Department of Medicine, Division of Gastroenterology, North Shore University Health System, Evanston, IL, USA.
Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, IL, USA.
Surg Endosc. 2018 Jul;32(7):3108-3113. doi: 10.1007/s00464-018-6025-3. Epub 2018 Jan 16.
A target goal for screening adenoma detection rate (S-ADR) of ≥ 25% has been set to define high-quality colonoscopy performance. However, there is no current accepted target goal for ADR in colorectal cancer (CRC) surveillance. This makes quality assessment challenging when physicians perform cancer surveillance colonoscopy but minimal screening procedures.
In this cohort study, consecutive colonoscopies performed at either Rush University Medical Center or Rush Oak Park Hospital by a gastroenterologist or colorectal surgeon in average risk screening population and CRC surveillance population were reviewed retrospectively from 2006 to 2012 and prospectively from 2013 to 2016. ADR in first surveillance colonoscopy following surgical resection of CRC (CRC-ADR) was reported in high-quality detectors (HQD) or low-quality detectors (LQD) based on achievement of 25% ADR in consecutive screening colonoscopy in average risk patients. Pearson's correlation was used to describe the association between individual S-ADR and CRC-ADR for colonoscopists.
There was a very strong positive correlation (r = 0.88, p = 0.002) between ADR in average risk screening and first time CRC surveillance. For HQD as defined by S-ADR ≥ 25% (n = 10 colonoscopists), the CRC-ADR was 37.7% (78/207, SD 8%) which was very similar to their respective S-ADR of 33.4% (816/2440, p = 0.22). For LQD (n = 5 colonoscopists), the CRC-ADR was 20.2% (40/198) which was similar to their respective S-ADR of 20.1% (119/591, p = 0.99). The CRC-ADR was significantly higher for HQD than for LQD (37.7 vs. 20.2%, p < 0.0001).
The major finding of this study is a defined CRC-ADR for HQD based on the ability to achieve S-ADR ≥ 25%. S-ADR strongly correlates with CRC-ADR. CRC-ADR is quite similar to the colonoscopists' respective S-ADR for both HQD and LQD. For colonoscopists who perform limited screening colonoscopies but do perform CRC surveillance colonoscopies, ADR metrics similar to S-ADR to assess quality in colonoscopy could be considered.
为了定义高质量结肠镜检查的性能，已经设定了筛查腺瘤检出率（S-ADR）≥25%的目标。然而，在医生进行癌症监测结肠镜检查但最小化筛查程序时，目前还没有接受结直肠癌（CRC）监测中 ADR 的目标。
在这项队列研究中，回顾性分析了 2006 年至 2012 年期间在 Rush 大学医学中心或 Rush Oak Park 医院由胃肠病学家或结直肠外科医生对平均风险筛查人群和 CRC 监测人群进行的连续结肠镜检查，并前瞻性分析了 2013 年至 2016 年期间的结肠镜检查。根据平均风险患者连续筛查结肠镜检查中达到 25%的 ADR，报告了 CRC 切除术后首次监测结肠镜检查中的 ADR（CRC-ADR）在高质量检测者（HQD）或低质量检测者（LQD）中的情况。使用 Pearson 相关系数描述结肠镜医师个体 S-ADR 和 CRC-ADR 之间的相关性。
平均风险筛查中的 ADR 与首次 CRC 监测之间存在很强的正相关（r=0.88，p=0.002）。根据 S-ADR≥25%（n=10 名结肠镜医师）定义为 HQD，CRC-ADR 为 37.7%（78/207，SD 8%），与各自的 S-ADR（2440 名中的 33.4%（816 名，p=0.22）非常相似。对于 LQD（n=5 名结肠镜医师），CRC-ADR 为 20.2%（40/198），与各自的 S-ADR（591 名中的 20.1%（119 名，p=0.99））相似。HQD 的 CRC-ADR 明显高于 LQD（37.7%比 20.2%，p<0.0001）。
本研究的主要发现是根据达到 S-ADR≥25%的能力为 HQD 定义了 CRC-ADR。S-ADR 与 CRC-ADR 密切相关。CRC-ADR 与 HQD 和 LQD 中结肠镜医师各自的 S-ADR 非常相似。对于仅进行有限的筛查结肠镜检查但进行 CRC 监测结肠镜检查的结肠镜医师，可以考虑使用类似于 S-ADR 的 ADR 指标来评估结肠镜检查的质量。
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