Quality Indicators for Colonoscopy and the Risk of Interval Cancer
In this large study of colorectal-cancer screening, the endoscopist's rate of adenoma detection was associated with the risk of interval colorectal cancer after screening colonoscopy. Colorectal cancers were less likely to be diagnosed between screening examinations when colonoscopies were perf...
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| Published in | The New England journal of medicine Vol. 362; no. 19; pp. 1795 - 1803 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Waltham, MA
Massachusetts Medical Society
13.05.2010
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| Subjects | |
| Online Access | Get full text |
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| Abstract | In this large study of colorectal-cancer screening, the endoscopist's rate of adenoma detection was associated with the risk of interval colorectal cancer after screening colonoscopy. Colorectal cancers were less likely to be diagnosed between screening examinations when colonoscopies were performed by endoscopists with an adenoma detection rate of 20% or more.
In this large study of colorectal-cancer screening, the endoscopist's rate of adenoma detection was associated with the risk of interval colorectal cancer after screening colonoscopy.
Although colonoscopy is widely used for colorectal-cancer screening,
1
–
3
its miss rate for cancers and adenomatous polyps (benign premalignant tumors or adenomas), which is low but not negligible, remains a concern.
4
–
6
It has been suggested that a high-quality examination that ensures the detection and removal of all neoplastic lesions is key for screening efficacy.
6
–
8
In response, professional societies have proposed the use of various quality-assessment indicators. Of such indicators, the rates of adenoma detection and cecal intubation are the most commonly used.
7
–
10
However, these measurements have never been validated, and it is not known whether an improvement . . . |
|---|---|
| AbstractList | Background Although rates of detection of adenomatous lesions (tumors or polyps) and cecal intubation are recommended for use as quality indicators for screening colonoscopy, these measurements have not been validated, and their importance remains uncertain. Methods We used a multivariate Cox proportional-hazards regression model to evaluate the influence of quality indicators for colonoscopy on the risk of interval cancer. Data were collected from 186 endoscopists who were involved in a colonoscopy-based colorectal-cancer screening program involving 45,026 subjects. Interval cancer was defined as colorectal adenocarcinoma that was diagnosed between the time of screening colonoscopy and the scheduled time of surveillance colonoscopy. We derived data on quality indicators for colonoscopy from the screening program's database and data on interval cancers from cancer registries. The primary aim of the study was to assess the association between quality indicators for colonoscopy and the risk of interval cancer. Results A total of 42 interval colorectal cancers were identified during a period of 188,788 person-years. The endoscopist's rate of detection of adenomas was significantly associated with the risk of interval colorectal cancer (P=0.008), whereas the rate of cecal intubation was not significantly associated with this risk (P=0.50). The hazard ratios for adenoma detection rates of less than 11.0%, 11.0 to 14.9%, and 15.0 to 19.9%, as compared with a rate of 20.0% or higher, were 10.94 (95% confidence interval [CI], 1.37 to 87.01), 10.75 (95% CI, 1.36 to 85.06), and 12.50 (95% CI, 1.51 to 103.43), respectively (P=0.02 for all comparisons). Conclusions The adenoma detection rate is an independent predictor of the risk of interval colorectal cancer after screening colonoscopy. Although rates of detection of adenomatous lesions (tumors or polyps) and cecal intubation are recommended for use as quality indicators for screening colonoscopy, these measurements have not been validated, and their importance remains uncertain. We used a multivariate Cox proportional-hazards regression model to evaluate the influence of quality indicators for colonoscopy on the risk of interval cancer. Data were collected from 186 endoscopists who were involved in a colonoscopy-based colorectal-cancer screening program involving 45,026 subjects. Interval cancer was defined as colorectal adenocarcinoma that was diagnosed between the time of screening colonoscopy and the scheduled time of surveillance colonoscopy. We derived data on quality indicators for colonoscopy from the screening program's database and data on interval cancers from cancer registries. The primary aim of the study was to assess the association between quality indicators for colonoscopy and the risk of interval cancer. A total of 42 interval colorectal cancers were identified during a period of 188,788 person-years. The endoscopist's rate of detection of adenomas was significantly associated with the risk of interval colorectal cancer (P=0.008), whereas the rate of cecal intubation was not significantly associated with this risk (P=0.50). The hazard ratios for adenoma detection rates of less than 11.0%, 11.0 to 14.9%, and 15.0 to 19.9%, as compared with a rate of 20.0% or higher, were 10.94 (95% confidence interval [CI], 1.37 to 87.01), 10.75 (95% CI, 1.36 to 85.06), and 12.50 (95% CI, 1.51 to 103.43), respectively (P=0.02 for all comparisons). The adenoma detection rate is an independent predictor of the risk of interval colorectal cancer after screening colonoscopy. Although rates of detection of adenomatous lesions (tumors or polyps) and cecal intubation are recommended for use as quality indicators for screening colonoscopy, these measurements have not been validated, and their importance remains uncertain.BACKGROUNDAlthough rates of detection of adenomatous lesions (tumors or polyps) and cecal intubation are recommended for use as quality indicators for screening colonoscopy, these measurements have not been validated, and their importance remains uncertain.We used a multivariate Cox proportional-hazards regression model to evaluate the influence of quality indicators for colonoscopy on the risk of interval cancer. Data were collected from 186 endoscopists who were involved in a colonoscopy-based