Division of Community Internal Medicine, Mayo Clinic, Scottsdale, Arizona 85259, USA.
Am J Gastroenterol. 2013 Jun;108(6):993-9. doi: 10.1038/ajg.2013.68. Epub 2013 Apr 9.
Little is known about the correlation between the polyp detection rate (PDR) and the adenoma detection rate (ADR) in individual colonic segments. The adenoma-to-polyp detection rate quotient (APDRQ) has been utilized in retrospective study as a constant to estimate ADR from PDR. It has been previously stated that diminutive polyps in the rectum are more likely to be non-adenomatous, compared with more proximal segments, yet the APDRQ uses data from the entire colon. We sought to characterize and compare ADR and PDR in each colonic segment, estimate ADR using the conversion factor, APDRQ, and assess the correlation between estimated and actual ADR for each colonic segment.
As part of a quality improvement program, a retrospective chart review was conducted of all outpatient colonoscopies performed by 20 gastroenterologists between 1 October 2010 and 31 March 2011 at a single academic tertiary-care referral center. PDR, ADR, and the APDRQ were calculated for each gastroenterologist, using data from the entire colon and then for each colonic segment separately. Actual ADR was compared with estimated ADR based on the measured APDRQ.
During 1,921 colonoscopies, 2,285 polyps were removed; 1,122 (49%) were adenomas. The mean (s.d.) PDR for the group was 49% (12.4%) (range, 16-64%). The mean (s.d.) ADR was 31% (7.4%) (range, 13-42%). PDR and ADR correlated well in segments proximal to the splenic flexure, but diverged in distal segments. ADR was significantly higher in the right colon (17.1%) than in the left (13.5%) (P=0.001). The correlation between estimated and actual ADR using the APDRQ was significantly higher in the right colon (r=0.95 (95% confidence interval (CI), 0.87-0.98)) than in the left (r=0.59 (95% CI, 0.17-0.83)) (P<0.05).
Although PDR and ADR correlate well in segments proximal to the splenic flexure, they do not correlate well in the left colon. Caution should be exercised when using PDR as a surrogate for ADR if data from the rectum and sigmoid are included.
关于个体结肠段的息肉检出率（PDR）和腺瘤检出率（ADR）之间的相关性，目前所知甚少。腺瘤-息肉检出率比值（APDRQ）曾被用于回顾性研究，作为从 PDR 估计 ADR 的常数。此前有研究表明，与近端结肠段相比，直肠内的微小息肉更有可能是非腺瘤性的，但 APDRQ 则使用整个结肠的数据。我们试图描述和比较每个结肠段的 ADR 和 PDR，使用转换系数 APDRQ 来估计 ADR，并评估每个结肠段的估计和实际 ADR 之间的相关性。
作为质量改进计划的一部分，对 2010 年 10 月 1 日至 2011 年 3 月 31 日期间在一家学术性三级转诊中心由 20 位胃肠病学家进行的所有门诊结肠镜检查进行了回顾性图表审查。使用整个结肠的数据，然后分别对每个结肠段计算每位胃肠病学家的 PDR、ADR 和 APDRQ。根据测量的 APDRQ，将实际 ADR 与估计的 ADR 进行比较。
在 1921 次结肠镜检查中，切除了 2285 个息肉；其中 1122 个（49%）为腺瘤。该组的平均（标准差）PDR 为 49%（12.4%）（范围 16-64%）。平均（标准差）ADR 为 31%（7.4%）（范围 13-42%）。在脾曲近端的结肠段，PDR 和 ADR 相关性良好，但在远端结肠段则出现差异。右半结肠（17.1%）的 ADR 明显高于左半结肠（13.5%）（P=0.001）。使用 APDRQ 估计的 ADR 与实际 ADR 之间的相关性在右半结肠中明显更高（r=0.95（95%置信区间（CI），0.87-0.98）），而在左半结肠中则较低（r=0.59（95%CI，0.17-0.83））（P<0.05）。
尽管 PDR 和 ADR 在脾曲近端的结肠段相关性良好，但在左半结肠段相关性不佳。如果包括直肠和乙状结肠的数据，则使用 PDR 作为 ADR 的替代物时应谨慎。
