Department of Gastroenterology, Pontchaillou Hospital, Rennes, France.
Gastrointest Endosc. 2011 Jul;74(1):141-7. doi: 10.1016/j.gie.2011.03.1179.
We previously showed a significant variability in adenoma detection among colonoscopists who were participating in a mass screening program. The reasons for such variability remain largely unknown.
To study intercenter variations in neoplasia detection.
Secondary analyses of colonoscopy findings from the 2 first rounds of a French screening program: logistic regressions and repeated-measures analyses of variance.
A total of 3487 colonoscopies performed by all 19 endoscopists who performed 30 examinations or more per round at 8 centers (6 private, 2 public).
Probabilities of detecting 1, 2, or 3 or more adenomas, 1 adenoma 10 mm or larger, or colorectal cancer, as well as the corresponding adjusted (for patient age and sex) per-center detection rates.
Endoscopy centers were not significant predictors of the probability of detecting any category of neoplasia with the exception of the 2 adenomas or more category (P < .005). The ranges of the adjusted detection rates for each of these categories were 33.1% to 43.1%, 11.1% to 21.6%, 3.6% to 8.1%, 16.3% to 23.6%, and 8.3% to 12.6%, respectively. When the colonoscopies that were performed by the 11 endoscopists who performed 30 examinations or more per center in 2 or more centers were separately analyzed, no intercenter statistically significant variability was observed with the exception of 1 endoscopist and the 1 adenoma category. In a subgroup of 1100 colonoscopies performed by 6 endoscopists who were working at the same 3 centers, intercenter variability was not statistically significant.
Type II error because of sample sizes.
In our setting, intercenter variability did not explain interendoscopist variability for neoplasia detection rate.
我们之前的研究显示，在参与大规模筛查计划的结肠镜检查医生中，腺瘤检出率存在显著差异。但导致这种差异的原因尚不清楚。
研究不同中心间结直肠肿瘤检出率的差异。
对法国筛查项目前两轮结肠镜检查结果的二次分析：逻辑回归和方差重复测量分析。
19 名内镜医生共进行了 3487 例结肠镜检查，每位医生在 8 个中心（6 家私人诊所和 2 家公立医院）进行 30 次或以上的结肠镜检查。
检出 1 个、2 个或 3 个或更多腺瘤、1 个 10mm 或更大的腺瘤或结直肠癌的概率，以及相应的每中心检出率（调整患者年龄和性别）。
除了检出 2 个或更多腺瘤的类别外（P＜0.005），内镜中心不是检测任何结直肠肿瘤类别的概率的显著预测因子。这些类别的调整检出率范围分别为 33.1%至 43.1%、11.1%至 21.6%、3.6%至 8.1%、16.3%至 23.6%和 8.3%至 12.6%。当单独分析在 2 个或以上中心完成 30 次或以上结肠镜检查的 11 名内镜医生的结肠镜检查时，除了 1 名内镜医生和 1 个腺瘤类别外，没有观察到各中心间统计学上显著的差异。在由在 3 个相同中心工作的 6 名内镜医生进行的 1100 例结肠镜检查的亚组中，各中心间的差异无统计学意义。
由于样本量的限制，存在 II 型错误。
在我们的研究中，不同中心间的差异并不能解释结直肠肿瘤检出率的内镜医生间的差异。
