2-129.4）增加到164.7 (95%CI 140.8-188.6) / 10,000筛查和AFT随访结肠镜检查。在以最低不良反应五分位数作为参考的多变量模型中，在最高不良反应五分位数中，筛查CRC检测的比值比（ORs）为1.27 (95% CI 1.14-1.41)， AFT随访结肠镜检查的比值比（ORs）为1.50 （95% CI 1.16-1.93）。与高adr /高SSLDR内镜医师相比，无论SSLDR如何，低adr内镜医师CRC检测的or都较低(高SSLDR， 0.87, 95% CI 0.80-0.96；低ssldr 0.92, 95% CI 0.85-0.98)，但高adr /低ssldr内窥镜医师相似。结论sadr反映了CRC的普遍发现以及CRC前体的发现和清除。我们的研究结果表明，由于遗漏的结直肠癌，PCCRC并不罕见，特别是在不良反应低的内镜医师中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gastroenterology 医学-胃肠肝病学

CiteScore

45.60

自引率

2.40%

发文量

4366

审稿时长

26 days

期刊介绍： Gastroenterology is the most prominent journal in the field of gastrointestinal disease. It is the flagship journal of the American Gastroenterological Association and delivers authoritative coverage of clinical, translational, and basic studies of all aspects of the digestive system, including the liver and pancreas, as well as nutrition. Some regular features of Gastroenterology include original research studies by leading authorities, comprehensive reviews and perspectives on important topics in adult and pediatric gastroenterology and hepatology. The journal also includes features such as editorials, correspondence, and commentaries, as well as special sections like "Mentoring, Education and Training Corner," "Diversity, Equity and Inclusion in GI," "Gastro Digest," "Gastro Curbside Consult," and "Gastro Grand Rounds." Gastroenterology also provides digital media materials such as videos and "GI Rapid Reel" animations. It is abstracted and indexed in various databases including Scopus, Biological Abstracts, Current Contents, Embase, Nutrition Abstracts, Chemical Abstracts, Current Awareness in Biological Sciences, PubMed/Medline, and the Science Citation Index.