Sakata Shinichiro, Klein Kerenaftali, Stevenson Andrew R L, Hewett David G
1 Faculty of Medicine, The University of Queensland, Brisbane, Australia 2 Department of Colon and Rectal Surgery, Royal Brisbane & Women's Hospital, Brisbane, Australia 3 Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia 4 Department of Gastroenterology, Mater Health Services, Brisbane, Australia.
Dis Colon Rectum. 2017 Sep;60(9):987-991. doi: 10.1097/DCR.0000000000000859.
The success of current and proposed strategies to reduce colorectal cancer (CRC) incidence and mortality rates are fundamentally based on measurement accuracy.
The aim of this study was to evaluate the densities of colorectal polyps individually measured at colonoscopy and whether measurement bias is a systemic phenomenon among colonoscopists.
A population-wide, observational study.
All hospitals of the government-funded health system in Brisbane, Australia.
Our study investigated measurement bias at colonoscopy through systematic analysis of 8,591 individual polyp measurements recorded from 12,597 colonoscopies. All colonoscopies performed over a 12-month period between December 1, 2014, and November 30, 2015, were included.
A total of 12,597 electronic colonoscopy reports were individually reviewed, hospital-by-hospital, and 8,591 individual size measurements from 18,276 detected polyps (47%) were obtained.
Our study is limited because the true size of unresected polyps was unknown. We chose not to compare pathologic and histologic sizes as resection specimens sent to pathologists are morphologically different and are measured differently to the pre-resection polyp images seen by endoscopists.
Colonoscopists may be inaccurate in the measurement of polyp size and appear biased towards and against certain size measurements. These findings cast doubt over the validity of international post-polypectomy surveillance guidelines and the safety of optical diagnosis as a potential management paradigm for diminutive colorectal polyps. They also question the historical accuracy of polyp size data and risk estimates upon which these strategies were based.
当前以及拟议的降低结直肠癌（CRC）发病率和死亡率策略的成功，从根本上基于测量的准确性。
本研究旨在评估结肠镜检查时单独测量的结直肠息肉密度，以及测量偏差在结肠镜医师中是否为一种系统性现象。
一项全人群的观察性研究。
澳大利亚布里斯班政府资助卫生系统的所有医院。
我们的研究通过对12597例结肠镜检查记录的8591个个体息肉测量值进行系统分析，调查了结肠镜检查时的测量偏差。纳入了2014年12月1日至2015年11月30日这12个月期间进行的所有结肠镜检查。
逐家医院对总共12597份电子结肠镜检查报告进行了单独审查，从18276个检测到的息肉（47%）中获得了8591个个体大小测量值。
我们的研究存在局限性，因为未切除息肉的真实大小未知。我们选择不比较病理和组织学大小，因为送检病理学家的切除标本在形态上不同，其测量方式与内镜医师术前看到的息肉图像不同。
结肠镜医师在息肉大小测量方面可能不准确，并且似乎对某些大小测量存在偏向或偏差。这些发现对国际息肉切除术后监测指南的有效性以及光学诊断作为微小结直肠息肉潜在管理模式的安全性提出了质疑。它们还对息肉大小数据的历史准确性以及这些策略所基于的风险估计提出了疑问。
