Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Gastrointest Endosc. 2019 Mar;89(3):607-613.e1. doi: 10.1016/j.gie.2018.11.014. Epub 2018 Nov 16.
Recent guidelines propose higher adenoma detection rate (ADR) benchmarks for colonoscopies performed for positive results for fecal immunochemical tests (FIT), but this is based on low-quality evidence. We aimed to compare ADR, advanced ADR (AADR), and number of adenomas per colonoscopy (APC) in direct screening colonoscopy (DSC) versus FIT-positive colonoscopy (FITC) in a multicenter Asia-Pacific cohort to justify differential targets.
Asymptomatic average-risk patients ≥50 years of age who underwent screening colonoscopy directly or as follow-up for positive OC-Sensor FIT results were identified from 8 sites across the Asia-Pacific region. Overall, sex-specific ADR, overall AADR, and overall APC were compared between the 2 screening methods. Multivariable logistic regression was performed to adjust for confounding by differences in patient characteristics. Linear regression was used to correlate ADR with APC and to propose APC benchmarks.
A total of 2901 (mean age, 60.1 years; 57% men) individuals had DSC, and 2485 (mean age, 62.8 years; 57% men) underwent FITC. Overall ADR (53.6% vs 37.5%; odds ratio [OR], 1.93; P < .001), male-specific ADR (61.6% vs 44.6%; OR, 2; P < .001), female-specific ADR (43.2% vs 28.2%; OR, 1.94; P < .001) and overall AADR (29.9% vs 4.9%; OR, 8.2; P < .001) in FITC were significantly higher than the corresponding values for DSC. Differences remained significant after adjustment for patient characteristics. ADR was strongly and positively correlated to APC, with an ADR of 45% and 35% correlating to an APC of ∼1 and ∼0.65.
Results from this international multicenter cohort study provide early evidence that newly proposed higher ADR targets are justified as quality indicators for FITC.
最近的指南建议对粪便免疫化学检测（FIT）阳性结果进行结肠镜检查时，提高腺瘤检出率（ADR）基准，但这是基于低质量证据。我们旨在比较亚太地区多中心队列中直接筛查结肠镜检查（DSC）与 FIT 阳性结肠镜检查（FITC）的 ADR、高级 ADR（AADR）和每例结肠镜检查的腺瘤数（APC），以证明差异目标的合理性。
从亚太地区 8 个地点识别出年龄≥50 岁、无症状、平均风险的患者，他们接受了直接筛查结肠镜检查或作为 OC-Sensor FIT 阳性结果的随访。比较了两种筛查方法的总体性别特异性 ADR、总体 AADR 和总体 APC。采用多变量逻辑回归校正患者特征差异引起的混杂。采用线性回归分析 ADR 与 APC 的相关性，并提出 APC 基准。
共 2901 例（平均年龄 60.1 岁，57%为男性）患者接受 DSC，2485 例（平均年龄 62.8 岁，57%为男性）患者接受 FITC。总体 ADR（53.6%比 37.5%；比值比[OR]，1.93；P<0.001）、男性特异性 ADR（61.6%比 44.6%；OR，2；P<0.001）、女性特异性 ADR（43.2%比 28.2%；OR，1.94；P<0.001）和总体 AADR（29.9%比 4.9%；OR，8.2；P<0.001）在 FITC 中明显高于 DSC。调整患者特征后，差异仍然显著。ADR 与 APC 呈强正相关，ADR 为 45%和 35%，APC 分别为 1 和 0.65。
这项国际多中心队列研究的结果提供了早期证据，证明新提出的更高 ADR 目标是 FITC 的质量指标是合理的。