colorectal-cancer screening program involving 45,026 subjects. Interval cancer was defined as colorectal adenocarcinoma that was diagnosed between the time of screening colonoscopy and the scheduled time of surveillance colonoscopy. We derived data on quality indicators for colonoscopy from the screening program's database and data on interval cancers from cancer registries. The primary aim of the study was to assess the association between quality indicators for colonoscopy and the risk of interval cancer.METHODSWe used a multivariate Cox proportional-hazards regression model to evaluate the influence of quality indicators for colonoscopy on the risk of interval cancer. Data were collected from 186 endoscopists who were involved in a colonoscopy-based colorectal-cancer screening program involving 45,026 subjects. Interval cancer was defined as colorectal adenocarcinoma that was diagnosed between the time of screening colonoscopy and the scheduled time of surveillance colonoscopy. We derived data on quality indicators for colonoscopy from the screening program's database and data on interval cancers from cancer registries. The primary aim of the study was to assess the association between quality indicators for colonoscopy and the risk of interval cancer.A total of 42 interval colorectal cancers were identified during a period of 188,788 person-years. The endoscopist's rate of detection of adenomas was significantly associated with the risk of interval colorectal cancer (P=0.008), whereas the rate of cecal intubation was not significantly associated with this risk (P=0.50). The hazard ratios for adenoma detection rates of less than 11.0%, 11.0 to 14.9%, and 15.0 to 19.9%, as compared with a rate of 20.0% or higher, were 10.94 (95% confidence interval [CI], 1.37 to 87.01), 10.75 (95% CI, 1.36 to 85.06), and 12.50 (95% CI, 1.51 to 103.43), respectively (P=0.02 for all comparisons).RESULTSA total of 42 interval colorectal cancers were identified during a period of 188,788 person-years. The endoscopist's rate of detection of adenomas was significantly associated with the risk of interval colorectal cancer (P=0.008), whereas the rate of cecal intubation was not significantly associated with this risk (P=0.50). The hazard ratios for adenoma detection rates of less than 11.0%, 11.0 to 14.9%, and 15.0 to 19.9%, as compared with a rate of 20.0% or higher, were 10.94 (95% confidence interval [CI], 1.37 to 87.01), 10.75 (95% CI, 1.36 to 85.06), and 12.50 (95% CI, 1.51 to 103.43), respectively (P=0.02 for all comparisons).The adenoma detection rate is an independent predictor of the risk of interval colorectal cancer after screening colonoscopy.CONCLUSIONSThe adenoma detection rate is an independent predictor of the risk of interval colorectal cancer after screening colonoscopy. In this large study of colorectal-cancer screening, the endoscopist's rate of adenoma detection was associated with the risk of interval colorectal cancer after screening colonoscopy. Colorectal cancers were less likely to be diagnosed between screening examinations when colonoscopies were performed by endoscopists with an adenoma detection rate of 20% or more. In this large study of colorectal-cancer screening, the endoscopist's rate of adenoma detection was associated with the risk of interval colorectal cancer after screening colonoscopy. Although colonoscopy is widely used for colorectal-cancer screening, 1 – 3 its miss rate for cancers and adenomatous polyps (benign premalignant tumors or adenomas), which is low but not negligible, remains a concern. 4 – 6 It has been suggested that a high-quality examination that ensures the detection and removal of all neoplastic lesions is key for screening efficacy. 6 – 8 In response, professional societies have proposed the use of various quality-assessment indicators. Of such indicators, the rates of adenoma detection and cecal intubation are the most commonly used. 7 – 10 However, these measurements have never been validated, and it is not known whether an improvement . . . |
| Author | Regula, Jaroslaw Polkowski, Marcin Butruk, Eugeniusz Rupinski, Maciej Zwierko, Maria Didkowska, Joanna Nowacki, Marek P Kaminski, Michal F Kraszewska, Ewa Wojciechowska, Urszula |
| Author_xml | – sequence: 1 givenname: Michal F surname: Kaminski fullname: Kaminski, Michal F – sequence: 2 givenname: Jaroslaw surname: Regula fullname: Regula, Jaroslaw – sequence: 3 givenname: Ewa surname: Kraszewska fullname: Kraszewska, Ewa – sequence: 4 givenname: Marcin surname: Polkowski fullname: Polkowski, Marcin – sequence: 5 givenname: Urszula surname: Wojciechowska fullname: Wojciechowska, Urszula – sequence: 6 givenname: Joanna surname: Didkowska fullname: Didkowska, Joanna – sequence: 7 givenname: Maria surname: Zwierko fullname: Zwierko, Maria – sequence: 8 givenname: Maciej surname: Rupinski fullname: Rupinski, Maciej – sequence: 9 givenname: Marek P surname: Nowacki fullname: Nowacki, Marek P – sequence: 10 givenname: Eugeniusz surname: Butruk fullname: Butruk, Eugeniusz |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22752421$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/20463339$$D View this record in MEDLINE/PubMed |
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| CODEN | NEJMAG |
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| Copyright | Copyright © 2010 Massachusetts Medical Society. All rights reserved. 2015 INIST-CNRS 2010 Massachusetts Medical Society |
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| Keywords | Medicine Quality assurance Colonoscopy Risk factor Risk Endoscopy Malignant tumor Cancer Interval |
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| SubjectTerms | Adenoma - diagnosis Adult Aged Biological and medical sciences Clinical Competence Colonic Polyps - diagnosis Colonoscopy - standards Colorectal cancer Colorectal Neoplasms - diagnosis Digestive system. Abdomen Early Detection of Cancer - standards Endoscopy General aspects Humans Intubation Investigative techniques, diagnostic techniques (general aspects) Medical sciences Medical screening Middle Aged Multivariate Analysis Poland Proportional Hazards Models Quality Indicators, Health Care Risk Factors |
| Title | Quality Indicators for Colonoscopy and the Risk of Interval Cancer |
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