Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany.
Gastroenterology. 2015 Aug;149(2):356-66.e1. doi: 10.1053/j.gastro.2015.04.012. Epub 2015 Apr 22.
BACKGROUND & AIMS: The adenoma detection rate (ADR) is an important quality indicator of screening colonoscopy; it is inversely associated with risk of interval cancers and colorectal cancer mortality. We assessed trends in the ADR in the first 10 years of the German screening colonoscopy program.
We calculated age-adjusted and age-specific detection rates of nonadvanced adenomas and advanced adenomas for each calendar year based on 4.4 million screening colonoscopies conducted from 2003 through 2012 and reported to the German screening colonoscopy registry.
We observed a steady and strong increase in rate of detection of nonadvanced adenomas in both sexes and all age groups. Age-adjusted rates of detection of nonadvanced adenomas increased from 13.3% to 22.3% among men and from 8.4% to 14.9% among women. This increase was mostly due to an increase in detection rates of adenomas <0.5 cm, and it is partly explained by an innovation effect (higher ADRs among incoming colonoscopists than among leaving colonoscopists, and relatively stable ADRs among continuing colonoscopists). Only modest increases were observed in detection rates of advanced adenomas (from 7.4% to 9.0% among men, and from 4.4% to 5.2% among women) and colorectal cancer. In 2012, overall ADR reached 31.3% and 20.1% in men and women, respectively.
We observed a strong increase in ADRs from 2003 through 2012 in Germany. Although we cannot exclude the effects of secular trends in colorectal neoplasm prevalence, the observed increase was mainly the result of a steady increase in detection of nonadvanced adenomas (especially adenomas <0.5 cm). Further research should address potential implications for defining screening and surveillance intervals.
腺瘤检出率（ADR）是筛查结肠镜检查的重要质量指标；它与间隔期癌症和结直肠癌死亡率呈负相关。我们评估了德国筛查结肠镜检查计划实施前 10 年的 ADR 趋势。
我们根据 2003 年至 2012 年进行的 440 万例筛查结肠镜检查结果，计算了每年基于年龄调整和年龄特异性的非高级别腺瘤和高级别腺瘤的检出率，并向德国筛查结肠镜检查登记处报告。
我们观察到男女两性和所有年龄组的非高级别腺瘤检出率呈稳定且强劲的上升趋势。男性非高级别腺瘤的检出率从 13.3%增加到 22.3%，女性从 8.4%增加到 14.9%。这种增加主要归因于 0.5cm 以下腺瘤检出率的增加，部分原因是创新效应（新入职结肠镜检查医生的 ADR 高于离职医生，且继续从业的医生的 ADR 相对稳定）。高级别腺瘤（男性从 7.4%增加到 9.0%，女性从 4.4%增加到 5.2%）和结直肠癌的检出率仅略有增加。2012 年，男性和女性的总体 ADR 分别达到 31.3%和 20.1%。
我们观察到 2003 年至 2012 年间德国 ADR 呈强劲上升趋势。尽管我们不能排除结直肠肿瘤患病率的长期趋势的影响，但观察到的上升主要是由于非高级别腺瘤（尤其是 0.5cm 以下腺瘤）检出率的稳步上升所致。进一步的研究应该解决潜在的对定义筛查和监测间隔的影响。
