Department of Gastroenterology, Kaiser Permanente Northern California, Santa Clara, California, USA.
Department of Medicine, Kaiser Permanente Northern California, Santa Clara, California, USA.
Gastrointest Endosc. 2018 Mar;87(3):755-765.e1. doi: 10.1016/j.gie.2017.08.012. Epub 2017 Aug 24.
Sessile serrated adenomas (SSAs) are precursors of 15% to 30% of colorectal cancers but are frequently underdiagnosed. We sought to measure the SSA detection rate (SDR) and predictors of SSA detection after educational training for community gastroenterologists and pathologists.
Colonoscopy and pathology data (2010-2014) from 3 medical centers at Kaiser Permanente Northern California were accessed electronically. Gastroenterologists and pathologists attended a training session on SSA diagnosis in 2012. Mean SDRs and patient-level predictors of SSA detection post-training (2013-2014) were investigated.
Mean SDRs increased from .6% in 2010-2012 to 3.7% in 2013-2014. The increase in the detection of proximal SSAs was accompanied by a decrease in the detection of proximal hyperplastic polyps (HPs). Among 34,161 colonoscopies performed in 2013 to 2014, SDRs for screening, fecal immunochemical test positivity, surveillance, and diagnostic indication were 4.2%, 4.5%, 4.9%, and 3.0%, respectively. SSA detection was lower among Asians (adjusted odds ratio [aOR], .46; 95% confidence interval [CI], .31-.69) and Hispanics (aOR, .59; 95% CI, .36-.95) compared with non-Hispanic whites and higher among patients with synchronous conventional adenoma (aOR, 1.46; 95% CI, 1.15-1.86), HP (aOR, 1.74; 95% CI, 1.30-2.34), and current smokers (aOR, 1.78; 95% CI, 1.17-2.72). SDRs varied widely among experienced gastroenterologists, even after training (1.1%-8.1%). There was a moderately strong correlation between adenoma detection rate (ADR) and SDR for any SSA (r = .64, P = .0003) and for right-sided SSAs (r = .71, P < .0001).
Educational training significantly increased the detection of SSA, but a wide variation in SDR remained across gastroenterologists. SSA detection was inversely associated with Asian and Hispanic race/ethnicity and positively associated with the presence of conventional adenoma, HP, and current smoking. There was a moderately strong correlation between ADR and SDR.
无蒂锯齿状腺瘤（SSA）是 15%-30%结直肠癌的前体，但常被漏诊。我们旨在衡量社区胃肠病学家和病理学家接受教育培训后 SSA 的检出率（SDR）及其预测因素。
电子检索了 Kaiser Permanente 北加利福尼亚州的 3 个医疗中心 2010-2014 年的结肠镜检查和病理数据。胃肠病学家和病理学家于 2012 年参加了 SSA 诊断培训课程。调查了培训后的平均 SDR 和患者水平的 SSA 检出预测因素（2013-2014 年）。
平均 SDR 从 2010-2012 年的 0.6%增加到 2013-2014 年的 3.7%。近端 SSA 检出率的增加伴随着近端增生性息肉（HP）检出率的降低。在 2013 年至 2014 年进行的 34161 次结肠镜检查中，筛查、粪便免疫化学试验阳性、监测和诊断适应证的 SDR 分别为 4.2%、4.5%、4.9%和 3.0%。与非西班牙裔白人相比，亚洲人（调整后的优势比 [aOR]，0.46；95%置信区间 [CI]，0.31-0.69）和西班牙裔（aOR，0.59；95% CI，0.36-0.95）的 SSA 检出率较低，而同时存在常规腺瘤（aOR，1.46；95% CI，1.15-1.86）、HP（aOR，1.74；95% CI，1.30-2.34）和当前吸烟者（aOR，1.78；95% CI，1.17-2.72）的患者 SSA 检出率较高。即使在培训后，经验丰富的胃肠病学家之间的 SDR 差异也很大（1.1%-8.1%）。任何 SSA 的腺瘤检出率（ADR）与 SDR 之间存在中度强相关性（r = 0.64，P = 0.0003），右侧 SSA 的相关性更强（r = 0.71，P < 0.0001）。
教育培训显著提高了 SSA 的检出率，但胃肠病学家之间的 SDR 差异仍然很大。SSA 的检出与亚洲人和西班牙裔的种族/民族呈负相关，与常规腺瘤、HP 和当前吸烟呈正相关。ADR 与 SDR 之间存在中度强相关性。
