Huang Junjie, Chan Paul S F, Pang Tiffany W Y, Choi Peter, Chen Xiao, Lok Veeleah, Zheng Zhi-Jie, Wong Martin C S
The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Department of Global Health, School of Public Health, Peking University, Beijing, China.
Endosc Int Open. 2021 Mar;9(3):E472-E481. doi: 10.1055/a-1333-1776. Epub 2021 Feb 19.
Serrated lesions are precursors of approximately one-third of colorectal cancers (CRCs). Information on their detection rate was lacking as an important reference for CRC screening. This study was a systematic review and meta-analysis to determine the overall detection rate for serrated lesions and their subtypes in average-risk populations undergoing CRC screening with colonoscopy. MEDLINE and Embase were searched to identify population-based studies that reported the detection rate for serrated lesions. Studies on average-risk populations using colonoscopy as a screening tool were included. Metaprop was applied to model within-study variability by binomial distribution, and Freeman-Tukey Double Arcsine Transformation was adopted to stabilise the variances. The detection rate was presented in proportions using random-effects models. In total, 17 studies involving 129,001 average-risk individuals were included. The overall detection rates for serrated lesions (19.0 %, 95 % CI = 15.3 %-23.0 %), sessile serrated polyps (2.5 %, 95 % CI = 1.5 %-3.8 %), and traditional serrated adenomas (0.3 %, 95 % CI = 0.1 %-0.8 %) were estimated. Subgroup analysis indicated a higher detection rate for serrated lesions among males (22.0 %) than females (14.0 %), and Caucasians (25.9 %) than Asians (14.6 %). The detection rate for sessile serrated polyps was also higher among Caucasians (2.9 %) than Asians (0.7 %). This study determined the overall detection rate for serrated lesions and their different subtypes. The pooled detection rate estimates can be used as a reference for establishing CRC screening programs. Future studies may evaluate the independent factors associated with the presence of serrated lesions during colonoscopy to enhance their rate of detection.
锯齿状病变是约三分之一结直肠癌（CRC）的癌前病变。其检出率信息缺乏，而这是CRC筛查的一项重要参考依据。本研究是一项系统评价和荟萃分析，旨在确定接受结肠镜CRC筛查的平均风险人群中锯齿状病变及其亚型的总体检出率。检索MEDLINE和Embase以识别报告锯齿状病变检出率的基于人群的研究。纳入使用结肠镜作为筛查工具的平均风险人群研究。应用Metaprop通过二项分布对研究内变异性进行建模，并采用Freeman-Tukey双反正弦变换来稳定方差。采用随机效应模型以比例形式呈现检出率。总共纳入了17项涉及129,001名平均风险个体的研究。估计锯齿状病变的总体检出率为19.0%（95%CI=15.3%-23.0%），无蒂锯齿状息肉为2.5%（95%CI=1.5%-3.8%），传统锯齿状腺瘤为0.3%（95%CI=0.1%-0.8%）。亚组分析表明，男性锯齿状病变的检出率（22.0%）高于女性（14.0%），高加索人（25.9%）高于亚洲人（14.6%）。无蒂锯齿状息肉的检出率在高加索人（2.9%）中也高于亚洲人（0.7%）。本研究确定了锯齿状病变及其不同亚型的总体检出率。汇总的检出率估计值可作为建立CRC筛查计划的参考。未来的研究可评估结肠镜检查期间与锯齿状病变存在相关的独立因素，以提高其检出率。
