Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.
Dig Dis Sci. 2018 May;63(5):1167-1172. doi: 10.1007/s10620-018-4984-9. Epub 2018 Feb 22.
The adenoma detection rate (ADR) is a powerful measure of screening colonoscopy quality. Patients who undergo colonoscopy for the evaluation of a positive fecal immunochemical test (FIT) have increased prevalence of colorectal neoplasia, but it is not known whether separate quality benchmarks are required. The aim of this study was to compare the conventional ADR to the ADR of colonoscopies performed for the evaluation of positive FIT, in asymptomatic average-risk patients.
Patients ≥ 50 years old who underwent colonoscopy for the evaluation of a positive FIT between January 1, 2013, and July 31, 2014, at a tertiary Veterans Affairs Medical Center were identified. FIT performed for any indication other than average-risk screening was excluded. The comparison group included average-risk patients ≥ 50 years old undergoing screening colonoscopy during the same time frame. The two groups were compared for ADR, advanced neoplasm [adenoma ≥ 10 mm, tubulovillous, high-grade dysplasia, CRC, sessile serrated polyp (SSP) ≥ 10 mm], CRC, and SSP detection after propensity score adjustment using a logistic regression model adjusted for endoscopist.
There were 207 patients in the FIT group and 601 in the screening colonoscopy comparison group. After propensity score adjustment, ADR (72.9 vs. 50.0%, p = 0.003), number of adenomas per colonoscopy (3.3 ± 3.6 vs. 1.4 ± 2.3, p = 0.033), and advanced neoplasm detection rate (32.4 vs. 11.0%, p < 0.0001) were significantly higher in the FIT group. There were no significant differences in the number of CRC and the SSP detection rate.
In this cohort of average-risk Veterans, the ADR of colonoscopies performed for the evaluation of a positive FIT was higher than the ADR of screening colonoscopies. Patients with a positive FIT also had significantly more adenomas per colonoscopy and advanced neoplasms. These findings suggest that the quality of colonoscopies performed for a positive FIT is insufficiently assessed by the conventional ADR and requires additional quality metrics.
腺瘤检出率（ADR）是衡量筛查结肠镜质量的有力指标。因粪便免疫化学检测（FIT）阳性而接受结肠镜检查的患者结直肠肿瘤的患病率增加，但尚不清楚是否需要单独的质量基准。本研究的目的是比较在无症状的一般风险患者中，为评估阳性 FIT 而进行的传统 ADR 与结肠镜 ADR。
筛选 2013 年 1 月 1 日至 2014 年 7 月 31 日期间在一家三级退伍军人事务医疗中心因阳性 FIT 而接受结肠镜检查的年龄≥50 岁的患者。排除因除一般风险筛查外的任何原因而进行的 FIT。对照组包括在同一时间段内接受一般风险筛查的年龄≥50 岁的患者。在使用逻辑回归模型进行倾向评分调整后，比较两组的 ADR、高级肿瘤[腺瘤≥10mm、管状绒毛状、高级别异型增生、CRC、无蒂锯齿状息肉（SSP）≥10mm]、CRC 和 SSP 的检出率。该模型调整了内镜医师。
FIT 组有 207 例患者，筛查结肠镜比较组有 601 例患者。在进行倾向评分调整后，FIT 组的 ADR（72.9%比 50.0%，p=0.003）、每例结肠镜检查的腺瘤数（3.3±3.6 比 1.4±2.3，p=0.033）和高级肿瘤检出率（32.4%比 11.0%，p<0.0001）均显著更高。CRC 和 SSP 的检出率无显著差异。
在本队列中，为评估阳性 FIT 而进行的结肠镜检查的 ADR 高于筛查结肠镜检查。FIT 阳性患者的每例结肠镜检查的腺瘤数和高级肿瘤也明显更多。这些发现表明，阳性 FIT 结肠镜检查的质量不能仅通过传统的 ADR 来充分评估，还需要额外的质量指标。
