IJspeert Joep E G, van Doorn Sascha C, van der Brug Ymkje M, Bastiaansen Barbara A J, Fockens Paul, Dekker Evelien
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Procolo/Bergman Clinics, Amsterdam, The Netherlands.
Gastrointest Endosc. 2015 Nov;82(5):870-7. doi: 10.1016/j.gie.2015.02.044. Epub 2015 Apr 29.
The adenoma detection rate (ADR) is the most important surrogate quality parameter for colorectal cancer (CRC) prevention. However, serrated polyps also are precursors of CRC. Large, prospective studies comparing the detection rate of serrated polyps among endoscopists in an era of awareness about the malignant potential of serrated polyps have not yet been performed. We aimed to compare the proximal serrated polyp (PSP) detection rate and the clinically relevant serrated polyp (RSP) detection rate among endoscopists and to analyze the association between these parameters and the ADR.
Colonoscopy data were retrieved in one expert center between January 2011 and July 2014 by using a structured reporting system, enabling prospective and automatic quality assessment. Endoscopists who performed at least 50 colonoscopies within the timeframe were included for analysis. Multivariate logistic regression was used to compare the ADR, PSP detection rate, and RSP detection rate among endoscopists. The association among these parameters was calculated by using the Pearson r correlation coefficient. All lesions were assessed by an expert pathologist.
In total, 16 endoscopists and 2088 colonoscopies were included for analysis. The PSP detection rate ranged from 2.9% to 18.6% (mean 10.4%) among endoscopists. Corrected for confounders, the odds ratio to detect ≥1 PSP, compared with endoscopists with the highest detection rate, ranged from 0.79 (95% confidence interval [CI], 0.41-1.52) to 0.12 (95% CI, 0.03-0.55). The PSP detection rate was highly correlated with the RSP detection rate (ρ 0.94; P < .001), ranging from 4.3% to 20.9% (mean 13.9%). The PSP detection rate moderately correlated with the ADR (0.55; P = .03), which ranged from 23.2% to 49.2% (mean 35.2%).
The PSP detection rate is widely variable among endoscopists, strongly correlated with the RSP detection rate, and moderately correlated with the ADR. These results suggest a high miss rate of RSPs among endoscopists with low rates of PSP detection. Future research should determine the association between endoscopists' PSP detection rates and the risk of interval cancer.
腺瘤检出率（ADR）是结直肠癌（CRC）预防中最重要的替代质量参数。然而，锯齿状息肉也是CRC的前驱病变。在一个认识到锯齿状息肉具有恶性潜能的时代，尚未进行大规模前瞻性研究来比较内镜医师对锯齿状息肉的检出率。我们旨在比较内镜医师对近端锯齿状息肉（PSP）的检出率和临床相关锯齿状息肉（RSP）的检出率，并分析这些参数与ADR之间的关联。
通过使用结构化报告系统，在2011年1月至2014年7月期间于一个专家中心检索结肠镜检查数据，以实现前瞻性和自动质量评估。纳入在该时间段内至少进行50次结肠镜检查的内镜医师进行分析。采用多变量逻辑回归比较内镜医师之间的ADR、PSP检出率和RSP检出率。这些参数之间的关联通过Pearson r相关系数计算。所有病变均由专家病理学家评估。
总共纳入16名内镜医师和2088例结肠镜检查进行分析。内镜医师的PSP检出率在2.9%至18.6%之间（平均为10.4%）。校正混杂因素后，与检出率最高的内镜医师相比，检出≥1个PSP的比值比范围为0.79（95%置信区间[CI]，0.41 - 1.52）至0.12（95%CI，0.03 - 0.55）。PSP检出率与RSP检出率高度相关（ρ 0.94；P <.001），范围在4.3%至20.9%之间（平均为13.9%）。PSP检出率与ADR中度相关（0.55；P =.03），ADR范围在23.2%至49.2%之间（平均为35.2%）。
内镜医师之间的PSP检出率差异很大，与RSP检出率高度相关，与ADR中度相关。这些结果表明，PSP检出率低的内镜医师对RSP的漏诊率很高。未来的研究应确定内镜医师的PSP检出率与间隔期癌症风险之间的关联。
