Bressler Brian, Paszat Lawrence F, Vinden Christopher, Li Cindy, He Jingsong, Rabeneck Linda
Department of Medicine, University of Toronto, Ontario, Canada.
Gastroenterology. 2004 Aug;127(2):452-6. doi: 10.1053/j.gastro.2004.05.032.
BACKGROUND & AIMS: Colonoscopy contains an inherent miss rate for colorectal cancer. Although miss rates from academic centers or units known for their endoscopic expertise have been previously reported, the colorectal cancer miss rate of colonoscopy performed in usual clinical practice is unknown. We conducted a population-based study to estimate the proportion of right-sided colon cancers missed during colonoscopy in Ontario.
All persons > or =20 years old with a new diagnosis of right-sided colon cancer admitted to the hospital for surgical resection in Ontario from April 1, 1997, to March 31, 2001, were identified. Patients who had a colonoscopy within 3 years of their diagnosis were divided into 2 groups: detected cancers (those who had a colonoscopy up to 6 months before the diagnosis) and missed cancers (those who had a colonoscopy between 6 and 36 months before the diagnosis). Data were obtained from the Canadian Institute for Health Information Discharge Abstract Database, the Ontario Health Insurance Plan database, and the Registered Persons Database.
Between April 1, 1997, and March 31, 2001, we identified 4920 persons with a new diagnosis of right-sided colon cancer, of whom 2654 (53.9%) had had at least 1 colonoscopy within 3 years of their admission for surgical resection. Most (96.0%) had had their most recent colonoscopy up to 6 months before admission (detected cancers). However, 105 patients (4.0%) had their most recent colonoscopy between 6 and 36 months before admission to the hospital (missed cancers).
Among persons undergoing resection for right-sided colon cancer, the miss rate of colonoscopy for detecting cancer in usual clinical practice was 4.0%.
结肠镜检查对结直肠癌存在固有漏诊率。尽管此前已有学术中心或以内镜专业技术闻名的单位的漏诊率报道，但常规临床实践中结肠镜检查的结直肠癌漏诊率尚不清楚。我们开展了一项基于人群的研究，以估算安大略省结肠镜检查时右侧结肠癌的漏诊比例。
确定了1997年4月1日至2001年3月31日期间安大略省所有因手术切除而入院的新诊断为右侧结肠癌且年龄≥20岁的患者。在诊断后3年内进行过结肠镜检查的患者被分为两组：已检测到癌症的患者（诊断前6个月内进行过结肠镜检查的患者）和漏诊癌症的患者（诊断前6至36个月进行过结肠镜检查的患者）。数据来自加拿大健康信息研究所出院摘要数据库、安大略省医疗保险计划数据库和注册人员数据库。
1997年4月1日至2001年3月31日期间，我们确定了4920例新诊断为右侧结肠癌的患者，其中2654例（53.9%）在因手术切除入院前3年内至少进行过1次结肠镜检查。大多数（96.0%）患者在入院前6个月内进行了最近一次结肠镜检查（已检测到癌症）。然而，105例患者（4.0%）在入院前6至36个月进行了最近一次结肠镜检查（漏诊癌症）。
在接受右侧结肠癌切除术的患者中，常规临床实践中结肠镜检查检测癌症的漏诊率为4.0%。
